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_rstd	mrx_tier_locat_rsplt	mrx_tier_locat_oon	mrx_tier_locat_mostd	mrx_tier_locat_mosplt	mrx_tier_locat_ltc	mrx_tier_rstd_1m_num	mrx_tier_rstd_2m_num	mrx_tier_rstd_3m_num	mrx_tier_rsplt_1m_num	mrx_tier_rsplt_2m_num	mrx_tier_rsplt_3m_num	mrx_tier_extd_days_yn	mrx_tier_mostd_1m_num	mrx_tier_mostd_2m_num	mrx_tier_mostd_3m_num	mrx_tier_mosplt_1m_num	mrx_tier_mosplt_2m_num	mrx_tier_mosplt_3m_num	mrx_tier_oonp_1m_num	mrx_tier_oonp_othnumn	mrx_tier_ltcp_1m	mrx_tier_rstd_copay_1m	mrx_tier_rstd_copay_2m	mrx_tier_rstd_copay_3m	mrx_tier_rstd_coins_avg_1m	mrx_tier_rstd_coins_1m	mrx_tier_rstd_coins_2m	mrx_tier_rstd_coins_3m	mrx_tier_rsstd_copay_1m	mrx_tier_rsstd_copay_2m	mrx_tier_rsstd_copay_3m	mrx_tier_rsstd_coins_avg_1m	mrx_tier_rsstd_coins_1m	mrx_tier_rsstd_coins_2m	mrx_tier_rsstd_coins_3m	mrx_tier_rspfd_copay_1m	mrx_tier_rspfd_copay_2m	mrx_tier_rspfd_copay_3m	mrx_tier_rspfd_coins_avg_1m	mrx_tier_rspfd_coins_1m	mrx_tier_rspfd_coins_2m	mrx_tier_rspfd_coins_3m	mrx_tier_mostd_copay_1m	mrx_tier_mostd_copay_2m	mrx_tier_mostd_copay_3m	mrx_tier_mostd_coins_1m	mrx_tier_mostd_coins_2m	mrx_tier_mostd_coins_3m	mrx_tier_mosstd_copay_1m	mrx_tier_mosstd_copay_2m	mrx_tier_mosstd_copay_3m	mrx_tier_mosstd_coins_1m	mrx_tier_mosstd_coins_2m	mrx_tier_mosstd_coins_3m	mrx_tier_mospfd_copay_1m	mrx_tier_mospfd_copay_2m	mrx_tier_mospfd_copay_3m	mrx_tier_mospfd_coins_1m	mrx_tier_mospfd_coins_2m	mrx_tier_mospfd_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_1m	mrx_tier_ltcp_coins_1m	mrx_tier_rstd_copay_daily	mrx_tier_rsstd_copay_daily	mrx_tier_rspfd_copay_daily	mrx_tier_mostd_copay_daily	mrx_tier_mosstd_copay_daily	mrx_tier_mospfd_copay_daily	mrx_tier_ltcp_copay_daily	mrx_tier_form_model_desc	mrx_tier_includes_mmp	mrx_tier_copay_amt_rstd_mmpmin	mrx_tier_copay_amt_rstd_mmpmax	mrx_tier_copay_amt_oon_mmpmin	mrx_tier_copay_amt_oon_mmpmax	mrx_tier_copay_amt_mstd_mmpmin	mrx_tier_copay_amt_mstd_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	6	1	Generic Drugs	1	4	010000			110		01	100		1	30		90				2			90				30		31																																														0.00						0.00	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	6	2	Brand Drugs	1	4	000010			110		01	100		1	30		90				2			90				30		31																																														0.00						0.00	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	6	3	Non-Medicare Rx/OTC Drugs	1	4	010010			110		01	100		1	30		90				2			90				30		31																																														0.00						0.00	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			
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, 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	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H0028	001	0	1	01	01	H0028_001_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.66				0.66	0.66	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0028	001	0	1	01	01	H0028_001_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.66				0.66	0.66	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, 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, 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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H0028	004	0	1	01	01	H0028_004_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0028	004	0	1	01	01	H0028_004_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H0104	012	0	1	04	01	H0104_012_0	3	2	Generic	1	4	000100	1	2		110	01	110		1				30		90	1	30		90				30		31								20.00		60.00					20.00		40.00					20.00		40.00																20.00				20.00			0.66	0.66	0.66			0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0104	012	0	1	04	01	H0104_012_0	3	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				30		90	1	30		90				30		31								4.00		12.00					4.00		8.00					4.00		8.00																4.00				4.00			0.13	0.13	0.13			0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0104	012	0	1	04	01	H0104_012_0	3	3	Preferred Brand	1	4	010001	1	2		110	01	110		1				30		90	1	30		90				30		31								47.00		141.00					47.00		94.00					47.00		94.00																47.00				47.00			1.56	1.56	1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0104	012	0	1	04	01	H0104_012_0	3	4	Non-Preferred Brand	1	4	110000	1	2		110	01	110		1				30		90	1	30		90				30		31								100.00		300.00					100.00		200.00					100.00		200.00																100.00				100.00			3.33	3.33	3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0104	012	0	1	04	01	H0104_012_0	3	5	Specialty Tier	1	4	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0104	012	0	1	04	01	H0104_012_0	3	6	Select Care Drugs	1	4	010000	1	2		110	01	110		1				30		90	1	30		90				30		31								2.00		6.00					2.00		4.00					2.00		4.00																2.00				2.00			0.06	0.06	0.06			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0104	013	0	1	04	01	H0104_013_0	3	2	Generic	1	4	000100	1	2		110	01	110		1				30		90	1	30		90				30		31								20.00		60.00					20.00		40.00					20.00		40.00																20.00				20.00			0.66	0.66	0.66			0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0104	013	0	1	04	01	H0104_013_0	3	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				30		90	1	30		90				30		31								4.00		12.00					4.00		8.00					4.00		8.00																4.00				4.00			0.13	0.13	0.13			0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0104	013	0	1	04	01	H0104_013_0	3	3	Preferred Brand	1	4	010001	1	2		110	01	110		1				30		90	1	30		90				30		31								47.00		141.00					47.00		94.00					47.00		94.00																47.00				47.00			1.56	1.56	1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0104	013	0	1	04	01	H0104_013_0	3	6	Select Care Drugs	1	4	010000	1	2		110	01	110		1				30		90	1	30		90				30		31								2.00		6.00					2.00		4.00					2.00		4.00																2.00				2.00			0.06	0.06	0.06			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0104	013	0	1	04	01	H0104_013_0	3	5	Specialty Tier	1	4	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0104	013	0	1	04	01	H0104_013_0	3	4	Non-Preferred Brand	1	4	110000	1	2		110	01	110		1				30		90	1	30		90				30		31								100.00		300.00					100.00		200.00					100.00		200.00																100.00				100.00			3.33	3.33	3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0104	014	0	1	04	01	H0104_014_0	3	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				30		90	1	30		90				30		31								4.00		12.00					4.00		8.00					4.00		8.00																4.00				4.00			0.13	0.13	0.13			0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0104	014	0	1	04	01	H0104_014_0	3	2	Generic	1	4	000100	1	2		110	01	110		1				30		90	1	30		90				30		31								20.00		60.00					20.00		40.00					20.00		40.00																20.00				20.00			0.66	0.66	0.66			0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0104	014	0	1	04	01	H0104_014_0	3	5	Specialty Tier	1	4	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0104	014	0	1	04	01	H0104_014_0	3	4	Non-Preferred Brand	1	4	110000	1	2		110	01	110		1				30		90	1	30		90				30		31								100.00		300.00					100.00		200.00					100.00		200.00																100.00				100.00			3.33	3.33	3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0104	014	0	1	04	01	H0104_014_0	3	3	Preferred Brand	1	4	010001	1	2		110	01	110		1				30		90	1	30		90				30		31								47.00		141.00					47.00		94.00					47.00		94.00																47.00				47.00			1.56	1.56	1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0104	014	0	1	04	01	H0104_014_0	3	6	Select Care Drugs	1	4	010000	1	2		110	01	110		1				30		90	1	30		90				30		31								2.00		6.00					2.00		4.00					2.00		4.00																2.00				2.00			0.06	0.06	0.06			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0104	015	0	1	04	01	H0104_015_0	4	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				30		90	1	30		90				30		31								4.00		12.00					4.00		8.00					4.00		8.00																4.00				4.00			.13	.13	.13			.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0104	015	0	1	04	01	H0104_015_0	4	6	Select Care Drugs	1	4	010000	1	2		110	01	110		1				30		90	1	30		90				30		31								2.00		6.00					2.00		4.00					2.00		4.00																2.00				2.00			0.06	0.06	0.06			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0104	015	0	1	04	01	H0104_015_0	4	5	Specialty Tier	1	4	010010	1	1		110	01	110		1				30		90	1	30		90				30		31											1.00	33		33				1.00	33		33				33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0104	015	0	1	04	01	H0104_015_0	4	4	Non-Preferred Brand	1	4	110000	1	2		110	01	110		1				30		90	1	30		90				30		31								100.00		300.00					100.00		200.00					100.00		200.00																100.00				100.00			3.33	3.33	3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0104	015	0	1	04	01	H0104_015_0	4	3	Preferred Brand	1	4	010001	1	2		110	01	110		1				30		90	1	30		90				30		31								47.00		141.00					47.00		94.00					47.00		94.00																47.00				47.00			1.56	1.56	1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0104	015	0	1	04	01	H0104_015_0	4	2	Generic	1	4	000100	1	2		110	01	110		1				30		90	1	30		90				30		31								12.00		36.00					12.00		24.00					12.00		24.00																12.00				12.00			.40	.40	.40			.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0107	001	0	1	04	01	H0107_001_0	10	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0107	001	0	1	04	01	H0107_001_0	10	2	Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								11.00		33.00					6.00		18.00							33.00																11.00				11.00			0.37	0.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0107	001	0	1	04	01	H0107_001_0	10	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31								44.00		132.00					39.00		117.00							132.00																44.00				44.00			1.47	1.30				1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0107	001	0	1	04	01	H0107_001_0	10	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					85.00		255.00							285.00																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0107	001	0	1	04	01	H0107_001_0	10	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31											1330.00	33		33				1330.00	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0107	001	0	1	04	01	H0107_001_0	10	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0107	001	0	1	04	01	H0107_001_0	10	2	Generic	3	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								11.00		33.00					6.00		18.00							33.00																11.00				11.00			0.37	0.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0107	002	0	1	04	01	H0107_002_0	10	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0107	002	0	1	04	01	H0107_002_0	10	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0107	002	0	1	04	01	H0107_002_0	10	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31											1330.00	33		33				1330.00	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0107	002	0	1	04	01	H0107_002_0	10	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					85.00		255.00							285.00																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0107	002	0	1	04	01	H0107_002_0	10	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31								44.00		132.00					39.00		117.00							132.00																44.00				44.00			1.47	1.30				1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0107	002	0	1	04	01	H0107_002_0	10	2	Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								11.00		33.00					6.00		18.00							33.00																11.00				11.00			0.37	0.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0107	002	0	1	04	01	H0107_002_0	10	2	Generic	3	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								11.00		33.00					6.00		18.00							33.00																11.00				11.00			0.37	0.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0137	001	0	1	48	05	H0137_001_0	4	1	Generic Drugs	1	4	010000			111		10	111		1	31	60	90				1	31	60	90					10	31																																														0.00			0.00			0.00	Generic Drugs, Preferred Brand Drugs, Non-Preferred Brand Drugs	3	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				1	31	60	90					10	31																																														0.00			0.00			0.00	Generic Drugs, Preferred Brand Drugs, Non-Preferred Brand Drugs	3	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				1	31	60	90					10	31																																														0.00			0.00			0.00	Generic Drugs, Preferred Brand Drugs, Non-Preferred Brand Drugs	3	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	3	1	Generic	1	4	010000	1	2	111		01			1	30	60	90				2							30		31	5.00	10.00	11.25																																					5.00				5.00		0.17						0.16	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0141	004	1	1	01	01	H0141_004_1	3	2	Preferred Brand	1	4	000001	1	2	111		01	100		1	30	60	90				2			90				30		31	35.00	70.00	78.75																					78.75																35.00				35.00		1.17						1.13	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0141	004	1	1	01	01	H0141_004_1	3	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	3	3	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	30	60	90				2			90				30		31	85.00	170.00	191.25																					191.25																85.00				85.00		2.83						2.74	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0141	004	2	1	01	01	H0141_004_2	3	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	3	2	Preferred Brand	1	4	000001	1	2	111		01	100		1	30	60	90				2			90				30		31	35.00	70.00	78.75																					78.75																35.00				35.00		1.17						1.13	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0141	004	2	1	01	01	H0141_004_2	3	1	Generic	1	4	010000	1	2	111		01			1	30	60	90				2							30		31	5.00	10.00	11.25																																					5.00				5.00		0.17						0.16	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0141	004	2	1	01	01	H0141_004_2	3	3	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	30	60	90				2			90				30		31	85.00	170.00	191.25																					191.25																85.00				85.00		2.83						2.74	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0141	005	1	1	01	01	H0141_005_1	4	1	Generic	1	4	010000	1	2	111		01			1	30	60	90				2							30		31	5.00	10.00	11.25																																					5.00				5.00		0.17						0.16	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0141	005	1	1	01	01	H0141_005_1	4	3	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	30	60	90				2			90				30		31	85.00	170.00	191.25																					191.25																85.00				85.00		2.83						2.74	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0141	005	1	1	01	01	H0141_005_1	4	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	4	2	Preferred Brand	1	4	000001	1	2	111		01	100		1	30	60	90				2			90				30		31	35.00	70.00	78.75																					78.75																35.00				35.00		1.17						1.13	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0141	005	3	1	01	01	H0141_005_3	4	2	Preferred Brand	1	4	000001	1	2	111		01	100		1	30	60	90				2			90				30		31	35.00	70.00	78.75																					78.75																35.00				35.00		1.17						1.13	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0141	005	3	1	01	01	H0141_005_3	4	3	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	30	60	90				2			90				30		31	85.00	170.00	191.25																					191.25																85.00				85.00		2.83						2.74	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0141	005	3	1	01	01	H0141_005_3	4	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	4	1	Generic	1	4	010000	1	2	111		01			1	30	60	90				2							30		31	5.00	10.00	11.25																																					5.00				5.00		0.17						0.16	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0147	001	0	1	48	05	H0147_001_0	7	3	Non-Medicare Rx Drugs	1	4	010000			010		10			1	31														10	31																																														0.00						0.00	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	7	4	Non-Medicare OTC Drugs	1	4	010000			010		10			1	31														10	31																																														0.00						0.00	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	7	1	Generic Drugs	1	4	010010			111		10	111		1	31	62	93				2	31	62	93					10	31																																														0.00			0.00			0.00	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			
H0147	001	0	1	48	05	H0147_001_0	7	2	Brand Drugs	1	4	010010			111		10	111		1	31	62	93				2	31	62	93					10	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	7.40			0.00	7.40	0.00	7.40			
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																																														0.00						0.00	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	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	7.40					0.00	7.40			
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	2.95					0.00	2.95			
H0148	002	0	1	48	05	H0148_002_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	2.95					0.00	2.95			
H0148	002	0	1	48	05	H0148_002_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	7.40					0.00	7.40			
H0148	002	0	1	48	05	H0148_002_0	2	3	Non-Medicare Rx/OTC Drugs	1	4	010010			010		10			1	30														10	31																																														0.00						0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00			0.00	0.00			
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	1.00	2.00	2.00																			1.00		2.00																1.00				1.00		0.03			0.03			0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0150	024	1	1	01	01	H0150_024_1	4	2	Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	15.00	30.00	30.00																			15.00		30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	1.00	2.00	2.00																			1.00		2.00																1.00				1.00		0.03			0.03			0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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	95.00	190.00	190.00																			95.00		190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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				573.35	29	29	29																		29		29															29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0150	024	1	1	01	01	H0150_024_1	4	3	Preferred Brand	1	4	000101	1	2	111		01	110		1	30	60	90				2	30		90				30		31	47.00	94.00	94.00																			47.00		94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, 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	1.00	2.00	2.00																			1.00		2.00																1.00				1.00		0.03			0.03			0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0150	024	2	1	01	01	H0150_024_2	4	2	Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	15.00	30.00	30.00																			15.00		30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0150	024	2	1	01	01	H0150_024_2	4	3	Preferred Brand	1	4	000101	1	2	111		01	110		1	30	60	90				2	30		90				30		31	47.00	94.00	94.00																			47.00		94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, 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	95.00	190.00	190.00																			95.00		190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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				573.35	29	29	29																		29		29															29			29								Preferred Generic, 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	1.00	2.00	2.00																			1.00		2.00																1.00				1.00		0.03			0.03			0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0150	025	0	1	02	01	H0150_025_0	5	2	Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	12.00	24.00	30.00																			12.00		30.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0150	025	0	1	02	01	H0150_025_0	5	3	Preferred Brand	1	4	000101	1	2	111		01	110		1	30	60	90				2	30		90				30		31	45.00	90.00	112.50																			45.00		112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0150	025	0	1	02	01	H0150_025_0	5	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	85.00	170.00	212.50																			85.00		212.50																85.00				85.00		2.83			2.83			2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0150	025	0	1	02	01	H0150_025_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31				594.68	33	33	33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0150	025	0	1	02	01	H0150_025_0	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0150	025	0	1	02	01	H0150_025_0	5	2	Generic	3	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	12.00	24.00	30.00																			12.00		30.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0150	025	0	1	02	01	H0150_025_0	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0151	001	0	1	01	01	H0151_001_0	2	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				568.00	31		31																										31						31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0151	001	0	1	01	01	H0151_001_0	2	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0151	001	0	1	01	01	H0151_001_0	2	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		.26						.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0151	001	0	1	01	01	H0151_001_0	2	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0151	001	0	1	01	01	H0151_001_0	2	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0151	025	0	1	01	01	H0151_025_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		.26						.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0151	025	0	1	01	01	H0151_025_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0151	025	0	1	01	01	H0151_025_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0151	025	0	1	01	01	H0151_025_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				606.00	31		31																										31						31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0151	025	0	1	01	01	H0151_025_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0151	027	0	1	01	01	H0151_027_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		.26						.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0151	027	0	1	01	01	H0151_027_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				601.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0151	027	0	1	01	01	H0151_027_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0151	027	0	1	01	01	H0151_027_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0151	027	0	1	01	01	H0151_027_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0154	011	0	1	01	01	H0154_011_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0154	011	0	1	01	01	H0154_011_0	6	1	Preferred Generic	3	4	001000	1	2		110	01		100	1				30		90	1						90	30		31								4.00		12.00					0.00		0.00													12.00						0.00				4.00				4.00			.13	0.00				.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0154	011	0	1	01	01	H0154_011_0	6	4	Non-Preferred Brand	1	4	100100	1	1		110	01		100	1				30		90	1						90	30		31											100.00	50		50				100.00	50		50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0154	011	0	1	01	01	H0154_011_0	6	3	Preferred Brand	1	4	000001	1	2		110	01		100	1				30		90	1						90	30		31								47.00		141.00					47.00		141.00													141.00						117.50				47.00				47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0154	011	0	1	01	01	H0154_011_0	6	2	Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31								15.00		45.00					15.00		45.00													45.00						37.50				15.00				15.00			0.50	0.50				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0154	011	0	1	01	01	H0154_011_0	6	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31								4.00		12.00					0.00		0.00													12.00						0.00				4.00				4.00			0.13	0.00				0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0154	012	0	1	01	01	H0154_012_0	7	3	Preferred Brand	1	3	000001	1	1	110		01	100		1	30		90				1			90				30		31					25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0154	012	0	1	01	01	H0154_012_0	7	4	Non-Preferred Brand	1	3	100100	1	1	110		01	100		1	30		90				1			90				30		31					25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0154	012	0	1	01	01	H0154_012_0	7	5	Specialty Tier	1	3	010010	1	1	010		01			1	30													30		31					25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0154	012	0	1	01	01	H0154_012_0	7	1	Preferred Generic	1	3	001000	1	1	110		01	100		1	30		90				1			90				30		31					25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0154	012	0	1	01	01	H0154_012_0	7	2	Generic	1	3	000100	1	1	110		01	100		1	30		90				1			90				30		31					25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0154	014	0	1	01	01	H0154_014_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0154	014	0	1	01	01	H0154_014_0	5	4	Non-Preferred Brand	1	4	100100	1	1		110	01		100	1				30		90	1						90	30		31											100.00	50		50				100.00	50		50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0154	014	0	1	01	01	H0154_014_0	5	3	Preferred Brand	1	4	000001	1	2		110	01		100	1				30		90	1						90	30		31								47.00		141.00					47.00		141.00													141.00						117.50				47.00				47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0154	014	0	1	01	01	H0154_014_0	5	2	Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31								15.00		45.00					15.00		45.00													45.00						37.50				15.00				15.00			0.50	0.50				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0154	014	0	1	01	01	H0154_014_0	5	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31								4.00		12.00					0.00		0.00													12.00						0.00				4.00				4.00			0.13	0.00				0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0154	015	1	1	01	01	H0154_015_1	6	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31								4.00		12.00					0.00		0.00													12.00						0.00				4.00				4.00			0.13	0.00				0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0154	015	1	1	01	01	H0154_015_1	6	2	Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31								20.00		60.00					20.00		60.00													60.00						50.00				20.00				20.00			0.67	0.67				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0154	015	1	1	01	01	H0154_015_1	6	4	Non-Preferred Brand	1	4	100100	1	1		110	01		100	1				30		90	1						90	30		31											100.00	50		50				100.00	50		50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0154	015	1	1	01	01	H0154_015_1	6	3	Preferred Brand	1	4	000001	1	2		110	01		100	1				30		90	1						90	30		31								47.00		141.00					47.00		141.00													141.00						117.50				47.00				47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0154	015	1	1	01	01	H0154_015_1	6	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31											1.00	28						1.00	28																							28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0154	015	2	1	01	01	H0154_015_2	6	4	Non-Preferred Brand	1	4	100100	1	1		110	01		100	1				30		90	1						90	30		31											100.00	50		50				100.00	50		50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0154	015	2	1	01	01	H0154_015_2	6	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31								4.00		12.00					0.00		0.00													12.00						0.00				4.00				4.00			0.13	0.00				0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0154	015	2	1	01	01	H0154_015_2	6	2	Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31								20.00		60.00					20.00		60.00													60.00						50.00				20.00				20.00			0.67	0.67				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0154	015	2	1	01	01	H0154_015_2	6	3	Preferred Brand	1	4	000001	1	2		110	01		100	1				30		90	1						90	30		31								47.00		141.00					47.00		141.00													141.00						117.50				47.00				47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0154	015	2	1	01	01	H0154_015_2	6	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31											1.00	28						1.00	28																							28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0192	001	0	1	48	05	H0192_001_0	11	3	Non-Medicare Rx/OTC Drugs	1	4	000010			110		01	100		1	30		90				1			90				30		31																																														0.00						0.00	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	11	2	Brand Drugs	1	4	000010			110		01	100		1	30		90				1			90				30		31																																														0.00						0.00	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	11	1	Generic Drugs	1	4	010000			110		01	100		1	30		90				1			90				30		31																																														0.00						0.00	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	2	2	Brand Drugs	1	4	000010			110		01	100		1	30		90				2			90				30		31																																														0.25						0.24	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	7.40	0.00	7.40	0.00	7.40	0.00	7.40			
H0281	001	0	1	48	05	H0281_001_0	2	1	Generic Drugs	1	4	010000			110		01	100		1	30		90				2			90				30		31																																														0.00						0.00	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	2	3	Non-Medicare Rx/OTC Drugs	1	4	010010			110		01	100		1	30		90				2			90				30		31																																														0.00						0.00	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			
H0294	002	0	1	04	01	H0294_002_0	2	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0294	002	0	1	04	01	H0294_002_0	2	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0294	002	0	1	04	01	H0294_002_0	2	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				466.00	26		26																										26						26			26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0294	002	0	1	04	01	H0294_002_0	2	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		.13						.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0294	002	0	1	04	01	H0294_002_0	2	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		.40						.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0294	004	0	1	04	01	H0294_004_0	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31				346.00	25		25																										25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0294	004	0	1	04	01	H0294_004_0	2	4	Non-Preferred Brand	1	3	110000	1	2	110		01		100	1	30		90				1						90	30		31	98.00		294.00																											294.00						284.00				98.00				98.00		3.26						3.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0294	004	0	1	04	01	H0294_004_0	2	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0294	004	0	1	04	01	H0294_004_0	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		.10						.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0294	004	0	1	04	01	H0294_004_0	2	2	Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		.40						.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	001	0	1	01	01	H0302_001_0	2	2	Generic	3	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	10.00	20.00	30.00																					30.00																10.00				10.00		.33						.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H0302	001	0	1	01	01	H0302_001_0	2	5	Specialty Tier	1	4	101101	1	1	010		01			1	30													30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	001	0	1	01	01	H0302_001_0	2	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	30	60	90				1			90				30		31	90.00	180.00	270.00																					270.00																90.00				90.00		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	001	0	1	01	01	H0302_001_0	2	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	30	60	90				1			90				30		31	40.00	80.00	120.00																					120.00																40.00				40.00		1.33						1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	001	0	1	01	01	H0302_001_0	2	2	Generic	1	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	10.00	20.00	30.00																					30.00																10.00				10.00		.33						.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	001	0	1	01	01	H0302_001_0	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	001	0	1	01	01	H0302_001_0	2	3	Preferred Brand	3	4	000001	1	2	111		01	100		1	30	60	90				1			90				30		31	40.00	80.00	120.00																					120.00																40.00				40.00		1.33						1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H0302	006	0	1	01	01	H0302_006_0	2	2	Generic	3	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	10.00	20.00	30.00																					30.00																10.00				10.00		.33						.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H0302	006	0	1	01	01	H0302_006_0	2	5	Specialty Tier	1	4	101101	1	1	010		01			1	30													30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	006	0	1	01	01	H0302_006_0	2	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	30	60	90				1			90				30		31	95.00	190.00	285.00																					285.00																95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	006	0	1	01	01	H0302_006_0	2	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	30	60	90				1			90				30		31	45.00	90.00	135.00																					135.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	006	0	1	01	01	H0302_006_0	2	2	Generic	1	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	10.00	20.00	30.00																					30.00																10.00				10.00		.33						.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	006	0	1	01	01	H0302_006_0	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	006	0	1	01	01	H0302_006_0	2	3	Preferred Brand	3	4	000001	1	2	111		01	100		1	30	60	90				1			90				30		31	45.00	90.00	135.00																					135.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H0302	007	0	1	01	01	H0302_007_0	3	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	007	0	1	01	01	H0302_007_0	3	2	Generic	1	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	9.00	18.00	27.00																					27.00																9.00				9.00		.29						.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	007	0	1	01	01	H0302_007_0	3	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	30	60	90				1			90				30		31	30.00	60.00	90.00																					90.00																30.00				30.00		1.00						.96	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	007	0	1	01	01	H0302_007_0	3	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	30	60	90				1			90				30		31	80.00	160.00	240.00																					240.00																80.00				80.00		2.66						2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	007	0	1	01	01	H0302_007_0	3	5	Specialty Tier	1	4	101101	1	1	010		01			1	30													30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	007	0	1	01	01	H0302_007_0	3	2	Generic	3	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	9.00	18.00	27.00																					27.00																9.00				9.00		.29						.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H0302	007	0	1	01	01	H0302_007_0	3	3	Preferred Brand	3	4	000001	1	2	111		01	100		1	30	60	90				1			90				30		31	30.00	60.00	90.00																					90.00																30.00				30.00		1.00						0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H0302	008	0	1	01	01	H0302_008_0	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	008	0	1	01	01	H0302_008_0	2	2	Generic	1	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	10.00	20.00	30.00																					30.00																10.00				10.00		.33						.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	008	0	1	01	01	H0302_008_0	2	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	30	60	90				1			90				30		31	45.00	90.00	135.00																					135.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	008	0	1	01	01	H0302_008_0	2	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	30	60	90				1			90				30		31	95.00	190.00	285.00																					285.00																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	008	0	1	01	01	H0302_008_0	2	5	Specialty Tier	1	4	101101	1	1	010		01			1	30													30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	008	0	1	01	01	H0302_008_0	2	2	Generic	3	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	10.00	20.00	30.00																					30.00																10.00				10.00		.33						.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H0302	008	0	1	01	01	H0302_008_0	2	3	Preferred Brand	3	4	000001	1	2	111		01	100		1	30	60	90				1			90				30		31	45.00	90.00	135.00																					135.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H0332	002	0	1	01	01	H0332_002_0	3	1	Preferred Generic	1	4	001000	1	2		110	01			1				30		90	1							30		31								8.00		24.00					3.00		7.50																							8.00				8.00			0.27	0.10				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0332	002	0	1	01	01	H0332_002_0	3	2	Generic	1	4	000100	1	2		110	01			1				30		90	1							30		31								20.00		60.00					17.00		42.50																							20.00				20.00			0.67	0.57				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0332	002	0	1	01	01	H0332_002_0	3	3	Preferred Brand	1	4	000001	1	2		110	01			1				30		90	1							30		31								45.00		135.00					40.00		100.00																							45.00				45.00			1.50	1.33				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0332	002	0	1	01	01	H0332_002_0	3	4	Non-Preferred Brand	1	4	100000	1	2		110	01			1				30		90	1							30		31								70.00		210.00					60.00		150.00																							70.00				70.00			2.33	2.00				2.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0332	002	0	1	01	01	H0332_002_0	3	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		90	1							30		31												31		31					31		31																					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0332	002	0	1	01	01	H0332_002_0	3	1	Preferred Generic	3	4	001000	1	2		110	01			1				30		90	1							30		31								8.00		24.00					3.00		7.50																							8.00				8.00			0.27	0.10				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0332	004	0	1	02	01	H0332_004_0	3	1	Preferred Generic	1	4	001000	1	2		110	01			1				30		90	1							30		31								8.00		24.00					3.00		7.50																							8.00				8.00			0.27	0.10				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0332	004	0	1	02	01	H0332_004_0	3	2	Generic	1	4	000100	1	2		110	01			1				30		90	1							30		31								20.00		60.00					17.00		42.50																							20.00				20.00			0.67	0.57				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0332	004	0	1	02	01	H0332_004_0	3	1	Preferred Generic	3	4	001000	1	2		110	01			1				30		90	1							30		31								8.00		24.00					3.00		7.50																							8.00				8.00			0.27	0.10				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0332	004	0	1	02	01	H0332_004_0	3	5	Specialty Tier	1	4	010010	1	1		110	01			1				30		90	1							30		31												31		31					31		31																					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0332	004	0	1	02	01	H0332_004_0	3	4	Non-Preferred Brand	1	4	100000	1	2		110	01			1				30		90	1							30		31								70.00		210.00					60.00		150.00																							70.00				70.00			2.33	2.00				2.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0332	004	0	1	02	01	H0332_004_0	3	3	Preferred Brand	1	4	000001	1	2		110	01			1				30		90	1							30		31								45.00		135.00					40.00		100.00																							45.00				45.00			1.50	1.33				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0336	001	0	1	48	05	H0336_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 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	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 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	3	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	3	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	5	5	Specialty Tier	1	3	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		31					29	29	29																								29	29	29				29	29	29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	029	0	1	01	01	H0351_029_0	5	4	Non-Preferred Brand	1	3	100100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		31	100.00	200.00	300.00																									100.00	200.00	300.00				100.00	200.00	290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	029	0	1	01	01	H0351_029_0	5	3	Preferred Brand	1	3	000101	1	2	111		01		111	1	30	60	90				1				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	94.00	131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	029	0	1	01	01	H0351_029_0	5	1	Preferred Generic	1	3	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	029	0	1	01	01	H0351_029_0	5	2	Generic	1	3	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	40.00	57.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	029	0	1	01	01	H0351_029_0	5	6	Select Care Drugs	1	3	010010	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		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	038	0	1	01	01	H0351_038_0	3	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	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	038	0	1	01	01	H0351_038_0	3	4	Non-Preferred Brand	1	4	100100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	038	0	1	01	01	H0351_038_0	3	3	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	038	0	1	01	01	H0351_038_0	3	2	Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	42.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	038	0	1	01	01	H0351_038_0	3	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	12.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	038	0	1	01	01	H0351_038_0	3	6	Select Care Drugs	1	4	010010	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	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, 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		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	12.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	040	0	1	01	01	H0351_040_0	3	2	Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	42.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, 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		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, 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		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, 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		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, 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		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, 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		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	041	0	1	01	01	H0351_041_0	3	2	Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								17.00	34.00	51.00					12.00	24.00	36.00											17.00	34.00	51.00				12.00	24.00	33.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, 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		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, 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		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, 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		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, 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		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	042	0	1	01	01	H0351_042_0	3	2	Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	42.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	042	0	1	01	01	H0351_042_0	3	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	12.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	042	0	1	01	01	H0351_042_0	3	3	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	042	0	1	01	01	H0351_042_0	3	6	Select Care Drugs	1	4	010010	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	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	042	0	1	01	01	H0351_042_0	3	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	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	042	0	1	01	01	H0351_042_0	3	4	Non-Preferred Brand	1	4	100100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	043	1	1	01	01	H0351_043_1	3	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	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	043	1	1	01	01	H0351_043_1	3	4	Non-Preferred Brand	1	4	100100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	043	1	1	01	01	H0351_043_1	3	3	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	043	1	1	01	01	H0351_043_1	3	2	Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	42.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	043	1	1	01	01	H0351_043_1	3	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	043	1	1	01	01	H0351_043_1	3	6	Select Care Drugs	1	4	010010	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	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	043	3	1	01	01	H0351_043_3	3	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	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	043	3	1	01	01	H0351_043_3	3	4	Non-Preferred Brand	1	4	100100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	043	3	1	01	01	H0351_043_3	3	3	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	043	3	1	01	01	H0351_043_3	3	2	Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	42.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	043	3	1	01	01	H0351_043_3	3	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	043	3	1	01	01	H0351_043_3	3	6	Select Care Drugs	1	4	010010	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	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	044	1	1	01	01	H0351_044_1	3	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	044	1	1	01	01	H0351_044_1	3	2	Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	42.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	044	1	1	01	01	H0351_044_1	3	3	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	044	1	1	01	01	H0351_044_1	3	4	Non-Preferred Brand	1	4	100100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	044	1	1	01	01	H0351_044_1	3	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	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	044	1	1	01	01	H0351_044_1	3	6	Select Care Drugs	1	4	010010	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	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	044	2	1	01	01	H0351_044_2	3	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	044	2	1	01	01	H0351_044_2	3	2	Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	42.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	044	2	1	01	01	H0351_044_2	3	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	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	044	2	1	01	01	H0351_044_2	3	4	Non-Preferred Brand	1	4	100100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	044	2	1	01	01	H0351_044_2	3	3	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	044	2	1	01	01	H0351_044_2	3	6	Select Care Drugs	1	4	010010	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	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0354	001	0	1	01	01	H0354_001_0	6	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	100.00	200.00	300.00																			100.00		300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0354	001	0	1	01	01	H0354_001_0	6	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31				442.56	33	33	33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0354	001	0	1	01	01	H0354_001_0	6	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0354	001	0	1	01	01	H0354_001_0	6	2	Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	15.00	30.00	45.00																			15.00		45.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0354	001	0	1	01	01	H0354_001_0	6	3	Preferred Brand	1	4	000101	1	2	111		01	110		1	30	60	90				2	30		90				30		31	45.00	90.00	135.00																			45.00		135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0354	023	0	1	01	01	H0354_023_0	5	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	95.00	190.00	285.00																			95.00		285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0354	023	0	1	01	01	H0354_023_0	5	3	Preferred Brand	1	4	000101	1	2	111		01	110		1	30	60	90				2	30		90				30		31	45.00	90.00	135.00																			45.00		135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0354	023	0	1	01	01	H0354_023_0	5	2	Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	10.00	20.00	30.00																			10.00		30.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0354	023	0	1	01	01	H0354_023_0	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0354	023	0	1	01	01	H0354_023_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31				442.56	33	33	33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0354	024	0	1	01	01	H0354_024_0	4	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	95.00	190.00	285.00																			95.00		285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0354	024	0	1	01	01	H0354_024_0	4	3	Preferred Brand	1	4	000101	1	2	111		01	110		1	30	60	90				2	30		90				30		31	45.00	90.00	135.00																			45.00		135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0354	024	0	1	01	01	H0354_024_0	4	2	Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	10.00	20.00	30.00																			10.00		30.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0354	024	0	1	01	01	H0354_024_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0354	024	0	1	01	01	H0354_024_0	4	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31				442.56	33	33	33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0354	026	0	1	01	01	H0354_026_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0354	026	0	1	01	01	H0354_026_0	4	2	Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	5.00	10.00	15.00																			5.00		15.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0354	026	0	1	01	01	H0354_026_0	4	3	Preferred Brand	1	4	000101	1	2	111		01	110		1	30	60	90				2	30		90				30		31	45.00	90.00	135.00																			45.00		135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0354	026	0	1	01	01	H0354_026_0	4	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	95.00	190.00	285.00																			95.00		285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0354	026	0	1	01	01	H0354_026_0	4	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31				442.56	33	33	33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0354	027	0	1	01	01	H0354_027_0	6	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0354	027	0	1	01	01	H0354_027_0	6	2	Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	15.00	30.00	45.00																			15.00		45.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0354	027	0	1	01	01	H0354_027_0	6	3	Preferred Brand	1	4	000101	1	2	111		01	110		1	30	60	90				2	30		90				30		31	45.00	90.00	135.00																			45.00		135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0354	027	0	1	01	01	H0354_027_0	6	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	100.00	200.00	300.00																			100.00		300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0354	027	0	1	01	01	H0354_027_0	6	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31				415.42	33	33	33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0408	003	0	1	01	01	H0408_003_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		.26						.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0408	003	0	1	01	01	H0408_003_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0408	003	0	1	01	01	H0408_003_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0408	003	0	1	01	01	H0408_003_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0408	003	0	1	01	01	H0408_003_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				553.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0435	002	0	1	01	01	H0435_002_0	10	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								17.00	29.00	35.00					12.00	24.00	30.00					12.00	24.00	30.00																12.00				12.00			0.57	0.40	0.40			0.39	Preferred Generic, 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								9.00	13.00	15.00					4.00	8.00	10.00					4.00	8.00	10.00																4.00				4.00			.30	.13	.13			.13	Preferred Generic, 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								45.00	85.00	105.00					40.00	80.00	100.00					40.00	80.00	100.00																40.00				40.00			1.50	1.33	1.33			1.29	Preferred Generic, 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												30							30						30																	30			30								Preferred Generic, 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								95.00	185.00	275.00					90.00	180.00	270.00					90.00	180.00	270.00																90.00				90.00			3.17	3.00	3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0435	003	0	1	01	01	H0435_003_0	9	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								9.00	13.00	15.00					4.00	8.00	10.00					4.00	8.00	10.00																4.00				4.00			0.30	0.13	0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0435	003	0	1	01	01	H0435_003_0	9	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								17.00	29.00	35.00					12.00	24.00	30.00					12.00	24.00	30.00																12.00				12.00			0.57	0.40	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0435	003	0	1	01	01	H0435_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								95.00	185.00	275.00					90.00	180.00	270.00					90.00	180.00	270.00																90.00				90.00			3.17	3.00	3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0435	003	0	1	01	01	H0435_003_0	9	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								45.00	85.00	105.00					40.00	80.00	100.00					40.00	80.00	100.00																40.00				40.00			1.50	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0435	003	0	1	01	01	H0435_003_0	9	5	Specialty Tier	1	4	100000	1	1		010	01	010		1				30				30						30		31												33							33						33																	33			33								Preferred Generic, 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								45.00	85.00	105.00					40.00	80.00	100.00					40.00	80.00	100.00																40.00				40.00			1.50	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0435	004	0	1	01	01	H0435_004_0	7	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								17.00	29.00	35.00					12.00	24.00	30.00					12.00	24.00	30.00																12.00				12.00			0.57	0.40	0.40			0.39	Preferred Generic, 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								9.00	13.00	15.00					4.00	8.00	10.00					4.00	8.00	10.00																4.00				4.00			0.30	0.13	0.13			0.13	Preferred Generic, 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								95.00	185.00	275.00					90.00	180.00	270.00					90.00	180.00	270.00																90.00				90.00			3.17	3.00	3.00			2.90	Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0435	005	0	1	01	01	H0435_005_0	8	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								47.00	89.00	110.00					42.00	84.00	105.00					42.00	84.00	105.00																42.00				42.00			1.57	1.40	1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0435	005	0	1	01	01	H0435_005_0	8	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								17.00	29.00	35.00					12.00	24.00	30.00					12.00	24.00	30.00																12.00				12.00			0.57	0.40	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0435	005	0	1	01	01	H0435_005_0	8	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								10.00	15.00	17.50					5.00	10.00	12.50					5.00	10.00	12.50																5.00				5.00			0.33	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0435	005	0	1	01	01	H0435_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								95.00	185.00	275.00					90.00	180.00	270.00					90.00	180.00	270.00																90.00				90.00			3.17	3.00	3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0435	005	0	1	01	01	H0435_005_0	8	5	Specialty Tier	1	4	100000	1	1		010	01	010		1				30				30						30		31												28							28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0439	001	0	1	01	01	H0439_001_0	4	3	Preferred Brand	1	4	000101	1	2	111		01	110		1	30	60	90				2	30		90				30		31	45.00	90.00	135.00																			45.00		135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0439	001	0	1	01	01	H0439_001_0	4	2	Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	12.00	24.00	36.00																			12.00		36.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, 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	3.00	6.00	9.00																			3.00		9.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, 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	85.00	170.00	255.00																			85.00		255.00																85.00				85.00		2.83			2.83			2.74	Preferred Generic, 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				648.88	30	30	30																		30		30															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0480	001	0	1	48	05	H0480_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			
H0480	001	0	1	48	05	H0480_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			
H0480	001	0	1	48	05	H0480_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			
H0490	004	0	1	01	01	H0490_004_0	6	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0490	004	0	1	01	01	H0490_004_0	6	2	Generic	1	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	15.00	30.00	45.00																			15.00	30.00	45.00																15.00				15.00		0.48			0.48			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0490	004	0	1	01	01	H0490_004_0	6	3	Preferred Brand	1	4	010001	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0490	004	0	1	01	01	H0490_004_0	6	4	Non-Preferred Brand	1	4	110000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.06			3.06			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0490	004	0	1	01	01	H0490_004_0	6	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0504	015	0	1	01	01	H0504_015_0	5	3	Preferred Brand	1	4	010001	1	2		111	01	100		1				30	60	90	1			90				30		31								47.00	94.00	141.00					40.00	80.00	80.00							80.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	015	0	1	01	01	H0504_015_0	5	2	Generic	1	4	000100	1	2		111	01	100		1				30	60	90	1			90				30		31								12.00	24.00	36.00					5.00	10.00	10.00							10.00																12.00				12.00			0.40	0.17				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	015	0	1	01	01	H0504_015_0	5	2	Generic	3	4	000100	1	2		111	01	100		1				30	60	90	1			90				30		31								12.00	24.00	36.00					5.00	10.00	10.00							10.00																12.00				12.00			0.40	0.17				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
H0504	015	0	1	01	01	H0504_015_0	5	1	Preferred Generic	3	4	001000	1	2		111	01	100		1				30	60	90	1			90				30		31								7.00	14.00	21.00					0.00	0.00	0.00							0.00																7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
H0504	015	0	1	01	01	H0504_015_0	5	6	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	015	0	1	01	01	H0504_015_0	5	5	Injectable Drugs	1	4	010010	1	1		111	01	100		1				30	60	90	1			90				30		31											130.00	25	25	25				130.00	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	015	0	1	01	01	H0504_015_0	5	4	Non-Preferred Brand	1	4	110000	1	2		111	01	100		1				30	60	90	1			90				30		31								95.00	190.00	285.00					88.00	176.00	176.00							176.00																95.00				95.00			3.17	2.93				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	015	0	1	01	01	H0504_015_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	100		1				30	60	90	1			90				30		31								7.00	14.00	21.00					0.00	0.00	0.00							0.00																7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	017	0	1	01	01	H0504_017_0	6	1	Preferred Generic	1	4	001000	1	2		111	01	100		1				30	60	90	1			90				30		31								7.00	14.00	21.00					0.00	0.00	0.00							0.00																7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	017	0	1	01	01	H0504_017_0	6	1	Preferred Generic	3	4	001000	1	2		111	01	100		1				30	60	90	1			90				30		31								7.00	14.00	21.00					0.00	0.00	0.00							0.00																7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
H0504	017	0	1	01	01	H0504_017_0	6	6	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	017	0	1	01	01	H0504_017_0	6	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, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	017	0	1	01	01	H0504_017_0	6	4	Non-Preferred Brand	1	4	110000	1	2		111	01	100		1				30	60	90	1			90				30		31								95.00	190.00	285.00					90.00	180.00	180.00							180.00																95.00				95.00			3.17	3.00				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	017	0	1	01	01	H0504_017_0	6	3	Preferred Brand	1	4	010001	1	2		111	01	100		1				30	60	90	1			90				30		31								47.00	94.00	141.00					40.00	80.00	80.00							80.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	017	0	1	01	01	H0504_017_0	6	2	Generic	1	4	000100	1	2		111	01	100		1				30	60	90	1			90				30		31								12.00	24.00	36.00					5.00	10.00	10.00							10.00																12.00				12.00			0.40	0.17				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	017	0	1	01	01	H0504_017_0	6	2	Generic	3	4	000100	1	2		111	01	100		1				30	60	90	1			90				30		31								12.00	24.00	36.00					5.00	10.00	10.00							10.00																12.00				12.00			0.40	0.17				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
H0504	021	0	1	01	01	H0504_021_0	6	3	Preferred Brand	1	4	010001	1	2		111	01	100		1				30	60	90	1			90				30		31								37.00	74.00	111.00					30.00	60.00	60.00							60.00																37.00				37.00			1.23	1.00				1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	021	0	1	01	01	H0504_021_0	6	2	Generic	1	4	000100	1	2		111	01	100		1				30	60	90	1			90				30		31								10.00	20.00	30.00					3.00	6.00	6.00							6.00																10.00				10.00			0.33	0.10				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	021	0	1	01	01	H0504_021_0	6	1	Preferred Generic	1	4	001000	1	2		111	01	100		1				30	60	90	1			90				30		31								7.00	14.00	21.00					0.00	0.00	0.00							0.00																7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	021	0	1	01	01	H0504_021_0	6	4	Non-Preferred Brand	1	4	110000	1	2		111	01	100		1				30	60	90	1			90				30		31								72.00	144.00	216.00					65.00	130.00	130.00							130.00																72.00				72.00			2.40	2.17				2.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	021	0	1	01	01	H0504_021_0	6	3	Preferred Brand	3	4	010001	1	2		111	01	100		1				30	60	90	1			90				30		31								37.00	74.00	111.00					30.00	60.00	60.00							60.00																37.00				37.00			1.23	1.00				1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										2	2	
H0504	021	0	1	01	01	H0504_021_0	6	2	Generic	3	4	000100	1	2		111	01	100		1				30	60	90	1			90				30		31								10.00	20.00	30.00					3.00	6.00	6.00							6.00																10.00				10.00			0.33	0.10				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
H0504	021	0	1	01	01	H0504_021_0	6	1	Preferred Generic	3	4	001000	1	2		111	01	100		1				30	60	90	1			90				30		31								7.00	14.00	21.00					0.00	0.00	0.00							0.00																7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
H0504	021	0	1	01	01	H0504_021_0	6	6	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	021	0	1	01	01	H0504_021_0	6	5	Injectable Drugs	1	4	010010	1	1		111	01	100		1				30	60	90	1			90				30		31											123.00	25	25	25				123.00	25	25	25						25															25			25								Preferred Generic, 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								7.00	14.00	21.00					0.00	0.00	0.00							0.00																7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	026	0	1	01	01	H0504_026_0	5	2	Generic	1	4	000100	1	2		111	01	100		1				30	60	90	1			90				30		31								12.00	24.00	36.00					5.00	10.00	10.00							10.00																12.00				12.00			0.40	0.17				0.39	Preferred Generic, 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								47.00	94.00	141.00					40.00	80.00	80.00							80.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, 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								95.00	190.00	285.00					90.00	180.00	180.00							180.00																95.00				95.00			3.17	3.00				3.06	Preferred Generic, 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											118.00	25	25	25				118.00	25	25	25						25															25			25								Preferred Generic, 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		010	01	010		1				30				30						30		31												33							33						33																	33			33								Preferred Generic, 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								7.00	14.00	21.00					0.00	0.00	0.00							0.00																7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
H0504	026	0	1	01	01	H0504_026_0	5	2	Generic	3	4	000100	1	2		111	01	100		1				30	60	90	1			90				30		31								12.00	24.00	36.00					5.00	10.00	10.00							10.00																12.00				12.00			0.40	0.17				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
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											117.00	25	25	25				117.00	25	25	25						25															25			25								Preferred Generic, 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								95.00	190.00	285.00					88.00	176.00	176.00							176.00																95.00				95.00			3.17	2.93				3.06	Preferred Generic, 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								47.00	94.00	141.00					40.00	80.00	80.00							80.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	027	0	1	01	01	H0504_027_0	5	2	Generic	1	4	000100	1	2		111	01	100		1				30	60	90	1			90				30		31								12.00	24.00	36.00					5.00	10.00	10.00							10.00																12.00				12.00			0.40	0.17				0.39	Preferred Generic, 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								7.00	14.00	21.00					0.00	0.00	0.00							0.00																7.00				7.00			0.23	0.00				0.23	Preferred Generic, 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		010	01	010		1				30				30						30		31												33							33						33																	33			33								Preferred Generic, 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											61.00	25	25	25				61.00	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	028	0	1	01	01	H0504_028_0	5	6	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31												33							33						33																	33			33								Preferred Generic, 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								7.00	14.00	21.00					0.00	0.00	0.00							0.00																7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
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								7.00	14.00	21.00					0.00	0.00	0.00							0.00																7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	028	0	1	01	01	H0504_028_0	5	2	Generic	1	4	000100	1	2		111	01	100		1				30	60	90	1			90				30		31								12.00	24.00	36.00					5.00	10.00	10.00							10.00																12.00				12.00			0.40	0.17				0.39	Preferred Generic, 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								47.00	94.00	141.00					40.00	80.00	80.00							80.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, 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								90.00	180.00	270.00					82.00	164.00	164.00							164.00																90.00				90.00			3.00	2.73				2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
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								7.00	14.00	21.00					0.00	0.00	0.00							0.00																7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	029	0	1	01	01	H0504_029_0	5	2	Generic	1	4	000100	1	2		111	01	100		1				30	60	90	1			90				30		31								12.00	24.00	36.00					5.00	10.00	10.00							10.00																12.00				12.00			0.40	0.17				0.39	Preferred Generic, 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								47.00	94.00	141.00					40.00	80.00	80.00							80.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, 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								95.00	190.00	285.00					88.00	176.00	176.00							176.00																95.00				95.00			3.17	2.93				3.06	Preferred Generic, 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											90.00	25	25	25				90.00	25	25	25						25															25			25								Preferred Generic, 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		010	01	010		1				30				30						30		31												33							33						33																	33			33								Preferred Generic, 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								7.00	14.00	21.00					0.00	0.00	0.00							0.00																7.00				7.00			0.23	0.00				0.23	Preferred Generic, 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								7.00	14.00	21.00					0.00	0.00	0.00							0.00																7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	030	0	1	01	01	H0504_030_0	6	2	Generic	1	4	000100	1	2		111	01	100		1				30	60	90	1			90				30		31								12.00	24.00	36.00					5.00	10.00	10.00							10.00																12.00				12.00			0.40	0.17				0.39	Preferred Generic, 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								47.00	94.00	141.00					40.00	80.00	80.00							80.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, 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								95.00	190.00	285.00					90.00	180.00	180.00							180.00																95.00				95.00			3.17	3.00				3.06	Preferred Generic, 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											98.00	25	25	25				98.00	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	030	0	1	01	01	H0504_030_0	6	6	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
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								7.00	14.00	21.00					0.00	0.00	0.00							0.00																7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
H0504	031	0	1	01	01	H0504_031_0	6	1	Preferred Generic	1	4	001000	1	2		111	01	100		1				30	60	90	1			90				30		31								7.00	14.00	21.00					0.00	0.00	0.00							0.00																7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	031	0	1	01	01	H0504_031_0	6	1	Preferred Generic	3	4	001000	1	2		111	01	100		1				30	60	90	1			90				30		31								7.00	14.00	21.00					0.00	0.00	0.00							0.00																7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
H0504	031	0	1	01	01	H0504_031_0	6	6	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	031	0	1	01	01	H0504_031_0	6	5	Injectable Drugs	1	4	010010	1	1		111	01	100		1				30	60	90	1			90				30		31											95.00	25	25	25				95.00	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	031	0	1	01	01	H0504_031_0	6	4	Non-Preferred Brand	1	4	110000	1	2		111	01	100		1				30	60	90	1			90				30		31								95.00	190.00	285.00					90.00	180.00	180.00							180.00																95.00				95.00			3.17	3.00				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	031	0	1	01	01	H0504_031_0	6	3	Preferred Brand	1	4	010001	1	2		111	01	100		1				30	60	90	1			90				30		31								47.00	94.00	141.00					40.00	80.00	80.00							80.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	031	0	1	01	01	H0504_031_0	6	2	Generic	1	4	000100	1	2		111	01	100		1				30	60	90	1			90				30		31								12.00	24.00	36.00					5.00	10.00	10.00							10.00																12.00				12.00			0.40	0.17				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	032	0	1	01	01	H0504_032_0	6	1	Preferred Generic	1	4	001000	1	2		111	01	100		1				30	60	90	1			90				30		31								5.00	10.00	15.00					0.00	0.00	0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	032	0	1	01	01	H0504_032_0	6	1	Preferred Generic	3	4	001000	1	2		111	01	100		1				30	60	90	1			90				30		31								5.00	10.00	15.00					0.00	0.00	0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
H0504	032	0	1	01	01	H0504_032_0	6	6	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	032	0	1	01	01	H0504_032_0	6	5	Injectable Drugs	1	4	010010	1	1		111	01	100		1				30	60	90	1			90				30		31											88.00	25	25	25				88.00	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	032	0	1	01	01	H0504_032_0	6	4	Non-Preferred Brand	1	4	110000	1	2		111	01	100		1				30	60	90	1			90				30		31								95.00	190.00	285.00					90.00	180.00	180.00							180.00																95.00				95.00			3.17	3.00				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	032	0	1	01	01	H0504_032_0	6	3	Preferred Brand	1	4	010001	1	2		111	01	100		1				30	60	90	1			90				30		31								47.00	94.00	141.00					40.00	80.00	80.00							80.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	032	0	1	01	01	H0504_032_0	6	2	Generic	1	4	000100	1	2		111	01	100		1				30	60	90	1			90				30		31								12.00	24.00	36.00					5.00	10.00	10.00							10.00																12.00				12.00			0.40	0.17				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	032	0	1	01	01	H0504_032_0	6	2	Generic	3	4	000100	1	2		111	01	100		1				30	60	90	1			90				30		31								12.00	24.00	36.00					5.00	10.00	10.00							10.00																12.00				12.00			0.40	0.17				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
H0523	002	0	1	01	01	H0523_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0523	002	0	1	01	01	H0523_002_0	8	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								16.00	32.00	48.00					10.00	20.00	30.00					16.00	32.00	48.00																	16.00			16.00			0.53	0.33	0.53			0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0523	002	0	1	01	01	H0523_002_0	8	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0523	002	0	1	01	01	H0523_002_0	8	4	Non-Preferred Brand	1	4	110000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0523	002	0	1	01	01	H0523_002_0	8	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								6.00	12.00	18.00					0.00	0.00	0.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.00	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0523	022	0	1	01	01	H0523_022_0	10	4	Non-Preferred Brand	1	4	110000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0523	022	0	1	01	01	H0523_022_0	10	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								6.00	12.00	18.00					0.00	0.00	0.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.00	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0523	022	0	1	01	01	H0523_022_0	10	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								12.00	24.00	36.00					6.00	12.00	18.00					12.00	24.00	36.00																	12.00			12.00			0.40	0.20	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0523	022	0	1	01	01	H0523_022_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0523	022	0	1	01	01	H0523_022_0	10	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0523	031	0	1	01	01	H0523_031_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0523	031	0	1	01	01	H0523_031_0	10	4	Non-Preferred Brand	1	4	110000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0523	031	0	1	01	01	H0523_031_0	10	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0523	031	0	1	01	01	H0523_031_0	10	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					4.00	8.00	12.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.13	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0523	031	0	1	01	01	H0523_031_0	10	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								6.00	12.00	18.00					0.00	0.00	0.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.00	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0523	052	0	1	01	01	H0523_052_0	8	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0523	052	0	1	01	01	H0523_052_0	8	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					10.00	20.00	30.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.33	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0523	052	0	1	01	01	H0523_052_0	8	4	Non-Preferred Brand	1	4	110000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0523	052	0	1	01	01	H0523_052_0	8	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31											1.00	29						1.00	29						29																		29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0523	052	0	1	01	01	H0523_052_0	8	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								15.00	30.00	45.00					5.00	10.00	15.00					15.00	30.00	45.00																	15.00			15.00			0.50	0.17	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0523	052	0	1	01	01	H0523_052_0	8	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								15.00	30.00	45.00					5.00	10.00	15.00					15.00	30.00	45.00																	15.00			15.00			0.50	0.17	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0523	060	0	1	01	01	H0523_060_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0523	060	0	1	01	01	H0523_060_0	7	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0523	060	0	1	01	01	H0523_060_0	7	4	Non-Preferred Brand	1	4	110000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0523	060	0	1	01	01	H0523_060_0	7	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								6.00	12.00	18.00					0.00	0.00	0.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.00	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0523	060	0	1	01	01	H0523_060_0	7	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								11.00	22.00	33.00					5.00	10.00	15.00					11.00	22.00	33.00																	11.00			11.00			0.37	0.17	0.37			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0523	061	0	1	01	01	H0523_061_0	8	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0523	061	0	1	01	01	H0523_061_0	8	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								6.00	12.00	18.00					0.00	0.00	0.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.00	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0523	061	0	1	01	01	H0523_061_0	8	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								11.00	22.00	33.00					5.00	10.00	15.00					11.00	22.00	33.00																	11.00			11.00			0.37	0.17	0.37			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0523	061	0	1	01	01	H0523_061_0	8	4	Non-Preferred Brand	1	4	110000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0523	061	0	1	01	01	H0523_061_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0523	063	0	1	01	01	H0523_063_0	7	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								6.00	12.00	18.00					0.00	0.00	0.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.00	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0523	063	0	1	01	01	H0523_063_0	7	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								11.00	22.00	33.00					5.00	10.00	15.00					11.00	22.00	33.00																	11.00			11.00			0.37	0.17	0.37			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0523	063	0	1	01	01	H0523_063_0	7	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0523	063	0	1	01	01	H0523_063_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0523	063	0	1	01	01	H0523_063_0	7	4	Non-Preferred Brand	1	4	110000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0524	002	0	2	01	01	H0524_002_0	6	6	Vaccines	3	4	000001	1	2	010		01			1	30													30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	002	0	2	01	01	H0524_002_0	6	2	Generic	3	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	12.00		36.00																			12.00		24.00																12.00				12.00		.40			.40			.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	002	0	2	01	01	H0524_002_0	6	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		.16			.16			.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	002	0	2	01	01	H0524_002_0	6	6	Vaccines	1	4	000001	1	2	010		01			1	30													30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	002	0	2	01	01	H0524_002_0	6	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		100				2	30		100				30		31				1178.00	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	002	0	2	01	01	H0524_002_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		100				2	30		100				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	002	0	2	01	01	H0524_002_0	6	2	Generic	1	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	12.00		36.00																			12.00		24.00																12.00				12.00		.40			.40			.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	002	0	2	01	01	H0524_002_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		.16			.16			.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	002	0	2	01	01	H0524_002_0	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		100				2	30		100				30		31	95.00		285.00																			95.00		190.00																95.00				95.00		3.16			3.16			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	003	0	1	01	01	H0524_003_0	5	6	Vaccines	3	4	000001	1	2	010		01			1	30													30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	003	0	1	01	01	H0524_003_0	5	2	Generic	3	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		.33			.33			.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	003	0	1	01	01	H0524_003_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	3.00		9.00																			3.00		6.00																3.00				3.00		.10			.10			.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	003	0	1	01	01	H0524_003_0	5	6	Vaccines	1	4	000001	1	2	010		01			1	30													30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	003	0	1	01	01	H0524_003_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	3.00		9.00																			3.00		6.00																3.00				3.00		0.10			0.10			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	003	0	1	01	01	H0524_003_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		100				2	30		100				30		31	95.00		285.00																			95.00		190.00																95.00				95.00		3.16			3.16			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	003	0	1	01	01	H0524_003_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		100				2	30		100				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	003	0	1	01	01	H0524_003_0	5	2	Generic	1	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		.33			.33			.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	003	0	1	01	01	H0524_003_0	5	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		100				2	30		100				30		31				1139.00	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	008	0	1	01	01	H0524_008_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	008	0	1	01	01	H0524_008_0	6	2	Generic	3	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		.50			.50			.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	008	0	1	01	01	H0524_008_0	6	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		.16			.16			.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	008	0	1	01	01	H0524_008_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	008	0	1	01	01	H0524_008_0	6	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		100				2	30		100				30		31				1186.00	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	008	0	1	01	01	H0524_008_0	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		100				2	30		100				30		31	95.00		285.00																			95.00		190.00																95.00				95.00		3.16			3.16			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	008	0	1	01	01	H0524_008_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		100				2	30		100				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	008	0	1	01	01	H0524_008_0	6	2	Generic	1	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		.50			.50			.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	008	0	1	01	01	H0524_008_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		.16			.16			.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	010	0	2	01	01	H0524_010_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	010	0	2	01	01	H0524_010_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		.16			.16			.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	010	0	2	01	01	H0524_010_0	5	2	Generic	1	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		.50			.50			.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	010	0	2	01	01	H0524_010_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		100				2	30		100				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	010	0	2	01	01	H0524_010_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		100				2	30		100				30		31	95.00		285.00																			95.00		190.00																95.00				95.00		3.16			3.16			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	010	0	2	01	01	H0524_010_0	5	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		100				2	30		100				30		31				1033.00	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	010	0	2	01	01	H0524_010_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	010	0	2	01	01	H0524_010_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		.16			.16			.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	010	0	2	01	01	H0524_010_0	5	2	Generic	3	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		.50			.50			.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	013	0	1	01	01	H0524_013_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		.16			.16			.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	013	0	1	01	01	H0524_013_0	6	2	Generic	1	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		.50			.50			.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	013	0	1	01	01	H0524_013_0	6	6	Vaccines	3	4	000001	1	2	010		01			1	30													30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	013	0	1	01	01	H0524_013_0	6	2	Generic	3	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		.50			.50			.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	013	0	1	01	01	H0524_013_0	6	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		.16			.16			.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	013	0	1	01	01	H0524_013_0	6	6	Vaccines	1	4	000001	1	2	010		01			1	30													30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	013	0	1	01	01	H0524_013_0	6	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		100				2	30		100				30		31				1145.00	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	013	0	1	01	01	H0524_013_0	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		100				2	30		100				30		31	95.00		285.00																			95.00		190.00																95.00				95.00		3.16			3.16			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	013	0	1	01	01	H0524_013_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		100				2	30		100				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	015	0	1	01	01	H0524_015_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		.16			.16			.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	015	0	1	01	01	H0524_015_0	5	2	Generic	3	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	12.00		36.00																			12.00		24.00																12.00				12.00		.40			.40			.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	015	0	1	01	01	H0524_015_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		.16			.16			.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	015	0	1	01	01	H0524_015_0	5	6	Vaccines	1	4	000001	1	2	010		01			1	30													30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	015	0	1	01	01	H0524_015_0	5	6	Vaccines	3	4	000001	1	2	010		01			1	30													30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	015	0	1	01	01	H0524_015_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		100				2	30		100				30		31	95.00		285.00																			95.00		190.00																95.00				95.00		3.16			3.16			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	015	0	1	01	01	H0524_015_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		100				2	30		100				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	015	0	1	01	01	H0524_015_0	5	2	Generic	1	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	12.00		36.00																			12.00		24.00																12.00				12.00		.40			.40			.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	015	0	1	01	01	H0524_015_0	5	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		100				2	30		100				30		31				1144.00	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	029	0	1	01	01	H0524_029_0	6	1	Preferred Generic	1	3	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	8.00		24.00																			8.00		16.00																8.00				8.00		0.26			0.26			0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	029	0	1	01	01	H0524_029_0	6	2	Generic	1	3	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	17.00		51.00																			17.00		34.00																17.00				17.00		.56			.56			.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	029	0	1	01	01	H0524_029_0	6	6	Vaccines	1	3	000001	1	2	010		01			1	30													30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	029	0	1	01	01	H0524_029_0	6	4	Non-Preferred Brand	1	3	100000	1	2	110		01	110		1	30		100				2	30		100				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	029	0	1	01	01	H0524_029_0	6	5	Specialty Tier	1	3	100001	1	1	110		01	110		1	30		100				2	30		100				30		31				1147.00	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	029	0	1	01	01	H0524_029_0	6	3	Preferred Brand	1	3	000001	1	2	110		01	110		1	30		100				2	30		100				30		31	47.00		141.00																			47.00		94.00																47.00				47.00		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	030	0	1	01	01	H0524_030_0	6	5	Specialty Tier	1	3	100001	1	1	110		01	110		1	30		100				2	30		100				30		31				1005.00	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	030	0	1	01	01	H0524_030_0	6	6	Vaccines	1	3	000001	1	2	010		01			1	30													30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	030	0	1	01	01	H0524_030_0	6	4	Non-Preferred Brand	1	3	100000	1	2	110		01	110		1	30		100				2	30		100				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	030	0	1	01	01	H0524_030_0	6	3	Preferred Brand	1	3	000001	1	2	110		01	110		1	30		100				2	30		100				30		31	47.00		141.00																			47.00		94.00																47.00				47.00		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	030	0	1	01	01	H0524_030_0	6	2	Generic	1	3	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	19.00		57.00																			19.00		38.00																19.00				19.00		.63			.63			.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	030	0	1	01	01	H0524_030_0	6	1	Preferred Generic	1	3	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	8.00		24.00																			8.00		16.00																8.00				8.00		0.26			0.26			0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	031	0	1	01	01	H0524_031_0	4	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		100				2	30		100				30		31				1322.00	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	031	0	1	01	01	H0524_031_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	031	0	1	01	01	H0524_031_0	4	2	Generic	3	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		.50			.50			.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	031	0	1	01	01	H0524_031_0	4	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		.16			.16			.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	031	0	1	01	01	H0524_031_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	031	0	1	01	01	H0524_031_0	4	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		100				2	30		100				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	031	0	1	01	01	H0524_031_0	4	2	Generic	1	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		.50			.50			.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	031	0	1	01	01	H0524_031_0	4	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		.16			.16			.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	031	0	1	01	01	H0524_031_0	4	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		100				2	30		100				30		31	95.00		285.00																			95.00		190.00																95.00				95.00		3.16			3.16			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	032	0	1	01	01	H0524_032_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		100				2	30		100				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	032	0	1	01	01	H0524_032_0	5	6	Vaccines	3	4	000001	1	2	010		01			1	30													30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	032	0	1	01	01	H0524_032_0	5	2	Generic	3	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		.50			.50			.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	032	0	1	01	01	H0524_032_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		.16			.16			.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	032	0	1	01	01	H0524_032_0	5	6	Vaccines	1	4	000001	1	2	010		01			1	30													30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	032	0	1	01	01	H0524_032_0	5	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		100				2	30		100				30		31				917.00	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	032	0	1	01	01	H0524_032_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		100				2	30		100				30		31	95.00		285.00																			95.00		190.00																95.00				95.00		3.16			3.16			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	032	0	1	01	01	H0524_032_0	5	2	Generic	1	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		.50			.50			.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	032	0	1	01	01	H0524_032_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		.16			.16			.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	033	0	1	01	01	H0524_033_0	5	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		100				2	30		100				30		31				1304.00	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	033	0	1	01	01	H0524_033_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		100				2	30		100				30		31	95.00		285.00																			95.00		190.00																95.00				95.00		3.16			3.16			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	033	0	1	01	01	H0524_033_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		.16			.16			.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	033	0	1	01	01	H0524_033_0	5	2	Generic	3	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		.50			.50			.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	033	0	1	01	01	H0524_033_0	5	6	Vaccines	1	4	000001	1	2	010		01			1	30													30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	033	0	1	01	01	H0524_033_0	5	6	Vaccines	3	4	000001	1	2	010		01			1	30													30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	033	0	1	01	01	H0524_033_0	5	2	Generic	1	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		.50			.50			.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	033	0	1	01	01	H0524_033_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		.16			.16			.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	033	0	1	01	01	H0524_033_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		100				2	30		100				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	034	0	1	01	01	H0524_034_0	5	2	Generic	3	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	12.00		36.00																			12.00		24.00																12.00				12.00		.40			.40			.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	034	0	1	01	01	H0524_034_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		.16			.16			.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	034	0	1	01	01	H0524_034_0	5	6	Vaccines	1	4	000001	1	2	010		01			1	30													30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	034	0	1	01	01	H0524_034_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		.16			.16			.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	034	0	1	01	01	H0524_034_0	5	2	Generic	1	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	12.00		36.00																			12.00		24.00																12.00				12.00		.40			.40			.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	034	0	1	01	01	H0524_034_0	5	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		100				2	30		100				30		31				1366.00	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	034	0	1	01	01	H0524_034_0	5	6	Vaccines	3	4	000001	1	2	010		01			1	30													30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	034	0	1	01	01	H0524_034_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		100				2	30		100				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	034	0	1	01	01	H0524_034_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		100				2	30		100				30		31	95.00		285.00																			95.00		190.00																95.00				95.00		3.16			3.16			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	035	0	1	01	01	H0524_035_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	3.00		9.00																			3.00		6.00																3.00				3.00		.10			.10			.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	035	0	1	01	01	H0524_035_0	7	2	Generic	1	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		.33			.33			.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	035	0	1	01	01	H0524_035_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		100				2	30		100				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	035	0	1	01	01	H0524_035_0	7	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		100				2	30		100				30		31	95.00		285.00																			95.00		190.00																95.00				95.00		3.16			3.16			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	035	0	1	01	01	H0524_035_0	7	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		100				2	30		100				30		31				1607.00	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	035	0	1	01	01	H0524_035_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	035	0	1	01	01	H0524_035_0	7	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	3.00		9.00																			3.00		6.00																3.00				3.00		.10			.10			.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	035	0	1	01	01	H0524_035_0	7	2	Generic	3	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		.33			.33			.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	035	0	1	01	01	H0524_035_0	7	6	Vaccines	3	4	000001	1	2	010		01			1	30													30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	036	0	1	01	01	H0524_036_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	3.00		9.00																			3.00		6.00																3.00				3.00		.10			.10			.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	036	0	1	01	01	H0524_036_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	036	0	1	01	01	H0524_036_0	6	2	Generic	1	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		.33			.33			.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	036	0	1	01	01	H0524_036_0	6	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	3.00		9.00																			3.00		6.00																3.00				3.00		.10			.10			.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	036	0	1	01	01	H0524_036_0	6	2	Generic	3	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		.33			.33			.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	036	0	1	01	01	H0524_036_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	036	0	1	01	01	H0524_036_0	6	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		100				2	30		100				30		31				907.00	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	036	0	1	01	01	H0524_036_0	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		100				2	30		100				30		31	95.00		285.00																			95.00		190.00																95.00				95.00		3.16			3.16			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	036	0	1	01	01	H0524_036_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		100				2	30		100				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	037	0	1	01	01	H0524_037_0	5	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		100				2	30		100				30		31				1258.00	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	037	0	1	01	01	H0524_037_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		100				2	30		100				30		31	95.00		285.00																			95.00		190.00																95.00				95.00		3.16			3.16			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	037	0	1	01	01	H0524_037_0	5	6	Vaccines	1	4	000001	1	2	010		01			1	30													30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	037	0	1	01	01	H0524_037_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		.16			.16			.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	037	0	1	01	01	H0524_037_0	5	6	Vaccines	3	4	000001	1	2	010		01			1	30													30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	037	0	1	01	01	H0524_037_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		100				2	30		100				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	037	0	1	01	01	H0524_037_0	5	2	Generic	3	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	12.00		36.00																			12.00		24.00																12.00				12.00		.40			.40			.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	037	0	1	01	01	H0524_037_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		.16			.16			.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	037	0	1	01	01	H0524_037_0	5	2	Generic	1	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	12.00		36.00																			12.00		24.00																12.00				12.00		.40			.40			.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	038	0	1	01	01	H0524_038_0	5	6	Vaccines	3	4	000001	1	2	010		01			1	30													30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	038	0	1	01	01	H0524_038_0	5	2	Generic	3	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		.50			.50			.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	038	0	1	01	01	H0524_038_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		.16			.16			.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	038	0	1	01	01	H0524_038_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		.16			.16			.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	038	0	1	01	01	H0524_038_0	5	2	Generic	1	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		.50			.50			.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	038	0	1	01	01	H0524_038_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		100				2	30		100				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	038	0	1	01	01	H0524_038_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		100				2	30		100				30		31	95.00		285.00																			95.00		190.00																95.00				95.00		3.16			3.16			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	038	0	1	01	01	H0524_038_0	5	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		100				2	30		100				30		31				1331.00	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	038	0	1	01	01	H0524_038_0	5	6	Vaccines	1	4	000001	1	2	010		01			1	30													30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	039	0	1	01	01	H0524_039_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		100				2	30		100				30		31	95.00		285.00																			95.00		190.00																95.00				95.00		3.16			3.16			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	039	0	1	01	01	H0524_039_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		100				2	30		100				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	039	0	1	01	01	H0524_039_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		.16			.16			.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	039	0	1	01	01	H0524_039_0	5	2	Generic	1	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		.50			.50			.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	039	0	1	01	01	H0524_039_0	5	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		100				2	30		100				30		31				1290.00	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	039	0	1	01	01	H0524_039_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	039	0	1	01	01	H0524_039_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		.16			.16			.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	039	0	1	01	01	H0524_039_0	5	2	Generic	3	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		.50			.50			.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	039	0	1	01	01	H0524_039_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	040	0	1	01	01	H0524_040_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		100				2	30		100				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	040	0	1	01	01	H0524_040_0	5	2	Generic	1	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		.50			.50			.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	040	0	1	01	01	H0524_040_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		.16			.16			.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	040	0	1	01	01	H0524_040_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		100				2	30		100				30		31	95.00		285.00																			95.00		190.00																95.00				95.00		3.16			3.16			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	040	0	1	01	01	H0524_040_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	040	0	1	01	01	H0524_040_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	040	0	1	01	01	H0524_040_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		.16			.16			.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	040	0	1	01	01	H0524_040_0	5	2	Generic	3	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		.50			.50			.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	040	0	1	01	01	H0524_040_0	5	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		100				2	30		100				30		31				1090.00	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	041	0	1	01	01	H0524_041_0	5	2	Generic	3	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		.50			.50			.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	041	0	1	01	01	H0524_041_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		.16			.16			.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	041	0	1	01	01	H0524_041_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	041	0	1	01	01	H0524_041_0	5	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		100				2	30		100				30		31				1128.00	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	041	0	1	01	01	H0524_041_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		100				2	30		100				30		31	95.00		285.00																			95.00		190.00																95.00				95.00		3.16			3.16			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	041	0	1	01	01	H0524_041_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		100				2	30		100				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	041	0	1	01	01	H0524_041_0	5	2	Generic	1	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		.50			.50			.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	041	0	1	01	01	H0524_041_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		.16			.16			.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	041	0	1	01	01	H0524_041_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	042	0	1	01	01	H0524_042_0	5	6	Vaccines	3	4	000001	1	2	010		01			1	30													30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	042	0	1	01	01	H0524_042_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		.16			.16			.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	042	0	1	01	01	H0524_042_0	5	2	Generic	1	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		.50			.50			.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	042	0	1	01	01	H0524_042_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		100				2	30		100				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	042	0	1	01	01	H0524_042_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		100				2	30		100				30		31	95.00		285.00																			95.00		190.00																95.00				95.00		3.16			3.16			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	042	0	1	01	01	H0524_042_0	5	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		100				2	30		100				30		31				1552.00	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	042	0	1	01	01	H0524_042_0	5	6	Vaccines	1	4	000001	1	2	010		01			1	30													30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	042	0	1	01	01	H0524_042_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		.16			.16			.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	042	0	1	01	01	H0524_042_0	5	2	Generic	3	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		.50			.50			.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	043	0	1	01	01	H0524_043_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		100				2	30		100				30		31	95.00		285.00																			95.00		190.00																95.00				95.00		3.16			3.16			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	043	0	1	01	01	H0524_043_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		100				2	30		100				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	043	0	1	01	01	H0524_043_0	5	2	Generic	1	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		.50			.50			.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	043	0	1	01	01	H0524_043_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		.16			.16			.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	043	0	1	01	01	H0524_043_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	043	0	1	01	01	H0524_043_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	043	0	1	01	01	H0524_043_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		.16			.16			.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	043	0	1	01	01	H0524_043_0	5	2	Generic	3	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		.50			.50			.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	043	0	1	01	01	H0524_043_0	5	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		100				2	30		100				30		31				1209.00	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	046	0	1	01	01	H0524_046_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		100				2	30		100				30		31	95.00		285.00																			95.00		190.00																95.00				95.00		3.16			3.16			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	046	0	1	01	01	H0524_046_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		100				2	30		100				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	046	0	1	01	01	H0524_046_0	5	2	Generic	1	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		.50			.50			.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	046	0	1	01	01	H0524_046_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		.16			.16			.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	046	0	1	01	01	H0524_046_0	5	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		100				2	30		100				30		31				955.00	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	046	0	1	01	01	H0524_046_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	046	0	1	01	01	H0524_046_0	5	2	Generic	3	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		.50			.50			.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	046	0	1	01	01	H0524_046_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		.16			.16			.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	046	0	1	01	01	H0524_046_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	051	0	1	01	01	H0524_051_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	6.00		18.00																			6.00		12.00																6.00				6.00		.20			.20			.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	051	0	1	01	01	H0524_051_0	5	2	Generic	1	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	20.00		60.00																			20.00		40.00																20.00				20.00		.66			.66			.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	051	0	1	01	01	H0524_051_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		100				2	30		100				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	051	0	1	01	01	H0524_051_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		100				2	30		100				30		31	95.00		285.00																			95.00		190.00																95.00				95.00		3.16			3.16			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	051	0	1	01	01	H0524_051_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	051	0	1	01	01	H0524_051_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		100				2	30		100				30		31	6.00		18.00																			6.00		12.00																6.00				6.00		.20			.20			.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	051	0	1	01	01	H0524_051_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	051	0	1	01	01	H0524_051_0	5	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		100				2	30		100				30		31				1163.00	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	051	0	1	01	01	H0524_051_0	5	2	Generic	3	4	000100	1	2	110		01	110		1	30		100				2	30		100				30		31	20.00		60.00																			20.00		40.00																20.00				20.00		.66			.66			.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0543	001	0	1	01	01	H0543_001_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	001	0	1	01	01	H0543_001_0	4	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		.26						.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	001	0	1	01	01	H0543_001_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	001	0	1	01	01	H0543_001_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	001	0	1	01	01	H0543_001_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				738.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	004	0	1	01	01	H0543_004_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	004	0	1	01	01	H0543_004_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	004	0	1	01	01	H0543_004_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		.26						.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	004	0	1	01	01	H0543_004_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	004	0	1	01	01	H0543_004_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				665.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	007	0	1	01	01	H0543_007_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	007	0	1	01	01	H0543_007_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		.26						.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	007	0	1	01	01	H0543_007_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	007	0	1	01	01	H0543_007_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	007	0	1	01	01	H0543_007_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				796.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	013	0	1	01	01	H0543_013_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		.13						.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	013	0	1	01	01	H0543_013_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		.26						.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	013	0	1	01	01	H0543_013_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	013	0	1	01	01	H0543_013_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	013	0	1	01	01	H0543_013_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				570.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	019	0	1	01	01	H0543_019_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	019	0	1	01	01	H0543_019_0	3	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	019	0	1	01	01	H0543_019_0	3	2	Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	20.00		60.00																											60.00						0.00				20.00				20.00		0.66						0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	019	0	1	01	01	H0543_019_0	3	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	019	0	1	01	01	H0543_019_0	3	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31				580.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	022	0	1	01	01	H0543_022_0	3	2	Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	022	0	1	01	01	H0543_022_0	3	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	022	0	1	01	01	H0543_022_0	3	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	022	0	1	01	01	H0543_022_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	022	0	1	01	01	H0543_022_0	3	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31				536.00	26		26																										26						26			26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	028	0	1	01	01	H0543_028_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	028	0	1	01	01	H0543_028_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	028	0	1	01	01	H0543_028_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	028	0	1	01	01	H0543_028_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	028	0	1	01	01	H0543_028_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				466.00	25		25																										25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	029	0	1	01	01	H0543_029_0	3	2	Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	029	0	1	01	01	H0543_029_0	3	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	029	0	1	01	01	H0543_029_0	3	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	029	0	1	01	01	H0543_029_0	3	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31				431.00	25		25																										25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	029	0	1	01	01	H0543_029_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	032	0	1	01	01	H0543_032_0	3	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	032	0	1	01	01	H0543_032_0	3	2	Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	032	0	1	01	01	H0543_032_0	3	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	032	0	1	01	01	H0543_032_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	032	0	1	01	01	H0543_032_0	3	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31				459.00	25		25																										25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	035	0	1	01	01	H0543_035_0	3	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	035	0	1	01	01	H0543_035_0	3	2	Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	035	0	1	01	01	H0543_035_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	035	0	1	01	01	H0543_035_0	3	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	035	0	1	01	01	H0543_035_0	3	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31				575.00	28		28																										28						28			28			28								Preferred Generic, 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				497.00	27		27																										27						27			27			27								Preferred Generic, 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	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	036	0	1	01	01	H0543_036_0	3	2	Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, 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	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	036	0	1	01	01	H0543_036_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	060	0	1	01	01	H0543_060_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	060	0	1	01	01	H0543_060_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	060	0	1	01	01	H0543_060_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	060	0	1	01	01	H0543_060_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	060	0	1	01	01	H0543_060_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				659.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	070	0	1	01	01	H0543_070_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	070	0	1	01	01	H0543_070_0	3	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	070	0	1	01	01	H0543_070_0	3	2	Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	070	0	1	01	01	H0543_070_0	3	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	070	0	1	01	01	H0543_070_0	3	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31				428.00	25		25																										25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	086	0	1	01	01	H0543_086_0	3	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	086	0	1	01	01	H0543_086_0	3	2	Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	086	0	1	01	01	H0543_086_0	3	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	086	0	1	01	01	H0543_086_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	086	0	1	01	01	H0543_086_0	3	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31				897.00	26		26																										26						26			26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	089	0	1	01	01	H0543_089_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	089	0	1	01	01	H0543_089_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	089	0	1	01	01	H0543_089_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	089	0	1	01	01	H0543_089_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	089	0	1	01	01	H0543_089_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				485.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	138	0	1	01	01	H0543_138_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	138	0	1	01	01	H0543_138_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	138	0	1	01	01	H0543_138_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	7.00		21.00																											21.00						0.00				7.00				7.00		0.23						0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	138	0	1	01	01	H0543_138_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	138	0	1	01	01	H0543_138_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				710.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	138	0	1	01	01	H0543_138_0	3	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0543	138	0	1	01	01	H0543_138_0	3	2	Generic	3	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	7.00		21.00																											21.00						0.00				7.00				7.00		0.23						0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0543	140	0	1	01	01	H0543_140_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	140	0	1	01	01	H0543_140_0	3	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	140	0	1	01	01	H0543_140_0	3	2	Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	140	0	1	01	01	H0543_140_0	3	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	140	0	1	01	01	H0543_140_0	3	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31				514.00	26		26																										26						26			26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	144	0	1	01	01	H0543_144_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	144	0	1	01	01	H0543_144_0	4	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	7.00		21.00																											21.00						0.00				7.00				7.00		0.23						0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	144	0	1	01	01	H0543_144_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	144	0	1	01	01	H0543_144_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	144	0	1	01	01	H0543_144_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				601.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	144	0	1	01	01	H0543_144_0	4	1	Preferred Generic	3	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0543	144	0	1	01	01	H0543_144_0	4	2	Generic	3	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	7.00		21.00																											21.00						0.00				7.00				7.00		0.23						0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0543	145	0	1	01	01	H0543_145_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	145	0	1	01	01	H0543_145_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	145	0	1	01	01	H0543_145_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	145	0	1	01	01	H0543_145_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	145	0	1	01	01	H0543_145_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				607.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	146	0	1	01	01	H0543_146_0	3	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	146	0	1	01	01	H0543_146_0	3	2	Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	146	0	1	01	01	H0543_146_0	3	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31				492.00	26		26																										26						26			26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	146	0	1	01	01	H0543_146_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	146	0	1	01	01	H0543_146_0	3	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	147	0	1	01	01	H0543_147_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	147	0	1	01	01	H0543_147_0	4	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	147	0	1	01	01	H0543_147_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	147	0	1	01	01	H0543_147_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	147	0	1	01	01	H0543_147_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				403.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	148	0	1	01	01	H0543_148_0	4	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	148	0	1	01	01	H0543_148_0	4	2	Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	13.00		39.00																											39.00						0.00				13.00				13.00		0.43						0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	148	0	1	01	01	H0543_148_0	4	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	148	0	1	01	01	H0543_148_0	4	4	Non-Preferred Brand	1	3	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	148	0	1	01	01	H0543_148_0	4	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31				596.00	25		25																										25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	151	0	1	01	01	H0543_151_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	151	0	1	01	01	H0543_151_0	3	2	Generic	3	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	7.00		21.00																											21.00						0.00				7.00				7.00		0.23						0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0543	151	0	1	01	01	H0543_151_0	3	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0543	151	0	1	01	01	H0543_151_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				680.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	151	0	1	01	01	H0543_151_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	151	0	1	01	01	H0543_151_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	7.00		21.00																											21.00						0.00				7.00				7.00		0.23						0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	151	0	1	01	01	H0543_151_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	152	0	1	01	01	H0543_152_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	152	0	1	01	01	H0543_152_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	5.00		15.00																											15.00						0.00				5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	152	0	1	01	01	H0543_152_0	4	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	9.00		27.00																											27.00						0.00				9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	152	0	1	01	01	H0543_152_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0543	152	0	1	01	01	H0543_152_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				616.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0544	002	0	1	01	01	H0544_002_0	10	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	002	0	1	01	01	H0544_002_0	10	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	7.50		22.50																					18.75																7.50				7.50		.24						.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	002	0	1	01	01	H0544_002_0	10	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	37.50		112.50																					93.75																37.50				37.50		1.20						1.20	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	002	0	1	01	01	H0544_002_0	10	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	85.00		255.00																					212.50																85.00				85.00		2.74						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	002	0	1	01	01	H0544_002_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	002	0	1	01	01	H0544_002_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	002	0	1	01	01	H0544_002_0	10	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	002	0	1	01	01	H0544_002_0	10	2	Generic	3	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	7.50		22.50																					18.75																7.50				7.50		.24						.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	002	0	1	01	01	H0544_002_0	10	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				584.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	003	0	1	01	01	H0544_003_0	6	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	003	0	1	01	01	H0544_003_0	6	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	003	0	1	01	01	H0544_003_0	6	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	003	0	1	01	01	H0544_003_0	6	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				2.40	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	003	0	1	01	01	H0544_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	003	0	1	01	01	H0544_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	003	0	1	01	01	H0544_003_0	6	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	003	0	1	01	01	H0544_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	003	0	1	01	01	H0544_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	004	0	1	01	01	H0544_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	004	0	1	01	01	H0544_004_0	7	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	7.50		22.50																					18.75																7.50				7.50		.24						.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	004	0	1	01	01	H0544_004_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	37.50		112.50																					93.75																37.50				37.50		1.20						1.20	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	004	0	1	01	01	H0544_004_0	7	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	85.00		255.00																					212.50																85.00				85.00		2.74						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	004	0	1	01	01	H0544_004_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	004	0	1	01	01	H0544_004_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	004	0	1	01	01	H0544_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	004	0	1	01	01	H0544_004_0	7	2	Generic	3	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	7.50		22.50																					18.75																7.50				7.50		.24						.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	004	0	1	01	01	H0544_004_0	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				584.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	005	0	1	01	01	H0544_005_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	005	0	1	01	01	H0544_005_0	7	2	Generic	3	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	7.50		22.50																					18.75																7.50				7.50		.24						.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	005	0	1	01	01	H0544_005_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	005	0	1	01	01	H0544_005_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	005	0	1	01	01	H0544_005_0	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				584.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	005	0	1	01	01	H0544_005_0	7	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	85.00		255.00																					212.50																85.00				85.00		2.74						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	005	0	1	01	01	H0544_005_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	005	0	1	01	01	H0544_005_0	7	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	7.50		22.50																					18.75																7.50				7.50		.24						.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	005	0	1	01	01	H0544_005_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	37.50		112.50																					93.75																37.50				37.50		1.20						1.20	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	007	0	1	01	01	H0544_007_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	5.00		15.00																					12.50																5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	007	0	1	01	01	H0544_007_0	7	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	12.50		37.50																					31.25																12.50				12.50		.40						.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	007	0	1	01	01	H0544_007_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	45.00		135.00																					112.50																45.00				45.00		1.45						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	007	0	1	01	01	H0544_007_0	7	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	95.00		285.00																					237.50																95.00				95.00		3.06						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	007	0	1	01	01	H0544_007_0	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				584.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	007	0	1	01	01	H0544_007_0	7	6	Select Care Drugs	1	4	010010	1	2	110		01	100		1	30		90				1			90				30		31	10.00		30.00																					25.00																10.00				10.00		0.32						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	008	0	1	01	01	H0544_008_0	8	2	Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			.40	.24				.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	008	0	1	01	01	H0544_008_0	8	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	008	0	1	01	01	H0544_008_0	8	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31								45.00		135.00					40.00		120.00							100.00																45.00				45.00			1.45	1.29				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	008	0	1	01	01	H0544_008_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H0544	008	0	1	01	01	H0544_008_0	8	2	Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			.40	.24				.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	008	0	1	01	01	H0544_008_0	8	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	008	0	1	01	01	H0544_008_0	8	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					85.00		255.00							212.50																95.00				95.00			3.06	2.74				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	008	0	1	01	01	H0544_008_0	8	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											584.00	33						584.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	008	0	1	01	01	H0544_008_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	010	0	1	01	01	H0544_010_0	9	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	010	0	1	01	01	H0544_010_0	9	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					85.00		255.00							212.50																95.00				95.00			3.06	2.74				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	010	0	1	01	01	H0544_010_0	9	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											584.00	33						584.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	010	0	1	01	01	H0544_010_0	9	2	Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			.40	.24				.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	010	0	1	01	01	H0544_010_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	010	0	1	01	01	H0544_010_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H0544	010	0	1	01	01	H0544_010_0	9	2	Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			.40	.24				.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	010	0	1	01	01	H0544_010_0	9	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	010	0	1	01	01	H0544_010_0	9	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31								45.00		135.00					40.00		120.00							100.00																45.00				45.00			1.45	1.29				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	012	0	1	01	01	H0544_012_0	7	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					85.00		255.00							212.50																95.00				95.00			3.06	2.74				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	012	0	1	01	01	H0544_012_0	7	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31								45.00		135.00					40.00		120.00							100.00																45.00				45.00			1.45	1.29				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	012	0	1	01	01	H0544_012_0	7	2	Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			.40	.24				.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	012	0	1	01	01	H0544_012_0	7	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	012	0	1	01	01	H0544_012_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H0544	012	0	1	01	01	H0544_012_0	7	2	Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			.40	.24				.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	012	0	1	01	01	H0544_012_0	7	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	012	0	1	01	01	H0544_012_0	7	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											584.00	33						584.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	012	0	1	01	01	H0544_012_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	013	0	1	01	01	H0544_013_0	7	2	Generic	3	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	7.50		22.50																					18.75																7.50				7.50		.24						.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	013	0	1	01	01	H0544_013_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	013	0	1	01	01	H0544_013_0	7	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	85.00		255.00																					212.50																85.00				85.00		2.74						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	013	0	1	01	01	H0544_013_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	37.50		112.50																					93.75																37.50				37.50		1.20						1.20	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	013	0	1	01	01	H0544_013_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	013	0	1	01	01	H0544_013_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	013	0	1	01	01	H0544_013_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	013	0	1	01	01	H0544_013_0	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				584.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	013	0	1	01	01	H0544_013_0	7	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	7.50		22.50																					18.75																7.50				7.50		.24						.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	014	0	1	01	01	H0544_014_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	014	0	1	01	01	H0544_014_0	7	2	Generic	3	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	7.50		22.50																					18.75																7.50				7.50		.24						.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	014	0	1	01	01	H0544_014_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	014	0	1	01	01	H0544_014_0	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				584.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	014	0	1	01	01	H0544_014_0	7	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	85.00		255.00																					212.50																85.00				85.00		2.74						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	014	0	1	01	01	H0544_014_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	37.50		112.50																					93.75																37.50				37.50		1.20						1.20	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	014	0	1	01	01	H0544_014_0	7	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	7.50		22.50																					18.75																7.50				7.50		.24						.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	014	0	1	01	01	H0544_014_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	014	0	1	01	01	H0544_014_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	015	0	1	01	01	H0544_015_0	8	2	Generic	3	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	7.50		22.50																					18.75																7.50				7.50		.24						.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	015	0	1	01	01	H0544_015_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	015	0	1	01	01	H0544_015_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	015	0	1	01	01	H0544_015_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	015	0	1	01	01	H0544_015_0	8	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	7.50		22.50																					18.75																7.50				7.50		.24						.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	015	0	1	01	01	H0544_015_0	8	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	37.50		112.50																					93.75																37.50				37.50		1.20						1.20	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	015	0	1	01	01	H0544_015_0	8	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	85.00		255.00																					212.50																85.00				85.00		2.74						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	015	0	1	01	01	H0544_015_0	8	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				584.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	015	0	1	01	01	H0544_015_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	019	0	1	01	01	H0544_019_0	6	2	Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			.40	.24				.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	019	0	1	01	01	H0544_019_0	6	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	019	0	1	01	01	H0544_019_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H0544	019	0	1	01	01	H0544_019_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	019	0	1	01	01	H0544_019_0	6	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	019	0	1	01	01	H0544_019_0	6	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					85.00		255.00							212.50																95.00				95.00			3.06	2.74				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	019	0	1	01	01	H0544_019_0	6	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31								45.00		135.00					40.00		120.00							100.00																45.00				45.00			1.45	1.29				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	019	0	1	01	01	H0544_019_0	6	2	Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			.40	.24				.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	019	0	1	01	01	H0544_019_0	6	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											584.00	33						584.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	020	0	1	01	01	H0544_020_0	6	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	020	0	1	01	01	H0544_020_0	6	2	Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			.40	.24				.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	020	0	1	01	01	H0544_020_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H0544	020	0	1	01	01	H0544_020_0	6	2	Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			.40	.24				.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	020	0	1	01	01	H0544_020_0	6	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	020	0	1	01	01	H0544_020_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	020	0	1	01	01	H0544_020_0	6	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											584.00	33						584.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	020	0	1	01	01	H0544_020_0	6	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31								45.00		135.00					40.00		120.00							100.00																45.00				45.00			1.45	1.29				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	020	0	1	01	01	H0544_020_0	6	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					85.00		255.00							212.50																95.00				95.00			3.06	2.74				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	021	0	1	01	01	H0544_021_0	7	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31								45.00		135.00					40.00		120.00							100.00																45.00				45.00			1.45	1.29				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	021	0	1	01	01	H0544_021_0	7	2	Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								15.50		46.50					10.50		31.50							26.25																15.50				15.50			.50	.33				.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	021	0	1	01	01	H0544_021_0	7	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								10.00		30.00					5.00		15.00							12.50																10.00				10.00			0.32	0.16				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	021	0	1	01	01	H0544_021_0	7	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											584.00	33						584.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	021	0	1	01	01	H0544_021_0	7	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					90.00		270.00							225.00																95.00				95.00			3.06	2.90				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	021	0	1	01	01	H0544_021_0	7	6	Select Care Drugs	1	4	010010	1	2		110	01	100		1				30		90	1			90				30		31								10.00		30.00					10.00		30.00							25.00																10.00				10.00			0.32	0.32				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	024	0	1	01	01	H0544_024_0	7	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	024	0	1	01	01	H0544_024_0	7	2	Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			.40	.24				.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	024	0	1	01	01	H0544_024_0	7	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31								45.00		135.00					40.00		120.00							100.00																45.00				45.00			1.45	1.29				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	024	0	1	01	01	H0544_024_0	7	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					85.00		255.00							212.50																95.00				95.00			3.06	2.74				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	024	0	1	01	01	H0544_024_0	7	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											584.00	33						584.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	024	0	1	01	01	H0544_024_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	024	0	1	01	01	H0544_024_0	7	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	024	0	1	01	01	H0544_024_0	7	2	Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			.40	.24				.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	024	0	1	01	01	H0544_024_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H0544	025	0	1	01	01	H0544_025_0	7	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	025	0	1	01	01	H0544_025_0	7	2	Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			.40	.24				.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	025	0	1	01	01	H0544_025_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H0544	025	0	1	01	01	H0544_025_0	7	2	Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			.40	.24				.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	025	0	1	01	01	H0544_025_0	7	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	025	0	1	01	01	H0544_025_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	025	0	1	01	01	H0544_025_0	7	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											584.00	33						584.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	025	0	1	01	01	H0544_025_0	7	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					85.00		255.00							212.50																95.00				95.00			3.06	2.74				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	025	0	1	01	01	H0544_025_0	7	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31								45.00		135.00					40.00		120.00							100.00																45.00				45.00			1.45	1.29				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	027	0	1	01	01	H0544_027_0	6	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	027	0	1	01	01	H0544_027_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	027	0	1	01	01	H0544_027_0	6	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	027	0	1	01	01	H0544_027_0	6	2	Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			.40	.24				.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	027	0	1	01	01	H0544_027_0	6	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											584.00	33						584.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	027	0	1	01	01	H0544_027_0	6	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					85.00		255.00							212.50																95.00				95.00			3.06	2.74				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	027	0	1	01	01	H0544_027_0	6	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31								45.00		135.00					40.00		120.00							100.00																45.00				45.00			1.45	1.29				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	027	0	1	01	01	H0544_027_0	6	2	Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			.40	.24				.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	027	0	1	01	01	H0544_027_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H0544	031	0	1	01	01	H0544_031_0	6	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	031	0	1	01	01	H0544_031_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H0544	031	0	1	01	01	H0544_031_0	6	2	Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			.40	.24				.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	031	0	1	01	01	H0544_031_0	6	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	031	0	1	01	01	H0544_031_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	031	0	1	01	01	H0544_031_0	6	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											584.00	33						584.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	031	0	1	01	01	H0544_031_0	6	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					85.00		255.00							212.50																95.00				95.00			3.06	2.74				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	031	0	1	01	01	H0544_031_0	6	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31								45.00		135.00					40.00		120.00							100.00																45.00				45.00			1.45	1.29				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	031	0	1	01	01	H0544_031_0	6	2	Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			.40	.24				.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	032	0	1	01	01	H0544_032_0	6	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					85.00		255.00							212.50																95.00				95.00			3.06	2.74				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	032	0	1	01	01	H0544_032_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	032	0	1	01	01	H0544_032_0	6	2	Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			.40	.24				.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	032	0	1	01	01	H0544_032_0	6	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	032	0	1	01	01	H0544_032_0	6	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31								45.00		135.00					40.00		120.00							100.00																45.00				45.00			1.45	1.29				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	032	0	1	01	01	H0544_032_0	6	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	032	0	1	01	01	H0544_032_0	6	2	Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			.40	.24				.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	032	0	1	01	01	H0544_032_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H0544	032	0	1	01	01	H0544_032_0	6	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											584.00	33						584.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	036	0	1	01	01	H0544_036_0	6	2	Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			.40	.24				.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	036	0	1	01	01	H0544_036_0	6	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	036	0	1	01	01	H0544_036_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H0544	036	0	1	01	01	H0544_036_0	6	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	036	0	1	01	01	H0544_036_0	6	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					85.00		255.00							212.50																95.00				95.00			3.06	2.74				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	036	0	1	01	01	H0544_036_0	6	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31								45.00		135.00					40.00		120.00							100.00																45.00				45.00			1.45	1.29				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	036	0	1	01	01	H0544_036_0	6	2	Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			.40	.24				.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	036	0	1	01	01	H0544_036_0	6	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											584.00	33						584.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	036	0	1	01	01	H0544_036_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	037	0	1	01	01	H0544_037_0	6	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	037	0	1	01	01	H0544_037_0	6	2	Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			.40	.24				.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	037	0	1	01	01	H0544_037_0	6	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	037	0	1	01	01	H0544_037_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	037	0	1	01	01	H0544_037_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H0544	037	0	1	01	01	H0544_037_0	6	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					85.00		255.00							212.50																95.00				95.00			3.06	2.74				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	037	0	1	01	01	H0544_037_0	6	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31								45.00		135.00					40.00		120.00							100.00																45.00				45.00			1.45	1.29				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	037	0	1	01	01	H0544_037_0	6	2	Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			.40	.24				.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	037	0	1	01	01	H0544_037_0	6	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											584.00	33						584.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	038	0	1	01	01	H0544_038_0	5	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	038	0	1	01	01	H0544_038_0	5	2	Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			.40	.24				.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	038	0	1	01	01	H0544_038_0	5	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31								45.00		135.00					40.00		120.00							100.00																45.00				45.00			1.45	1.29				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	038	0	1	01	01	H0544_038_0	5	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					85.00		255.00							212.50																95.00				95.00			3.06	2.74				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	038	0	1	01	01	H0544_038_0	5	2	Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			.40	.24				.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	038	0	1	01	01	H0544_038_0	5	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	038	0	1	01	01	H0544_038_0	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H0544	038	0	1	01	01	H0544_038_0	5	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											584.00	33						584.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	038	0	1	01	01	H0544_038_0	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	041	0	1	01	01	H0544_041_0	5	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	041	0	1	01	01	H0544_041_0	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	041	0	1	01	01	H0544_041_0	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	041	0	1	01	01	H0544_041_0	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				2.40	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	041	0	1	01	01	H0544_041_0	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	041	0	1	01	01	H0544_041_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	041	0	1	01	01	H0544_041_0	5	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	041	0	1	01	01	H0544_041_0	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	041	0	1	01	01	H0544_041_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	050	0	1	01	01	H0544_050_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	050	0	1	01	01	H0544_050_0	6	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	7.50		22.50																					18.75																7.50				7.50		.24						.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	050	0	1	01	01	H0544_050_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	40.00		120.00																					100.00																40.00				40.00		1.29						1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	050	0	1	01	01	H0544_050_0	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	85.00		255.00																					212.50																85.00				85.00		2.74						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	050	0	1	01	01	H0544_050_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H0544	050	0	1	01	01	H0544_050_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0544	050	0	1	01	01	H0544_050_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	050	0	1	01	01	H0544_050_0	6	2	Generic	3	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	7.50		22.50																					18.75																7.50				7.50		.24						.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0544	050	0	1	01	01	H0544_050_0	6	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				584.00	33																				33																	33			33								Preferred Generic, 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	5.00		15.00																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0545	001	0	1	01	01	H0545_001_0	7	2	Generic	1	4	000100	3	2	110		01	100		1	30		90				2			90				30		31	17.50		52.50																					35.00																17.50				17.50		.58						0.56	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0545	001	0	1	01	01	H0545_001_0	7	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31				510.38	33																																					33			33								Preferred Generic, 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	95.00		285.00																					237.50																95.00				95.00		3.17						3.06	Preferred Generic, 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	47.00		141.00																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0545	012	0	1	01	01	H0545_012_0	8	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31				261.70	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0545	012	0	1	01	01	H0545_012_0	8	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	31		90				1			90				31		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0545	012	0	1	01	01	H0545_012_0	8	2	Generic	3	4	000100	3	2	110		01	100		1	31		90				1			90				31		31	12.00		36.00																					36.00																12.00				12.00		.39						.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H0545	012	0	1	01	01	H0545_012_0	8	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	31		90				1			90				31		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0545	012	0	1	01	01	H0545_012_0	8	2	Generic	1	4	000100	3	2	110		01	100		1	31		90				1			90				31		31	12.00		36.00																					36.00																12.00				12.00		.39						.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0545	012	0	1	01	01	H0545_012_0	8	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	31		90				1			90				31		31	47.00		141.00																					141.00																47.00				47.00		1.52						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0545	012	0	1	01	01	H0545_012_0	8	4	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	31		90				2			90				31		31	95.00		285.00																					285.00																95.00				95.00		3.06						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0545	013	0	1	01	01	H0545_013_0	9	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	5.00		15.00																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0545	013	0	1	01	01	H0545_013_0	9	2	Generic	1	4	000100	3	2	110		01	100		1	30		90				2			90				30		31	15.00		45.00																					30.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0545	013	0	1	01	01	H0545_013_0	9	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	5.00		15.00																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0545	013	0	1	01	01	H0545_013_0	9	4	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				2			90				30		31	89.00		267.00																					178.00																89.00				89.00		2.97						2.87	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0545	013	0	1	01	01	H0545_013_0	9	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31				527.74	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0545	013	0	1	01	01	H0545_013_0	9	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	39.00		117.00																					78.00																39.00				39.00		1.30						1.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, 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		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, 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		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, 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		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
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		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	009	0	1	01	01	H0562_009_0	3	2	Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	30.00											15.00	30.00	45.00				10.00	20.00	20.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, 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		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, 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		31												30	30	30					30	30	30										30	30	30				30	30	30			30			30								Preferred Generic, 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		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	012	0	1	01	01	H0562_012_0	3	2	Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								20.00	40.00	60.00					12.00	24.00	36.00											20.00	40.00	60.00				12.00	24.00	24.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, 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		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, 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		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	10.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	039	0	1	01	01	H0562_039_0	4	2	Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								19.00	38.00	57.00					12.00	24.00	36.00											19.00	38.00	57.00				12.00	24.00	24.00				19.00				19.00			0.63	0.40		0.63	0.40	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	039	0	1	01	01	H0562_039_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	36.00				7.00	14.00	14.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	039	0	1	01	01	H0562_039_0	4	5	Specialty Tier	1	4	010010	1	1		111	01		111	1				30	60	90	1				30	60	90	30		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	039	0	1	01	01	H0562_039_0	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	039	0	1	01	01	H0562_039_0	4	6	Select Care Drugs	1	4	010010	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	039	0	1	01	01	H0562_039_0	4	3	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	055	0	1	01	01	H0562_055_0	3	6	Select Care Drugs	1	3	010010	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		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	055	0	1	01	01	H0562_055_0	3	5	Specialty Tier	1	3	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		31					27	27	27																								27	27	27				27	27	27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	055	0	1	01	01	H0562_055_0	3	4	Non-Preferred Brand	1	3	100100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		31	100.00	200.00	300.00																									100.00	200.00	300.00				100.00	200.00	290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	055	0	1	01	01	H0562_055_0	3	3	Preferred Brand	1	3	000101	1	2	111		01		111	1	30	60	90				1				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	94.00	131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	055	0	1	01	01	H0562_055_0	3	2	Generic	1	3	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	40.00	40.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	055	0	1	01	01	H0562_055_0	3	1	Preferred Generic	1	3	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, 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		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	10.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	068	0	1	01	01	H0562_068_0	3	2	Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	30.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, 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		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, 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		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, 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		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, 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		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, 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		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, 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		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, 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		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	079	0	1	01	01	H0562_079_0	3	2	Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	30.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, 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		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, 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		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	084	0	1	01	01	H0562_084_0	4	6	Select Care Drugs	1	4	010010	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	084	0	1	01	01	H0562_084_0	4	5	Specialty Tier	1	4	010010	1	1		111	01		111	1				30	60	90	1				30	60	90	30		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	084	0	1	01	01	H0562_084_0	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	084	0	1	01	01	H0562_084_0	4	3	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	084	0	1	01	01	H0562_084_0	4	2	Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								18.00	36.00	54.00					13.00	26.00	39.00											18.00	36.00	54.00				13.00	26.00	26.00				18.00				18.00			0.60	0.43		0.60	0.43	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	084	0	1	01	01	H0562_084_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	6.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, 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		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	090	0	1	01	01	H0562_090_0	3	2	Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, 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	000101	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, 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	100100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, 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		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, 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		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	092	0	1	01	01	H0562_092_0	3	2	Generic	3	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	30.00											15.00	30.00	45.00				10.00	20.00	20.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, 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		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, 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		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, 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		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, 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	100100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, 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	000101	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	092	0	1	01	01	H0562_092_0	3	2	Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	30.00											15.00	30.00	45.00				10.00	20.00	20.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, 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		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, 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		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
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		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	10.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	095	0	1	01	01	H0562_095_0	3	2	Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	30.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, 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		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, 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		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, 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		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, 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		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	096	0	1	01	01	H0562_096_0	3	2	Generic	1	3	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	30.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, 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		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, 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		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, 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		31												26	26	26					26	26	26										26	26	26				26	26	26			26			26								Preferred Generic, 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		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, 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		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	10.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	097	0	1	01	01	H0562_097_0	3	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	6.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	097	0	1	01	01	H0562_097_0	3	2	Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	30.00											15.00	30.00	45.00				10.00	20.00	20.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	097	0	1	01	01	H0562_097_0	3	3	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	097	0	1	01	01	H0562_097_0	3	4	Non-Preferred Brand	1	4	100100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	097	0	1	01	01	H0562_097_0	3	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	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	097	0	1	01	01	H0562_097_0	3	6	Select Care Drugs	1	4	010010	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	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	100	1	1	01	01	H0562_100_1	4	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	10.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	100	1	1	01	01	H0562_100_1	4	2	Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	100	1	1	01	01	H0562_100_1	4	3	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	100	1	1	01	01	H0562_100_1	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	100	1	1	01	01	H0562_100_1	4	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	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	100	1	1	01	01	H0562_100_1	4	1	Preferred Generic	3	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	10.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0562	100	1	1	01	01	H0562_100_1	4	6	Select Care Drugs	3	4	010010	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	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0562	100	1	1	01	01	H0562_100_1	4	6	Select Care Drugs	1	4	010010	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	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	100	1	1	01	01	H0562_100_1	4	2	Generic	3	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0562	100	2	1	01	01	H0562_100_2	3	6	Select Care Drugs	1	4	010010	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, 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		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	10.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0562	100	2	1	01	01	H0562_100_2	3	2	Generic	3	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, 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		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, 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		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, 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		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, 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		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	100	2	1	01	01	H0562_100_2	3	2	Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, 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		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	10.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, 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	100100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, 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		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	101	1	1	01	01	H0562_101_1	3	2	Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, 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	000101	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, 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		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	101	1	1	01	01	H0562_101_1	3	2	Generic	3	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, 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		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, 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		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, 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		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, 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		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, 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		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, 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		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0562	101	2	1	01	01	H0562_101_2	3	2	Generic	3	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0562	101	2	1	01	01	H0562_101_2	3	6	Select Care Drugs	3	4	010010	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	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0562	101	2	1	01	01	H0562_101_2	3	2	Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	101	2	1	01	01	H0562_101_2	3	4	Non-Preferred Brand	1	4	100100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, 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	000101	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
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		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, 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		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, 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		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, 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		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, 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		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	102	0	1	01	01	H0562_102_0	3	2	Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	30.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, 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		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	10.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, 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		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, 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		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, 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		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, 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		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	103	0	1	01	01	H0562_103_0	3	2	Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	30.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, 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		31								13.00	26.00	39.00					8.00	16.00	24.00											13.00	26.00	39.00				8.00	16.00	16.00				13.00				13.00			0.43	0.27		0.43	0.27	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	110	1	1	01	01	H0562_110_1	3	6	Select Care Drugs	1	3	010010	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		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	110	1	1	01	01	H0562_110_1	3	5	Specialty Tier	1	3	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		31					26	26	26																								26	26	26				26	26	26			26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	110	1	1	01	01	H0562_110_1	3	4	Non-Preferred Brand	1	3	100100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		31	100.00	200.00	300.00																									100.00	200.00	300.00				100.00	200.00	290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	110	1	1	01	01	H0562_110_1	3	3	Preferred Brand	1	3	000101	1	2	111		01		111	1	30	60	90				1				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	94.00	131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	110	1	1	01	01	H0562_110_1	3	2	Generic	1	3	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	40.00	40.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	110	1	1	01	01	H0562_110_1	3	1	Preferred Generic	1	3	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	110	2	1	01	01	H0562_110_2	3	6	Select Care Drugs	1	3	010010	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		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	110	2	1	01	01	H0562_110_2	3	5	Specialty Tier	1	3	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		31					26	26	26																								26	26	26				26	26	26			26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	110	2	1	01	01	H0562_110_2	3	1	Preferred Generic	1	3	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	110	2	1	01	01	H0562_110_2	3	2	Generic	1	3	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	40.00	40.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	110	2	1	01	01	H0562_110_2	3	3	Preferred Brand	1	3	000101	1	2	111		01		111	1	30	60	90				1				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	94.00	131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	110	2	1	01	01	H0562_110_2	3	4	Non-Preferred Brand	1	3	100100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		31	100.00	200.00	300.00																									100.00	200.00	300.00				100.00	200.00	290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	111	1	1	01	01	H0562_111_1	4	5	Specialty Tier	1	3	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		31					26	26	26																								26	26	26				26	26	26			26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	111	1	1	01	01	H0562_111_1	4	6	Select Care Drugs	1	3	010010	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		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	111	1	1	01	01	H0562_111_1	4	1	Preferred Generic	1	3	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	111	1	1	01	01	H0562_111_1	4	2	Generic	1	3	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	40.00	40.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	111	1	1	01	01	H0562_111_1	4	3	Preferred Brand	1	3	000101	1	2	111		01		111	1	30	60	90				1				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	94.00	131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	111	1	1	01	01	H0562_111_1	4	4	Non-Preferred Brand	1	3	100100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		31	100.00	200.00	300.00																									100.00	200.00	300.00				100.00	200.00	290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	111	2	1	01	01	H0562_111_2	4	1	Preferred Generic	1	3	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	111	2	1	01	01	H0562_111_2	4	2	Generic	1	3	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	40.00	40.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	111	2	1	01	01	H0562_111_2	4	6	Select Care Drugs	1	3	010010	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		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	111	2	1	01	01	H0562_111_2	4	4	Non-Preferred Brand	1	3	100100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		31	100.00	200.00	300.00																									100.00	200.00	300.00				100.00	200.00	290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	111	2	1	01	01	H0562_111_2	4	5	Specialty Tier	1	3	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		31					26	26	26																								26	26	26				26	26	26			26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	111	2	1	01	01	H0562_111_2	4	3	Preferred Brand	1	3	000101	1	2	111		01		111	1	30	60	90				1				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	94.00	131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	055	0	1	01	01	H0564_055_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	055	0	1	01	01	H0564_055_0	9	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0564	055	0	1	01	01	H0564_055_0	9	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	055	0	1	01	01	H0564_055_0	9	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								3.00	6.00	9.00					3.00	6.00	9.00					3.00	9.00	9.00																3.00				3.00			0.10	0.10	0.10			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	055	0	1	01	01	H0564_055_0	9	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	055	0	1	01	01	H0564_055_0	9	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								97.00	194.00	291.00					92.00	184.00	276.00					92.00	276.00	276.00																97.00				97.00			3.23	3.07	3.07			2.85	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	055	0	1	01	01	H0564_055_0	9	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34											833.03	25						833.03	25						25																	25			25								Preferred Generic, 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	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								36.00	72.00	108.00					36.00	72.00	108.00					36.00	108.00	108.00																36.00				36.00			1.20	1.20	1.20			1.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	056	0	1	01	01	H0564_056_0	8	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								1.00	2.00	3.00					1.00	2.00	3.00					1.00	3.00	3.00																1.00				1.00			0.03	0.03	0.03			0.03	Preferred Generic, 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	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, 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	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, 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	4	010010	1	1		010	01	010		1				30				30						30		34											809.51	25						809.51	25						25																	25			25								Preferred Generic, 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	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, 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	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0564	058	0	1	01	01	H0564_058_0	8	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	058	0	1	01	01	H0564_058_0	8	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								6.00	12.00	18.00					6.00	12.00	18.00					6.00	18.00	18.00																6.00				6.00			0.20	0.20	0.20			0.18	Preferred Generic, 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	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, 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	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, 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	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0564	058	0	1	01	01	H0564_058_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, 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	4	010010	1	1		010	01	010		1				30				30						30		34											832.57	25						832.57	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	059	0	1	01	01	H0564_059_0	9	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	059	0	1	01	01	H0564_059_0	9	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								7.00	14.00	21.00					7.00	14.00	21.00					7.00	21.00	21.00																7.00				7.00			0.23	0.23	0.23			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	059	0	1	01	01	H0564_059_0	9	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	059	0	1	01	01	H0564_059_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	059	0	1	01	01	H0564_059_0	9	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34											855.00	25						855.00	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	059	0	1	01	01	H0564_059_0	9	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								99.00	198.00	297.00					94.00	188.00	282.00					94.00	282.00	282.00																99.00				99.00			3.30	3.13	3.13			2.91	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	059	0	1	01	01	H0564_059_0	9	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0564	060	0	1	01	01	H0564_060_0	10	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	15.00	15.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	060	0	1	01	01	H0564_060_0	10	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	060	0	1	01	01	H0564_060_0	10	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	060	0	1	01	01	H0564_060_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	060	0	1	01	01	H0564_060_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0564	060	0	1	01	01	H0564_060_0	10	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34											1331.55	33						1331.55	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	060	0	1	01	01	H0564_060_0	10	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	061	0	1	01	01	H0564_061_0	11	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0564	061	0	1	01	01	H0564_061_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	061	0	1	01	01	H0564_061_0	11	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34											1566.49	33						1566.49	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	061	0	1	01	01	H0564_061_0	11	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	061	0	1	01	01	H0564_061_0	11	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	15.00	15.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	061	0	1	01	01	H0564_061_0	11	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	061	0	1	01	01	H0564_061_0	11	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	062	0	1	01	01	H0564_062_0	11	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	062	0	1	01	01	H0564_062_0	11	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34											1359.47	33						1359.47	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	062	0	1	01	01	H0564_062_0	11	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	062	0	1	01	01	H0564_062_0	11	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00	36.00	36.00																17.00				17.00			0.57	0.40	0.40			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	062	0	1	01	01	H0564_062_0	11	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	062	0	1	01	01	H0564_062_0	11	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0564	062	0	1	01	01	H0564_062_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	063	0	1	01	01	H0564_063_0	11	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	063	0	1	01	01	H0564_063_0	11	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34											1431.20	33						1431.20	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	063	0	1	01	01	H0564_063_0	11	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0564	063	0	1	01	01	H0564_063_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	063	0	1	01	01	H0564_063_0	11	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	063	0	1	01	01	H0564_063_0	11	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	063	0	1	01	01	H0564_063_0	11	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00	36.00	36.00																17.00				17.00			0.57	0.40	0.40			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	067	1	1	01	01	H0564_067_1	10	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	067	1	1	01	01	H0564_067_1	10	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	15.00	15.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	067	1	1	01	01	H0564_067_1	10	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	067	1	1	01	01	H0564_067_1	10	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	067	1	1	01	01	H0564_067_1	10	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34											1942.80	33						1942.80	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	067	1	1	01	01	H0564_067_1	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0564	067	1	1	01	01	H0564_067_1	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	067	2	1	01	01	H0564_067_2	10	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	067	2	1	01	01	H0564_067_2	10	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	067	2	1	01	01	H0564_067_2	10	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	15.00	15.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	067	2	1	01	01	H0564_067_2	10	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	067	2	1	01	01	H0564_067_2	10	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34											1942.80	33						1942.80	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	067	2	1	01	01	H0564_067_2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	067	2	1	01	01	H0564_067_2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0564	068	0	1	01	01	H0564_068_0	11	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	068	0	1	01	01	H0564_068_0	11	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	068	0	1	01	01	H0564_068_0	11	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	068	0	1	01	01	H0564_068_0	11	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	15.00	15.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	068	0	1	01	01	H0564_068_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	068	0	1	01	01	H0564_068_0	11	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34											1354.62	33						1354.62	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	068	0	1	01	01	H0564_068_0	11	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0564	069	0	1	01	01	H0564_069_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	069	0	1	01	01	H0564_069_0	10	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	069	0	1	01	01	H0564_069_0	10	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00	36.00	36.00																17.00				17.00			0.57	0.40	0.40			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	069	0	1	01	01	H0564_069_0	10	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34											2283.78	33						2283.78	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	069	0	1	01	01	H0564_069_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0564	069	0	1	01	01	H0564_069_0	10	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								46.00	92.00	138.00					41.00	82.00	123.00					41.00	123.00	123.00																46.00				46.00			1.53	1.37	1.37			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	069	0	1	01	01	H0564_069_0	10	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	070	0	1	01	01	H0564_070_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	070	0	1	01	01	H0564_070_0	10	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34											1437.42	33						1437.42	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	070	0	1	01	01	H0564_070_0	10	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	070	0	1	01	01	H0564_070_0	10	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	070	0	1	01	01	H0564_070_0	10	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00	36.00	36.00																17.00				17.00			0.57	0.40	0.40			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	070	0	1	01	01	H0564_070_0	10	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	070	0	1	01	01	H0564_070_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0564	071	0	1	01	01	H0564_071_0	10	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	071	0	1	01	01	H0564_071_0	10	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	071	0	1	01	01	H0564_071_0	10	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	071	0	1	01	01	H0564_071_0	10	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34											2876.48	33						2876.48	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	071	0	1	01	01	H0564_071_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	071	0	1	01	01	H0564_071_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0564	071	0	1	01	01	H0564_071_0	10	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	15.00	15.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	072	0	1	01	01	H0564_072_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	072	0	1	01	01	H0564_072_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0564	072	0	1	01	01	H0564_072_0	10	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34											2046.71	33						2046.71	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	072	0	1	01	01	H0564_072_0	10	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	072	0	1	01	01	H0564_072_0	10	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	072	0	1	01	01	H0564_072_0	10	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	072	0	1	01	01	H0564_072_0	10	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	15.00	15.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	074	0	1	01	01	H0564_074_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0564	074	0	1	01	01	H0564_074_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	074	0	1	01	01	H0564_074_0	10	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34											2771.74	33						2771.74	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	074	0	1	01	01	H0564_074_0	10	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	074	0	1	01	01	H0564_074_0	10	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	074	0	1	01	01	H0564_074_0	10	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	074	0	1	01	01	H0564_074_0	10	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	15.00	15.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	076	0	1	01	01	H0564_076_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	076	0	1	01	01	H0564_076_0	11	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0564	076	0	1	01	01	H0564_076_0	11	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34											1757.31	33						1757.31	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	076	0	1	01	01	H0564_076_0	11	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	076	0	1	01	01	H0564_076_0	11	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	076	0	1	01	01	H0564_076_0	11	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	076	0	1	01	01	H0564_076_0	11	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00	9.00	9.00																8.00				8.00			0.27	0.10	0.10			0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	077	0	1	01	01	H0564_077_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0564	077	0	1	01	01	H0564_077_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	077	0	1	01	01	H0564_077_0	10	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34											1982.44	33						1982.44	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	077	0	1	01	01	H0564_077_0	10	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	077	0	1	01	01	H0564_077_0	10	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	077	0	1	01	01	H0564_077_0	10	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	077	0	1	01	01	H0564_077_0	10	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00	9.00	9.00																8.00				8.00			0.27	0.10	0.10			0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	078	0	1	01	01	H0564_078_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	078	0	1	01	01	H0564_078_0	9	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0564	078	0	1	01	01	H0564_078_0	9	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34											861.55	25						861.55	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	078	0	1	01	01	H0564_078_0	9	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	078	0	1	01	01	H0564_078_0	9	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	078	0	1	01	01	H0564_078_0	9	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								4.00	8.00	12.00					4.00	8.00	12.00					4.00	12.00	12.00																4.00				4.00			0.13	0.13	0.13			0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	078	0	1	01	01	H0564_078_0	9	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	079	0	1	01	01	H0564_079_0	9	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	079	0	1	01	01	H0564_079_0	9	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								1.00	2.00	3.00					1.00	2.00	3.00					1.00	3.00	3.00																1.00				1.00			0.03	0.03	0.03			0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	079	0	1	01	01	H0564_079_0	9	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	079	0	1	01	01	H0564_079_0	9	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								77.00	154.00	231.00					72.00	144.00	216.00					72.00	216.00	216.00																77.00				77.00			2.57	2.40	2.40			2.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	079	0	1	01	01	H0564_079_0	9	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34											790.82	25						790.82	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	079	0	1	01	01	H0564_079_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	079	0	1	01	01	H0564_079_0	9	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0564	080	0	1	01	01	H0564_080_0	9	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	080	0	1	01	01	H0564_080_0	9	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								7.00	14.00	21.00					7.00	14.00	21.00					7.00	21.00	21.00																7.00				7.00			0.23	0.23	0.23			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	080	0	1	01	01	H0564_080_0	9	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	080	0	1	01	01	H0564_080_0	9	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0564	080	0	1	01	01	H0564_080_0	9	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34											805.43	25						805.43	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	080	0	1	01	01	H0564_080_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	080	0	1	01	01	H0564_080_0	9	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								97.00	194.00	291.00					92.00	184.00	276.00					92.00	276.00	276.00																97.00				97.00			3.23	3.07	3.07			2.85	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0571	001	0	1	01	01	H0571_001_0	4	1	Preferred Generic	1	4	001000	1	2		111	10	100		1				31	60	90	1			90					14	31								3.00	6.00	9.00					3.00	6.00	6.00							6.00																	3.00			3.00			.09	.09				.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0571	001	0	1	01	01	H0571_001_0	4	2	Generic	1	4	000100	1	2		111	10	100		1				31	60	90	1			90					14	31								7.00	14.00	21.00					7.00	14.00	14.00							14.00																	7.00			7.00			.22	.22				.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0571	001	0	1	01	01	H0571_001_0	4	5	Specialty Tier	1	4	100001	1	1		111	10	100		1				31	60	90	2			90					14	31											1.00	20	20	20				1.00	20	20	20						20																20		20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0571	001	0	1	01	01	H0571_001_0	4	4	Non-Preferred Brand	1	4	100000	1	2		111	10	100		1				31	60	90	1			90					14	31								60.00	120.00	180.00					60.00	120.00	120.00							120.00																	60.00			60.00			1.93	1.93				1.93	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0571	001	0	1	01	01	H0571_001_0	4	3	Preferred Brand	1	4	000001	1	2		111	10	100		1				31	60	90	1			90					14	31								40.00	80.00	120.00					40.00	80.00	80.00							80.00																	40.00			40.00			1.29	1.29				1.29	Preferred Generic, 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	3.00		7.50																					7.50																3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	017	0	1	18	06	H0602_017_0	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	75.00		187.50																					187.50																75.00				75.00		2.50						2.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	017	0	1	18	06	H0602_017_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	45.00		112.50																					112.50																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	017	0	1	18	06	H0602_017_0	6	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	20.00		50.00																					50.00																20.00				20.00		0.66						0.64	Preferred Generic, 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				1344.32	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	019	0	1	18	06	H0602_019_0	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				1277.56	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	019	0	1	18	06	H0602_019_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	3.00		7.50																					7.50																3.00				3.00		0.10						.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	019	0	1	18	06	H0602_019_0	7	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	20.00		50.00																					50.00																20.00				20.00		0.66						0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	019	0	1	18	06	H0602_019_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	40.00		100.00																					100.00																40.00				40.00		1.33						1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	019	0	1	18	06	H0602_019_0	7	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	60.00		150.00																					150.00																60.00				60.00		2.00						1.93	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	019	0	1	18	06	H0602_019_0	7	2	Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	20.00		50.00																					50.00																20.00				20.00		0.66						.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0602	019	0	1	18	06	H0602_019_0	7	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	3.00		7.50																					7.50																3.00				3.00		0.10						.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0602	020	0	1	18	06	H0602_020_0	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	75.00		187.50																					187.50																75.00				75.00		2.50						2.41	Preferred Generic, 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				1487.28	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	3.00		7.50																					7.50																3.00				3.00		0.10						.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	020	0	1	18	06	H0602_020_0	6	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	20.00		50.00																					50.00																20.00				20.00		0.66						.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	020	0	1	18	06	H0602_020_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	45.00		112.50																					112.50																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	022	0	1	18	06	H0602_022_0	6	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				1161.07	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	022	0	1	18	06	H0602_022_0	6	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	20.00		50.00																					50.00																20.00				20.00		0.66						.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	022	0	1	18	06	H0602_022_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	45.00		112.50																					112.50																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	022	0	1	18	06	H0602_022_0	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	75.00		187.50																					187.50																75.00				75.00		2.50						2.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	022	0	1	18	06	H0602_022_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	3.00		7.50																					7.50																3.00				3.00		0.10						.09	Preferred Generic, 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				728.89	28																				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	039	0	1	18	06	H0602_039_0	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	75.00		187.50																					187.50																75.00				75.00		2.50						2.41	Preferred Generic, 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	3.00		7.50																					7.50																3.00				3.00		0.10						.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	039	0	1	18	06	H0602_039_0	6	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	20.00		50.00																					50.00																20.00				20.00		0.66						.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	039	0	1	18	06	H0602_039_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	45.00		112.50																					112.50																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	043	0	1	18	06	H0602_043_0	7	3	Preferred Brand	1	3	000001	1	2	110		01	100		1	30		90				2			90				30		31	47.00		117.50																					117.50																47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	043	0	1	18	06	H0602_043_0	7	5	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		31				639.20	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	043	0	1	18	06	H0602_043_0	7	2	Generic	1	3	000100	1	2	110		01	100		1	30		90				2			90				30		31	20.00		50.00																					50.00																20.00				20.00		0.66						.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	043	0	1	18	06	H0602_043_0	7	4	Non-Preferred Brand	1	3	100000	1	1	110		01	100		1	30		90				2			90				30		31				96.37	27		27																				27															27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	043	0	1	18	06	H0602_043_0	7	1	Preferred Generic	1	3	001000	1	2	110		01	100		1	30		90				2			90				30		31	10.00		25.00																					25.00																10.00				10.00		0.33						.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0609	002	0	1	01	01	H0609_002_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0609	002	0	1	01	01	H0609_002_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0609	002	0	1	01	01	H0609_002_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0609	002	0	1	01	01	H0609_002_0	4	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0609	002	0	1	01	01	H0609_002_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				506.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0609	007	0	1	01	01	H0609_007_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0609	007	0	1	01	01	H0609_007_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0609	007	0	1	01	01	H0609_007_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0609	007	0	1	01	01	H0609_007_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				519.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0609	007	0	1	01	01	H0609_007_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0609	012	0	1	01	01	H0609_012_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0609	012	0	1	01	01	H0609_012_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0609	012	0	1	01	01	H0609_012_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0609	012	0	1	01	01	H0609_012_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0609	012	0	1	01	01	H0609_012_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				436.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0609	020	0	1	01	01	H0609_020_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0609	020	0	1	01	01	H0609_020_0	4	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0609	020	0	1	01	01	H0609_020_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0609	020	0	1	01	01	H0609_020_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0609	020	0	1	01	01	H0609_020_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				450.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0609	025	0	1	01	01	H0609_025_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0609	025	0	1	01	01	H0609_025_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	9.00		27.00																											27.00						0.00				9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0609	025	0	1	01	01	H0609_025_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0609	025	0	1	01	01	H0609_025_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0609	025	0	1	01	01	H0609_025_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				444.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0609	026	0	1	01	01	H0609_026_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0609	026	0	1	01	01	H0609_026_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0609	026	0	1	01	01	H0609_026_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0609	026	0	1	01	01	H0609_026_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0609	026	0	1	01	01	H0609_026_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				519.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0609	027	0	1	01	01	H0609_027_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0609	027	0	1	01	01	H0609_027_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				595.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0609	027	0	1	01	01	H0609_027_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0609	027	0	1	01	01	H0609_027_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0609	027	0	1	01	01	H0609_027_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0609	028	0	1	01	01	H0609_028_0	3	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0609	028	0	1	01	01	H0609_028_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				704.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0609	028	0	1	01	01	H0609_028_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0609	028	0	1	01	01	H0609_028_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0609	028	0	1	01	01	H0609_028_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0609	028	0	1	01	01	H0609_028_0	3	2	Generic	3	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0609	028	0	1	01	01	H0609_028_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0630	013	0	1	01	01	H0630_013_0	11	2	Generic	3	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		.33			.33			.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	013	0	1	01	01	H0630_013_0	11	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	7.00		21.00																			7.00		14.00																7.00				7.00		.23			.23			.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	013	0	1	01	01	H0630_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	013	0	1	01	01	H0630_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	013	0	1	01	01	H0630_013_0	11	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		90				2	30		90				30		31				1910.00	33		33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	013	0	1	01	01	H0630_013_0	11	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				2	30		90				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	013	0	1	01	01	H0630_013_0	11	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				2	30		90				30		31	47.00		141.00																			47.00		94.00																47.00				47.00		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	013	0	1	01	01	H0630_013_0	11	2	Generic	1	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		.33			.33			.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	013	0	1	01	01	H0630_013_0	11	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	7.00		21.00																			7.00		14.00																7.00				7.00		0.23			0.23			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	015	0	1	01	01	H0630_015_0	11	2	Generic	3	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		.33			.33			.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
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	6.00		18.00																			6.00		12.00																6.00				6.00		.20			.20			.19	Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	015	0	1	01	01	H0630_015_0	11	2	Generic	1	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, 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	47.00		141.00																			47.00		94.00																47.00				47.00		1.56			1.56			1.51	Preferred Generic, 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	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, 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				1627.00	33		33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
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	6.00		18.00																			6.00		12.00																6.00				6.00		.20			.20			.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	016	0	1	01	01	H0630_016_0	12	2	Generic	3	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		.33			.33			.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	016	0	1	01	01	H0630_016_0	12	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	4.00		12.00																			4.00		8.00																4.00				4.00		.13			.13			0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	016	0	1	01	01	H0630_016_0	12	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	016	0	1	01	01	H0630_016_0	12	2	Generic	1	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		.33			.33			.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	016	0	1	01	01	H0630_016_0	12	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				2	30		90				30		31	40.00		120.00																			40.00		80.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	016	0	1	01	01	H0630_016_0	12	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				2	30		90				30		31	95.00		285.00																			95.00		190.00																95.00				95.00		3.16			3.16			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	016	0	1	01	01	H0630_016_0	12	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		90				2	30		90				30		31				2018.00	33		33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	016	0	1	01	01	H0630_016_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	016	0	1	01	01	H0630_016_0	12	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	4.00		12.00																			4.00		8.00																4.00				4.00		.13			.13			.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	017	0	1	01	01	H0630_017_0	11	2	Generic	3	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		.33			.33			.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	017	0	1	01	01	H0630_017_0	11	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	7.00		21.00																			7.00		14.00																7.00				7.00		.23			.23			.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	017	0	1	01	01	H0630_017_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	017	0	1	01	01	H0630_017_0	11	2	Generic	1	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		.33			.33			.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	017	0	1	01	01	H0630_017_0	11	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				2	30		90				30		31	47.00		141.00																			47.00		94.00																47.00				47.00		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	017	0	1	01	01	H0630_017_0	11	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				2	30		90				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	017	0	1	01	01	H0630_017_0	11	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		90				2	30		90				30		31				2938.00	33		33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	017	0	1	01	01	H0630_017_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	017	0	1	01	01	H0630_017_0	11	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	7.00		21.00																			7.00		14.00																7.00				7.00		.23			.23			.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	018	0	1	01	01	H0630_018_0	11	2	Generic	3	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		.33			.33			.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	018	0	1	01	01	H0630_018_0	11	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	7.00		21.00																			7.00		14.00																7.00				7.00		.23			.23			.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	018	0	1	01	01	H0630_018_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	018	0	1	01	01	H0630_018_0	11	2	Generic	1	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	018	0	1	01	01	H0630_018_0	11	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				2	30		90				30		31	47.00		141.00																			47.00		94.00																47.00				47.00		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	018	0	1	01	01	H0630_018_0	11	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				2	30		90				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	018	0	1	01	01	H0630_018_0	11	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		90				2	30		90				30		31				1711.00	33		33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	018	0	1	01	01	H0630_018_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	018	0	1	01	01	H0630_018_0	11	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	7.00		21.00																			7.00		14.00																7.00				7.00		.23			.23			.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	020	0	1	01	01	H0630_020_0	11	2	Generic	3	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		.33			.33			.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	020	0	1	01	01	H0630_020_0	11	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	7.00		21.00																			7.00		14.00																7.00				7.00		0.23			.23			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	020	0	1	01	01	H0630_020_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	020	0	1	01	01	H0630_020_0	11	2	Generic	1	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	020	0	1	01	01	H0630_020_0	11	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				2	30		90				30		31	47.00		141.00																			47.00		94.00																47.00				47.00		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	020	0	1	01	01	H0630_020_0	11	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				2	30		90				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	020	0	1	01	01	H0630_020_0	11	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		90				2	30		90				30		31				1741.00	33		33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	020	0	1	01	01	H0630_020_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	020	0	1	01	01	H0630_020_0	11	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	7.00		21.00																			7.00		14.00																7.00				7.00		.23			.23			.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	021	0	1	01	01	H0630_021_0	12	2	Generic	3	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		.33			.33			.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	021	0	1	01	01	H0630_021_0	12	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	021	0	1	01	01	H0630_021_0	12	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	6.00		18.00																			6.00		12.00																6.00				6.00		.20			.20			.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	021	0	1	01	01	H0630_021_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	021	0	1	01	01	H0630_021_0	12	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	6.00		18.00																			6.00		12.00																6.00				6.00		.20			.20			.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	021	0	1	01	01	H0630_021_0	12	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				2	30		90				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	021	0	1	01	01	H0630_021_0	12	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				2	30		90				30		31	47.00		141.00																			47.00		94.00																47.00				47.00		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	021	0	1	01	01	H0630_021_0	12	2	Generic	1	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	021	0	1	01	01	H0630_021_0	12	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		90				2	30		90				30		31				2179.00	33		33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0710	006	0	1	04	01	H0710_006_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0710	006	0	1	04	01	H0710_006_0	3	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0710	006	0	1	04	01	H0710_006_0	3	2	Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0710	006	0	1	04	01	H0710_006_0	3	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0710	006	0	1	04	01	H0710_006_0	3	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31				452.00	31		31																										31						31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0710	008	0	1	04	01	H0710_008_0	3	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0710	008	0	1	04	01	H0710_008_0	3	2	Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0710	008	0	1	04	01	H0710_008_0	3	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0710	008	0	1	04	01	H0710_008_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0710	008	0	1	04	01	H0710_008_0	3	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31				452.00	31		31																										31						31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0710	009	0	1	04	01	H0710_009_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0710	009	0	1	04	01	H0710_009_0	3	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0710	009	0	1	04	01	H0710_009_0	3	2	Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0710	009	0	1	04	01	H0710_009_0	3	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0710	009	0	1	04	01	H0710_009_0	3	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31				445.00	30		30																										30						30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0710	012	0	1	04	01	H0710_012_0	3	2	Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0710	012	0	1	04	01	H0710_012_0	3	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0710	012	0	1	04	01	H0710_012_0	3	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0710	012	0	1	04	01	H0710_012_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0710	012	0	1	04	01	H0710_012_0	3	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31				452.00	31		31																										31						31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0710	018	0	1	04	01	H0710_018_0	2	2	Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	11.00		33.00																											33.00						0.00				11.00				11.00		0.36						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0710	018	0	1	04	01	H0710_018_0	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0710	018	0	1	04	01	H0710_018_0	2	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0710	018	0	1	04	01	H0710_018_0	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31				445.00	31		31																										31						31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0710	018	0	1	04	01	H0710_018_0	2	4	Non-Preferred Brand	1	3	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0712	005	0	1	01	01	H0712_005_0	3	1	Preferred Generic	1	2	001000	1	2	110		01		110	1	30		90				1				30		90	30		31	2.00		6.00																									2.00		6.00				2.00		0.00				2.00				2.00		0.07				0.07	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0712	005	0	1	01	01	H0712_005_0	3	2	Generic	1	2	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	8.00		24.00																									8.00		24.00				8.00		20.00				8.00				8.00		0.27				0.27	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0712	005	0	1	01	01	H0712_005_0	3	4	Non-Preferred Brand	1	2	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				82.90	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0712	005	0	1	01	01	H0712_005_0	3	3	Preferred Brand	1	2	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	35.00		105.00																									35.00		105.00				35.00		87.50				35.00				35.00		1.17				1.17	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0712	005	0	1	01	01	H0712_005_0	3	5	Specialty Tier	1	2	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0712	019	0	1	01	01	H0712_019_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		110	1	30		90				1				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0712	019	0	1	01	01	H0712_019_0	4	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		37.50				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0712	019	0	1	01	01	H0712_019_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0712	019	0	1	01	01	H0712_019_0	4	4	Non-Preferred Brand	1	4	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				59.60	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0712	019	0	1	01	01	H0712_019_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0712	020	0	1	01	01	H0712_020_0	4	4	Non-Preferred Brand	1	2	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				63.40	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0712	020	0	1	01	01	H0712_020_0	4	3	Preferred Brand	1	2	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	46.00		138.00																									46.00		138.00				46.00		115.00				46.00				46.00		1.53				1.53	1.53	1.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0712	020	0	1	01	01	H0712_020_0	4	2	Generic	1	2	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		30.00				12.00				12.00		0.40				0.40	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0712	020	0	1	01	01	H0712_020_0	4	1	Preferred Generic	1	2	001000	1	2	110		01		110	1	30		90				1				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0712	020	0	1	01	01	H0712_020_0	4	5	Specialty Tier	1	2	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0735	001	0	1	04	01	H0735_001_0	8	1	Preferred Generic	1	4	001000	1	2	110		10	100		1	30		90				1			90					29	31	6.00		18.00																					12.00																	6.00			6.00		0.20						0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0735	001	0	1	04	01	H0735_001_0	8	2	Generic	1	4	000100	1	2	110		10	100		1	30		90				1			90					29	31	15.00		45.00																					30.00																	15.00			15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0735	001	0	1	04	01	H0735_001_0	8	3	Preferred Brand	1	4	000001	1	2	110		10	100		1	30		90				1			90					29	31	45.00		135.00																					90.00																	45.00			45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0735	001	0	1	04	01	H0735_001_0	8	4	Non-Preferred Brand	1	4	100000	1	2	110		10	100		1	30		90				1			90					29	31	90.00		270.00																					180.00																	90.00			90.00		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0735	001	0	1	04	01	H0735_001_0	8	5	Specialty Tier	1	4	010010	1	1	110		10	100		1	30		90				1			90					29	31				2040.57	30		30																				30																30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0735	002	0	1	04	01	H0735_002_0	9	4	Non-Preferred Brand	1	4	100000	1	2	110		10	100		1	30		90				1			90					29	31	80.00		200.00																					160.00																	80.00			80.00		2.67						2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0735	002	0	1	04	01	H0735_002_0	9	3	Preferred Brand	1	4	000001	1	2	110		10	100		1	30		90				1			90					29	31	40.00		100.00																					80.00																	40.00			40.00		1.33						1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0735	002	0	1	04	01	H0735_002_0	9	2	Generic	1	4	000100	1	2	110		10	100		1	30		90				1			90					29	31	12.00		30.00																					24.00																	12.00			12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0735	002	0	1	04	01	H0735_002_0	9	1	Preferred Generic	1	4	001000	1	2	110		10	100		1	30		90				1			90					29	31	6.00		15.00																					12.00																	6.00			6.00		0.20						0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0735	002	0	1	04	01	H0735_002_0	9	5	Specialty Tier	1	4	010010	1	1	110		10	100		1	30		90				1			90					29	31				2151.81	28		28																				28																28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0755	030	0	1	01	01	H0755_030_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0755	030	0	1	01	01	H0755_030_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0755	030	0	1	01	01	H0755_030_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0755	030	0	1	01	01	H0755_030_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0755	030	0	1	01	01	H0755_030_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				466.00	30		30																										30						30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0755	031	0	1	01	01	H0755_031_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	9.00		27.00																											27.00						0.00				9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0755	031	0	1	01	01	H0755_031_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0755	031	0	1	01	01	H0755_031_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0755	031	0	1	01	01	H0755_031_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				440.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0755	031	0	1	01	01	H0755_031_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0755	033	0	1	01	01	H0755_033_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0755	033	0	1	01	01	H0755_033_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0755	033	0	1	01	01	H0755_033_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0755	033	0	1	01	01	H0755_033_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0755	033	0	1	01	01	H0755_033_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				477.00	30		30																										30						30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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																																														0.00			0.00			0.00	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	4	Non-Medicare OTC Drugs	1	4	010010			111		01	111		1	30	60	90				2	30	60	90				30		31																																														0.00			0.00			0.00	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	3	Non-Medicare Rx Drugs	1	4	010010			111		01	111		1	30	60	90				2	30	60	90				30		31																																														0.00			0.00			0.00	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	2	Brand Drugs	1	4	000010			111		01	111		1	30	60	90				2	30	60	90				30		31																																														0.00			0.00			0.00	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			
H0838	020	0	1	01	01	H0838_020_0	15	5	Specialty Tier	1	4	100000	1	1	110		01	100		1	30		90				1			90				30		31				1.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	020	0	1	01	01	H0838_020_0	15	4	Non-Preferred Brand	1	4	100000	1	1	110		01	100		1	30		90				1			90				30		31				125.59	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	020	0	1	01	01	H0838_020_0	15	3	Preferred Brand	1	4	000001	1	1	110		01	100		1	30		90				2			90				30		31				53.82	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	020	0	1	01	01	H0838_020_0	15	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	13.00		39.00																					26.00																13.00				13.00		0.43						0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	020	0	1	01	01	H0838_020_0	15	6	Select Diabetic Drugs	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	11.00		33.00																					22.00																11.00				11.00		0.37						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	020	0	1	01	01	H0838_020_0	15	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	024	0	1	01	01	H0838_024_0	15	6	Select Diabetic Drugs	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	024	0	1	01	01	H0838_024_0	15	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	024	0	1	01	01	H0838_024_0	15	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	024	0	1	01	01	H0838_024_0	15	3	Preferred Brand	1	4	000001	1	1	110		01	100		1	30		90				2			90				30		31				62.61	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	024	0	1	01	01	H0838_024_0	15	4	Non-Preferred Brand	1	4	100000	1	1	110		01	100		1	30		90				1			90				30		31				86.98	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	024	0	1	01	01	H0838_024_0	15	5	Specialty Tier	1	4	100000	1	1	110		01	100		1	30		90				1			90				30		31				1.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	025	0	1	01	01	H0838_025_0	15	5	Specialty Tier	1	4	100000	1	1	110		01	100		1	30		90				2			90				30		31				1.00	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	025	0	1	01	01	H0838_025_0	15	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	90.00		270.00																					180.00																90.00				90.00		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	025	0	1	01	01	H0838_025_0	15	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	45.00		135.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	025	0	1	01	01	H0838_025_0	15	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	9.00		27.00																					18.00																9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	025	0	1	01	01	H0838_025_0	15	6	Select Diabetic Drugs	3	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	11.00		33.00																					22.00																11.00				11.00		0.37						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs										1		
H0838	025	0	1	01	01	H0838_025_0	15	6	Select Diabetic Drugs	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	11.00		33.00																					22.00																11.00				11.00		0.37						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	025	0	1	01	01	H0838_025_0	15	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs										1		
H0838	025	0	1	01	01	H0838_025_0	15	2	Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	9.00		27.00																					18.00																9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs										1		
H0838	025	0	1	01	01	H0838_025_0	15	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	026	0	1	01	01	H0838_026_0	15	5	Specialty Tier	1	4	100000	1	1	110		01	100		1	30		90				2			90				30		31				1.00	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	026	0	1	01	01	H0838_026_0	15	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	90.00		270.00																					180.00																90.00				90.00		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	026	0	1	01	01	H0838_026_0	15	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	45.00		135.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	026	0	1	01	01	H0838_026_0	15	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	9.00		27.00																					18.00																9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	026	0	1	01	01	H0838_026_0	15	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	026	0	1	01	01	H0838_026_0	15	6	Select Diabetic Drugs	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	9.00		27.00																					18.00																9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	027	0	1	01	01	H0838_027_0	15	2	Generic	1	4	000100	1	1	110		01	100		1	30		90				2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	027	0	1	01	01	H0838_027_0	15	1	Preferred Generic	1	4	001000	1	1	110		01	100		1	30		90				2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	027	0	1	01	01	H0838_027_0	15	6	Select Diabetic Drugs	1	4	000001	1	1	110		01	100		1	30		90				1			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	027	0	1	01	01	H0838_027_0	15	5	Specialty Tier	1	4	100000	1	1	110		01	100		1	30		90				1			90				30		31				1.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	027	0	1	01	01	H0838_027_0	15	4	Non-Preferred Brand	1	4	100000	1	1	110		01	100		1	30		90				1			90				30		31				71.34	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	027	0	1	01	01	H0838_027_0	15	3	Preferred Brand	1	4	000001	1	1	110		01	100		1	30		90				2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	028	0	1	01	01	H0838_028_0	15	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs										1		
H0838	028	0	1	01	01	H0838_028_0	15	2	Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	9.00		27.00																					18.00																9.00				9.00		.30						.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs										1		
H0838	028	0	1	01	01	H0838_028_0	15	6	Select Diabetic Drugs	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	11.00		33.00																					22.00																11.00				11.00		0.37						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	028	0	1	01	01	H0838_028_0	15	5	Specialty Tier	1	4	100000	1	1	110		01	100		1	30		90				2			90				30		31				1.00	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	028	0	1	01	01	H0838_028_0	15	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	90.00		270.00																					180.00																90.00				90.00		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	028	0	1	01	01	H0838_028_0	15	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	45.00		135.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	028	0	1	01	01	H0838_028_0	15	6	Select Diabetic Drugs	3	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	11.00		33.00																					22.00																11.00				11.00		.30						.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs										1		
H0838	028	0	1	01	01	H0838_028_0	15	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	028	0	1	01	01	H0838_028_0	15	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	9.00		27.00																					18.00																9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	029	0	1	01	01	H0838_029_0	15	1	Preferred Generic	1	4	001000	1	1	110		01	100		1	30		90				2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	029	0	1	01	01	H0838_029_0	15	2	Generic	1	4	000100	1	1	110		01	100		1	30		90				2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	029	0	1	01	01	H0838_029_0	15	6	Select Diabetic Drugs	1	4	000001	1	1	110		01	100		1	30		90				1			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	029	0	1	01	01	H0838_029_0	15	5	Specialty Tier	1	4	100000	1	1	110		01	100		1	30		90				1			90				30		31				1.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	029	0	1	01	01	H0838_029_0	15	4	Non-Preferred Brand	1	4	100000	1	1	110		01	100		1	30		90				1			90				30		31				69.73	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	029	0	1	01	01	H0838_029_0	15	3	Preferred Brand	1	4	000001	1	1	110		01	100		1	30		90				2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	030	0	1	01	01	H0838_030_0	15	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	90.00		270.00																					180.00																90.00				90.00		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	030	0	1	01	01	H0838_030_0	15	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	45.00		135.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	030	0	1	01	01	H0838_030_0	15	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	9.00		27.00																					18.00																9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	030	0	1	01	01	H0838_030_0	15	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	030	0	1	01	01	H0838_030_0	15	6	Select Diabetic Drugs	3	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	11.00		33.00																					22.00																11.00				11.00		0.37						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs										1		
H0838	030	0	1	01	01	H0838_030_0	15	6	Select Diabetic Drugs	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	11.00		33.00																					22.00																11.00				11.00		0.37						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	030	0	1	01	01	H0838_030_0	15	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs										1		
H0838	030	0	1	01	01	H0838_030_0	15	2	Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	9.00		27.00																					18.00																9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs										1		
H0838	030	0	1	01	01	H0838_030_0	15	5	Specialty Tier	1	4	100000	1	1	110		01	100		1	30		90				2			90				30		31				1.00	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	031	0	1	01	01	H0838_031_0	15	4	Non-Preferred Brand	1	4	100000	1	1	110		01	100		1	30		90				1			90				30		31				70.40	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	031	0	1	01	01	H0838_031_0	15	3	Preferred Brand	1	4	000001	1	1	110		01	100		1	30		90				2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	031	0	1	01	01	H0838_031_0	15	2	Generic	1	4	000100	1	1	110		01	100		1	30		90				2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	031	0	1	01	01	H0838_031_0	15	1	Preferred Generic	1	4	001000	1	1	110		01	100		1	30		90				2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	031	0	1	01	01	H0838_031_0	15	5	Specialty Tier	1	4	100000	1	1	110		01	100		1	30		90				1			90				30		31				1.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	031	0	1	01	01	H0838_031_0	15	6	Select Diabetic Drugs	1	4	000001	1	1	110		01	100		1	30		90				1			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	032	0	1	01	01	H0838_032_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	032	0	1	01	01	H0838_032_0	14	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	9.00		27.00																					18.00																9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	032	0	1	01	01	H0838_032_0	14	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	45.00		135.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	032	0	1	01	01	H0838_032_0	14	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	90.00		270.00																					180.00																90.00				90.00		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	032	0	1	01	01	H0838_032_0	14	5	Specialty Tier	1	4	100000	1	1	110		01	100		1	30		90				2			90				30		31				1.00	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	032	0	1	01	01	H0838_032_0	14	6	Select Diabetic Drugs	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	11.00		33.00																					22.00																11.00				11.00		0.37						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	033	0	1	01	01	H0838_033_0	15	1	Preferred Generic	1	4	001000	1	1	110		01	100		1	30		90				2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	033	0	1	01	01	H0838_033_0	15	5	Specialty Tier	1	4	100000	1	1	110		01	100		1	30		90				1			90				30		31				1.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	033	0	1	01	01	H0838_033_0	15	4	Non-Preferred Brand	1	4	100000	1	1	110		01	100		1	30		90				1			90				30		31				75.92	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	033	0	1	01	01	H0838_033_0	15	3	Preferred Brand	1	4	000001	1	1	110		01	100		1	30		90				2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	033	0	1	01	01	H0838_033_0	15	2	Generic	1	4	000100	1	1	110		01	100		1	30		90				2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	033	0	1	01	01	H0838_033_0	15	6	Select Diabetic Drugs	1	4	000001	1	1	110		01	100		1	30		90				1			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0840	001	0	1	04	01	H0840_001_0	12	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0840	001	0	1	04	01	H0840_001_0	12	2	Generic	1	4	000101	1	2	111		10	111		1	30	60	90				1	30	60	90					10	31	20.00	40.00	60.00																			20.00	20.00	20.00																	20.00			20.00		.67			.67			.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0840	001	0	1	04	01	H0840_001_0	12	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0840	001	0	1	04	01	H0840_001_0	12	4	Non-Preferred Brand	1	4	100100	1	2	111		10	111		1	30	60	90				1	30	60	90					10	31	90.00	180.00	270.00																			90.00	90.00	90.00																	90.00			90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0840	001	0	1	04	01	H0840_001_0	12	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0840	001	0	1	04	01	H0840_001_0	12	3	Preferred Brand	1	4	000101	1	2	111		10	111		1	30	60	90				1	30	60	90					10	31	35.00	70.00	105.00																			35.00	35.00	35.00																	35.00			35.00		1.17			1.17			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0879	002	0	1	04	01	H0879_002_0	11	2	Generic	1	4	000100	1	2	110		01	100		1	31		90				1			90				31		34	7.00		21.00																					17.50																7.00				7.00		0.23						.21	Preferred Generic, 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	45.00		135.00																					112.50																45.00				45.00		1.45						1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0879	002	0	1	04	01	H0879_002_0	11	6	Vaccines	3	4	000010	1	2	010		01	010		1	31							31						31		34	0.00																					0.00																		0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0879	002	0	1	04	01	H0879_002_0	11	5	Specialty Tier	1	4	000010	1	1	010		01	010		1	31							31						31		34				1.00	31																				31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0879	002	0	1	04	01	H0879_002_0	11	6	Vaccines	1	4	000010	1	2	010		01	010		1	31							31						31		34	0.00																					0.00																		0.00				0.00		0.00			0.00			0.00	Preferred Generic, 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	95.00		285.00																					237.50																95.00				95.00		3.06						2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0913	002	0	1	01	01	H0913_002_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0913	002	0	1	01	01	H0913_002_0	4	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0913	002	0	1	01	01	H0913_002_0	4	4	Non-Preferred Brand	1	4	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				74.70	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0913	002	0	1	01	01	H0913_002_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0913	002	0	1	01	01	H0913_002_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		110	1	30		90				1				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0913	012	0	1	01	01	H0913_012_0	4	4	Non-Preferred Brand	1	4	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				66.10	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0913	012	0	1	01	01	H0913_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0913	012	0	1	01	01	H0913_012_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0913	012	0	1	01	01	H0913_012_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		110	1	30		90				1				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0913	012	0	1	01	01	H0913_012_0	4	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0913	013	0	1	01	01	H0913_013_0	4	5	Specialty Tier	1	2	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0913	013	0	1	01	01	H0913_013_0	4	4	Non-Preferred Brand	1	2	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				72.80	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0913	013	0	1	01	01	H0913_013_0	4	2	Generic	1	2	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		15.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0913	013	0	1	01	01	H0913_013_0	4	3	Preferred Brand	1	2	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	33.00		99.00																									33.00		99.00				33.00		82.50				33.00				33.00		1.10				1.10	1.10	1.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0913	013	0	1	01	01	H0913_013_0	4	1	Preferred Generic	1	2	001000	1	2	110		01		110	1	30		90				1				30		90	30		31	2.00		6.00																									2.00		6.00				2.00		0.00				2.00				2.00		0.07				0.07	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0927	001	0	1	48	05	H0927_001_0	3	2	Brand Drugs	1	4	000110			110		01	100		1	30		90				1			90				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	3	3	Non-Medicare OTC Drugs	1	4	000001			110		01	100		1	30		90				1			90				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			
H0927	001	0	1	48	05	H0927_001_0	3	1	Generic Drugs	1	4	010000			110		01	100		1	30		90				1			90				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			
H0981	001	0	1	01	01	H0981_001_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	30	60	90				1			90				30		31				949.52	33	33	33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0981	001	0	1	01	01	H0981_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0981	001	0	1	01	01	H0981_001_0	5	2	Generic	1	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	7.00	14.00	21.00																					14.00																7.00				7.00		0.23						0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0981	001	0	1	01	01	H0981_001_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	30	60	90				1			90				30		31	20.00	40.00	60.00																					40.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0981	001	0	1	01	01	H0981_001_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	30	60	90				1			90				30		31	65.00	130.00	195.00																					130.00																65.00				65.00		2.17						2.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0981	001	0	1	01	01	H0981_001_0	5	1	Preferred Generic	3	4	001000	1	1	111		01	100		1	30	60	90				1			90				30		31				0.00	0	0	0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0981	001	0	1	01	01	H0981_001_0	5	2	Generic	3	4	000100	1	1	111		01	100		1	30	60	90				1			90				30		31				0.00	0	0	0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0981	002	0	1	01	01	H0981_002_0	6	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	30	60	90				1			90				30		31				984.15	33	33	33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0981	002	0	1	01	01	H0981_002_0	6	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0981	002	0	1	01	01	H0981_002_0	6	2	Generic	3	4	000100	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0981	002	0	1	01	01	H0981_002_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0981	002	0	1	01	01	H0981_002_0	6	2	Generic	1	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	8.00	16.00	24.00																					16.00																8.00				8.00		0.27						0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0981	002	0	1	01	01	H0981_002_0	6	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	30	60	90				1			90				30		31	20.00	40.00	60.00																					40.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0981	002	0	1	01	01	H0981_002_0	6	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	30	60	90				1			90				30		31	75.00	150.00	225.00																					150.00																75.00				75.00		2.50						2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1016	001	0	1	01	01	H1016_001_0	12	1	Preferred Generic	1	4	001001	3	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1016	001	0	1	01	01	H1016_001_0	12	2	Generic	1	4	000101	3	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	9.00																3.00				3.00		0.10			0.10			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1016	001	0	1	01	01	H1016_001_0	12	3	Preferred Brand	1	4	010001	3	2	111		01	111		1	30	60	90				1	30	60	90				30		31	35.00	70.00	105.00																			35.00	70.00	105.00																35.00				35.00		1.16			1.16			1.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1016	001	0	1	01	01	H1016_001_0	12	4	Non-Preferred Brand	1	4	110000	3	2	111		01	111		1	30	60	90				1	30	60	90				30		31	70.00	140.00	210.00																			70.00	140.00	210.00																70.00				70.00		2.33			2.33			2.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1016	001	0	1	01	01	H1016_001_0	12	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				696.39	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1016	001	0	1	01	01	H1016_001_0	12	1	Preferred Generic	3	4	001001	3	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H1016	001	0	1	01	01	H1016_001_0	12	2	Generic	3	4	000101	3	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	9.00																3.00				3.00		0.10			0.10			0.09	Preferred Generic, 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	001001	3	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1016	021	0	1	01	01	H1016_021_0	7	2	Generic	1	4	000101	3	2	111		01	111		1	30	60	90				1	30	60	90				30		31	7.00	14.00	21.00																			7.00	14.00	21.00																7.00				7.00		0.23			0.23			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1016	021	0	1	01	01	H1016_021_0	7	3	Preferred Brand	1	4	010001	3	2	111		01	111		1	30	60	90				1	30	60	90				30		31	35.00	70.00	105.00																			35.00	70.00	105.00																35.00				35.00		1.16			1.16			1.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1016	021	0	1	01	01	H1016_021_0	7	4	Non-Preferred Brand	1	4	110000	3	2	111		01	111		1	30	60	90				1	30	60	90				30		31	70.00	140.00	210.00																			70.00	140.00	210.00																70.00				70.00		2.33			2.33			2.25	Preferred Generic, 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	010		1	30							30						30		31				696.39	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1016	021	0	1	01	01	H1016_021_0	7	1	Preferred Generic	3	4	001001	3	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H1016	021	0	1	01	01	H1016_021_0	7	2	Generic	3	4	000101	3	2	111		01	111		1	30	60	90				1	30	60	90				30		31	7.00	14.00	21.00																			7.00	14.00	21.00																7.00				7.00		0.23			0.23			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H1019	001	0	1	01	01	H1019_001_0	2	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	40.00		120.00																									40.00		120.00				40.00		110.00				40.00				40.00		1.33				1.33	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	001	0	1	01	01	H1019_001_0	2	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	85.00		255.00																									85.00		255.00				85.00		245.00				85.00				85.00		2.83				2.83	2.83	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	001	0	1	01	01	H1019_001_0	2	2	Generic	1	4	000101	3	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	001	0	1	01	01	H1019_001_0	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	001	0	1	01	01	H1019_001_0	2	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	001	0	1	01	01	H1019_001_0	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1019	001	0	1	01	01	H1019_001_0	2	2	Generic	3	4	000101	3	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H1019	001	0	1	01	01	H1019_001_0	2	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	40.00		120.00																									40.00		120.00				40.00		110.00				40.00				40.00		1.33				1.33	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	001	0	1	01	01	H1019_001_0	2	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	85.00		255.00																									85.00		255.00				85.00		245.00				85.00				85.00		2.83				2.83	2.83	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	001	0	1	01	01	H1019_001_0	2	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	006	0	1	01	01	H1019_006_0	3	2	Generic	1	4	000101	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	006	0	1	01	01	H1019_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, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	35.00		105.00																									35.00		105.00				35.00		95.00				35.00				35.00		1.16				1.16	1.16	1.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	006	0	1	01	01	H1019_006_0	3	2	Generic	3	4	000101	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
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	35.00		105.00																									35.00		105.00				35.00		95.00				35.00				35.00		1.16				1.16	1.16	1.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	006	0	1	01	01	H1019_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1019	023	0	1	01	01	H1019_023_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	023	0	1	01	01	H1019_023_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	023	0	1	01	01	H1019_023_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	023	0	1	01	01	H1019_023_0	5	2	Generic	1	4	000101	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	023	0	1	01	01	H1019_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	024	0	1	01	01	H1019_024_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	024	0	1	01	01	H1019_024_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	024	0	1	01	01	H1019_024_0	6	2	Generic	1	4	000101	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	024	0	1	01	01	H1019_024_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	024	0	1	01	01	H1019_024_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, 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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	026	0	1	01	01	H1019_026_0	5	2	Generic	1	4	000101	3	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	026	0	1	01	01	H1019_026_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, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	027	0	1	01	01	H1019_027_0	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1019	027	0	1	01	01	H1019_027_0	2	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1019	027	0	1	01	01	H1019_027_0	2	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	027	0	1	01	01	H1019_027_0	2	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	95.00		285.00																									95.00		285.00				95.00		275.00				95.00				95.00		3.16				3.16	3.16	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	027	0	1	01	01	H1019_027_0	2	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	027	0	1	01	01	H1019_027_0	2	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	95.00		285.00																									95.00		285.00				95.00		275.00				95.00				95.00		3.16				3.16	3.16	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	027	0	1	01	01	H1019_027_0	2	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	027	0	1	01	01	H1019_027_0	2	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	027	0	1	01	01	H1019_027_0	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	027	0	1	01	01	H1019_027_0	2	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	028	0	1	01	01	H1019_028_0	5	2	Generic	1	4	000101	3	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	028	0	1	01	01	H1019_028_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, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	043	0	1	01	01	H1019_043_0	2	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1019	043	0	1	01	01	H1019_043_0	2	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.66				0.66	0.66	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1019	043	0	1	01	01	H1019_043_0	2	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	043	0	1	01	01	H1019_043_0	2	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	95.00		285.00																									95.00		285.00				95.00		275.00				95.00				95.00		3.16				3.16	3.16	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	043	0	1	01	01	H1019_043_0	2	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	043	0	1	01	01	H1019_043_0	2	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	95.00		285.00																									95.00		285.00				95.00		275.00				95.00				95.00		3.16				3.16	3.16	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	043	0	1	01	01	H1019_043_0	2	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	043	0	1	01	01	H1019_043_0	2	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.66				0.66	0.66	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	043	0	1	01	01	H1019_043_0	2	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	043	0	1	01	01	H1019_043_0	2	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	054	0	1	01	01	H1019_054_0	2	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	054	0	1	01	01	H1019_054_0	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1019	054	0	1	01	01	H1019_054_0	2	2	Generic	3	4	000101	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H1019	054	0	1	01	01	H1019_054_0	2	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.66				0.66	0.66	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	054	0	1	01	01	H1019_054_0	2	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	75.00		225.00																									75.00		225.00				75.00		215.00				75.00				75.00		2.50				2.50	2.50	2.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	054	0	1	01	01	H1019_054_0	2	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	054	0	1	01	01	H1019_054_0	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	054	0	1	01	01	H1019_054_0	2	2	Generic	1	4	000101	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	054	0	1	01	01	H1019_054_0	2	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.66				0.66	0.66	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	054	0	1	01	01	H1019_054_0	2	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	75.00		225.00																									75.00		225.00				75.00		215.00				75.00				75.00		2.50				2.50	2.50	2.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	057	0	1	01	01	H1019_057_0	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	057	0	1	01	01	H1019_057_0	2	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	057	0	1	01	01	H1019_057_0	2	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	35.00		105.00																									35.00		105.00				35.00		95.00				35.00				35.00		1.16				1.16	1.16	1.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	057	0	1	01	01	H1019_057_0	2	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	85.00		255.00																									85.00		255.00				85.00		245.00				85.00				85.00		2.83				2.83	2.83	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	057	0	1	01	01	H1019_057_0	2	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	057	0	1	01	01	H1019_057_0	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1019	057	0	1	01	01	H1019_057_0	2	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1019	057	0	1	01	01	H1019_057_0	2	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	35.00		105.00																									35.00		105.00				35.00		95.00				35.00				35.00		1.16				1.16	1.16	1.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	057	0	1	01	01	H1019_057_0	2	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	85.00		255.00																									85.00		255.00				85.00		245.00				85.00				85.00		2.83				2.83	2.83	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	057	0	1	01	01	H1019_057_0	2	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	060	0	1	01	01	H1019_060_0	2	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	60.00		180.00																									60.00		180.00				60.00		170.00				60.00				60.00		2.00				2.00	2.00	1.93	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	060	0	1	01	01	H1019_060_0	2	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	060	0	1	01	01	H1019_060_0	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	060	0	1	01	01	H1019_060_0	2	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	060	0	1	01	01	H1019_060_0	2	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	35.00		105.00																									35.00		105.00				35.00		95.00				35.00				35.00		1.16				1.16	1.16	1.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	060	0	1	01	01	H1019_060_0	2	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	60.00		180.00																									60.00		180.00				60.00		170.00				60.00				60.00		2.00				2.00	2.00	1.93	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	060	0	1	01	01	H1019_060_0	2	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	060	0	1	01	01	H1019_060_0	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	060	0	1	01	01	H1019_060_0	2	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	060	0	1	01	01	H1019_060_0	2	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	35.00		105.00																									35.00		105.00				35.00		95.00				35.00				35.00		1.16				1.16	1.16	1.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	062	0	1	01	01	H1019_062_0	2	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	90.00		270.00																									90.00		270.00				90.00		260.00				90.00				90.00		3.00				3.00	3.00	2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	062	0	1	01	01	H1019_062_0	2	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	062	0	1	01	01	H1019_062_0	2	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	062	0	1	01	01	H1019_062_0	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	062	0	1	01	01	H1019_062_0	2	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	062	0	1	01	01	H1019_062_0	2	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	90.00		270.00																									90.00		270.00				90.00		260.00				90.00				90.00		3.00				3.00	3.00	2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	062	0	1	01	01	H1019_062_0	2	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	062	0	1	01	01	H1019_062_0	2	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	062	0	1	01	01	H1019_062_0	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	062	0	1	01	01	H1019_062_0	2	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	063	0	1	01	01	H1019_063_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	063	0	1	01	01	H1019_063_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		20.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	063	0	1	01	01	H1019_063_0	3	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1019	063	0	1	01	01	H1019_063_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1019	063	0	1	01	01	H1019_063_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	063	0	1	01	01	H1019_063_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	063	0	1	01	01	H1019_063_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		20.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	063	0	1	01	01	H1019_063_0	3	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	063	0	1	01	01	H1019_063_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	063	0	1	01	01	H1019_063_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	065	0	1	01	01	H1019_065_0	2	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	065	0	1	01	01	H1019_065_0	2	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	065	0	1	01	01	H1019_065_0	2	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	065	0	1	01	01	H1019_065_0	2	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	065	0	1	01	01	H1019_065_0	2	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	065	0	1	01	01	H1019_065_0	2	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1019	065	0	1	01	01	H1019_065_0	2	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1019	065	0	1	01	01	H1019_065_0	2	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	065	0	1	01	01	H1019_065_0	2	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	065	0	1	01	01	H1019_065_0	2	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	069	0	1	01	01	H1019_069_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	95.00		285.00																									95.00		285.00				95.00		275.00				95.00				95.00		3.16				3.16	3.16	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	069	0	1	01	01	H1019_069_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	069	0	1	01	01	H1019_069_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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, 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, 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	95.00		285.00																									95.00		285.00				95.00		275.00				95.00				95.00		3.16				3.16	3.16	3.06	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	069	0	1	01	01	H1019_069_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1019	073	0	1	01	01	H1019_073_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	073	0	1	01	01	H1019_073_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	073	0	1	01	01	H1019_073_0	5	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	073	0	1	01	01	H1019_073_0	5	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	073	0	1	01	01	H1019_073_0	5	2	Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	076	0	1	01	01	H1019_076_0	2	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	076	0	1	01	01	H1019_076_0	2	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	076	0	1	01	01	H1019_076_0	2	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	076	0	1	01	01	H1019_076_0	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	076	0	1	01	01	H1019_076_0	2	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	076	0	1	01	01	H1019_076_0	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	076	0	1	01	01	H1019_076_0	2	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	076	0	1	01	01	H1019_076_0	2	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	076	0	1	01	01	H1019_076_0	2	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	076	0	1	01	01	H1019_076_0	2	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1019	077	0	1	01	01	H1019_077_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	077	0	1	01	01	H1019_077_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	077	0	1	01	01	H1019_077_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	077	0	1	01	01	H1019_077_0	5	2	Generic	1	4	000101	3	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	077	0	1	01	01	H1019_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	079	0	1	01	01	H1019_079_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	079	0	1	01	01	H1019_079_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	079	0	1	01	01	H1019_079_0	5	2	Generic	1	4	000101	3	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	079	0	1	01	01	H1019_079_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	079	0	1	01	01	H1019_079_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	081	0	1	01	01	H1019_081_0	5	2	Generic	1	4	000101	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	081	0	1	01	01	H1019_081_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	081	0	1	01	01	H1019_081_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	081	0	1	01	01	H1019_081_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	081	0	1	01	01	H1019_081_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	083	0	1	01	01	H1019_083_0	6	2	Generic	1	4	000101	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	083	0	1	01	01	H1019_083_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	083	0	1	01	01	H1019_083_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	083	0	1	01	01	H1019_083_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	083	0	1	01	01	H1019_083_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	085	0	1	01	01	H1019_085_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	085	0	1	01	01	H1019_085_0	5	2	Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	085	0	1	01	01	H1019_085_0	5	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	085	0	1	01	01	H1019_085_0	5	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1019	085	0	1	01	01	H1019_085_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	001	0	1	01	01	H1026_001_0	3	2	Generic	1	4	000100	1	2		110	01	110		1				31		90	1	31		90				31		31								15.00		45.00					10.00		30.00					10.00		30.00																15.00				10.00			0.48	0.32	0.32			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	001	0	1	01	01	H1026_001_0	3	3	Preferred Brand	1	4	010001	1	2		110	01	110		1				31		90	1	31		90				31		31								47.00		141.00					42.00		126.00					42.00		126.00																47.00				42.00			1.52	1.35	1.35			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	001	0	1	01	01	H1026_001_0	3	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31								5.00		15.00					0.00		0.00					0.00		0.00																5.00				0.00			0.16	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	001	0	1	01	01	H1026_001_0	3	4	Non-Preferred Brand	1	4	110000	1	2		110	01	110		1				31		90	1	31		90				31		31								100.00		300.00					95.00		285.00					95.00		285.00																100.00				95.00			3.23	3.06	3.06			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	001	0	1	01	01	H1026_001_0	3	5	Specialty Tier	1	4	110001	1	1		010	01	010		1				31				31						31		31											582.02	33						582.02	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	001	0	1	01	01	H1026_001_0	3	1	Preferred Generic	3	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31								5.00		15.00					0.00		0.00					0.00		0.00																5.00				0.00			0.16	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1026	001	0	1	01	01	H1026_001_0	3	2	Generic	3	4	000100	1	2		110	01	110		1				31		90	1	31		90				31		31								15.00		45.00					10.00		30.00					10.00		30.00																15.00				10.00			0.48	0.32	0.32			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1026	038	0	1	01	01	H1026_038_0	4	2	Generic	1	4	000100	1	2		110	01	110		1				31		90	1	31		90				31		31								20.00		60.00					15.00		45.00					15.00		45.00																20.00				15.00			0.65	0.48	0.48			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	038	0	1	01	01	H1026_038_0	4	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31								10.00		30.00					5.00		15.00					5.00		15.00																10.00				5.00			0.32	0.16	0.16			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	038	0	1	01	01	H1026_038_0	4	3	Preferred Brand	1	4	010001	1	2		110	01	110		1				31		90	1	31		90				31		31								47.00		141.00					42.00		126.00					42.00		126.00																47.00				42.00			1.52	1.35	1.35			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	038	0	1	01	01	H1026_038_0	4	2	Generic	3	4	000100	1	2		110	01	110		1				31		90	1	31		90				31		31								20.00		60.00					15.00		45.00					15.00		45.00																20.00				15.00			0.65	0.48	0.48			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1026	038	0	1	01	01	H1026_038_0	4	1	Preferred Generic	3	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31								10.00		30.00					5.00		15.00					5.00		15.00																10.00				5.00			0.32	0.16	0.16			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1026	038	0	1	01	01	H1026_038_0	4	5	Specialty Tier	1	4	110001	1	1		010	01	010		1				31				31						31		31											581.55	33						581.55	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	038	0	1	01	01	H1026_038_0	4	4	Non-Preferred Brand	1	4	110000	1	2		110	01	110		1				31		90	1	31		90				31		31								100.00		300.00					95.00		285.00					95.00		285.00																100.00				95.00			3.23	3.06	3.06			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	040	0	1	01	01	H1026_040_0	3	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31								19.00		57.00					14.00		42.00					14.00		42.00																19.00				14.00			0.61	0.45	0.45			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	040	0	1	01	01	H1026_040_0	3	5	Specialty Tier	1	4	110001	1	1		010	01	010		1				31				31						31		31											610.26	33						610.26	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	040	0	1	01	01	H1026_040_0	3	4	Non-Preferred Brand	1	4	110000	1	2		110	01	110		1				31		90	1	31		90				31		31								100.00		300.00					95.00		285.00					95.00		285.00																100.00				95.00			3.23	3.06	3.06			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	040	0	1	01	01	H1026_040_0	3	3	Preferred Brand	1	4	010001	1	2		110	01	110		1				31		90	1	31		90				31		31								47.00		141.00					42.00		126.00					42.00		126.00																47.00				42.00			1.52	1.35	1.35			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	040	0	1	01	01	H1026_040_0	3	2	Generic	1	4	000100	1	2		110	01	110		1				31		90	1	31		90				31		31								20.00		60.00					15.00		45.00					15.00		45.00																20.00				15.00			0.65	0.48	0.48			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	040	0	1	01	01	H1026_040_0	3	1	Preferred Generic	3	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31								19.00		57.00					14.00		42.00					14.00		42.00																19.00				14.00			0.61	0.45	0.45			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1026	055	0	1	01	01	H1026_055_0	3	3	Preferred Brand	1	4	010001	1	2		110	01	110		1				31		90	1	31		90				31		31								47.00		141.00					42.00		126.00					42.00		126.00																47.00				42.00			1.52	1.35	1.35			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	055	0	1	01	01	H1026_055_0	3	2	Generic	1	4	000100	1	2		110	01	110		1				31		90	1	31		90				31		31								20.00		60.00					15.00		45.00					15.00		45.00																20.00				15.00			0.65	0.48	0.48			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	055	0	1	01	01	H1026_055_0	3	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31								13.00		39.00					8.00		24.00					8.00		24.00																13.00				8.00			0.42	0.26	0.26			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	055	0	1	01	01	H1026_055_0	3	4	Non-Preferred Brand	1	4	110000	1	2		110	01	110		1				31		90	1	31		90				31		31								100.00		300.00					95.00		285.00					95.00		285.00																100.00				95.00			3.23	3.06	3.06			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	055	0	1	01	01	H1026_055_0	3	2	Generic	3	4	000100	1	2		110	01	110		1				31		90	1	31		90				31		31								20.00		60.00					15.00		45.00					15.00		45.00																20.00				15.00			0.65	0.48	0.48			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1026	055	0	1	01	01	H1026_055_0	3	1	Preferred Generic	3	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31								13.00		39.00					8.00		24.00					8.00		24.00																13.00				8.00			0.42	0.26	0.26			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1026	055	0	1	01	01	H1026_055_0	3	5	Specialty Tier	1	4	110001	1	1		010	01	010		1				31				31						31		31											552.70	33						552.70	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	056	0	1	01	01	H1026_056_0	3	3	Preferred Brand	1	4	010001	1	2		110	01	110		1				31		90	1	31		90				31		31								47.00		141.00					42.00		126.00					42.00		126.00																47.00				42.00			1.52	1.35	1.35			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	056	0	1	01	01	H1026_056_0	3	2	Generic	1	4	000100	1	2		110	01	110		1				31		90	1	31		90				31		31								20.00		60.00					15.00		45.00					15.00		45.00																20.00				15.00			0.65	0.48	0.48			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	056	0	1	01	01	H1026_056_0	3	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31								13.00		39.00					8.00		24.00					8.00		24.00																13.00				8.00			0.42	0.26	0.26			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	056	0	1	01	01	H1026_056_0	3	4	Non-Preferred Brand	1	4	110000	1	2		110	01	110		1				31		90	1	31		90				31		31								100.00		300.00					95.00		285.00					95.00		285.00																100.00				95.00			3.23	3.06	3.06			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	056	0	1	01	01	H1026_056_0	3	5	Specialty Tier	1	4	110001	1	1		010	01	010		1				31				31						31		31											636.62	33						636.62	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	056	0	1	01	01	H1026_056_0	3	1	Preferred Generic	3	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31								13.00		39.00					8.00		24.00					8.00		24.00																13.00				8.00			0.42	0.26	0.26			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1026	056	0	1	01	01	H1026_056_0	3	2	Generic	3	4	000100	1	2		110	01	110		1				31		90	1	31		90				31		31								20.00		60.00					15.00		45.00					15.00		45.00																20.00				15.00			0.65	0.48	0.48			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1026	057	0	1	01	01	H1026_057_0	3	3	Preferred Brand	1	4	010001	1	2		110	01	110		1				31		90	1	31		90				31		31								47.00		141.00					42.00		126.00					42.00		126.00																47.00				42.00			1.52	1.35	1.35			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	057	0	1	01	01	H1026_057_0	3	2	Generic	1	4	000100	1	2		110	01	110		1				31		90	1	31		90				31		31								20.00		60.00					15.00		45.00					15.00		45.00																20.00				15.00			0.65	0.48	0.48			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	057	0	1	01	01	H1026_057_0	3	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31								9.00		27.00					4.00		12.00					4.00		12.00																9.00				4.00			0.29	0.13	0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	057	0	1	01	01	H1026_057_0	3	4	Non-Preferred Brand	1	4	110000	1	2		110	01	110		1				31		90	1	31		90				31		31								100.00		300.00					95.00		285.00					95.00		285.00																100.00				95.00			3.23	3.06	3.06			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	057	0	1	01	01	H1026_057_0	3	2	Generic	3	4	000100	1	2		110	01	110		1				31		90	1	31		90				31		31								20.00		60.00					15.00		45.00					15.00		45.00																20.00				15.00			0.65	0.48	0.48			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1026	057	0	1	01	01	H1026_057_0	3	1	Preferred Generic	3	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31								9.00		27.00					4.00		12.00					4.00		12.00																9.00				4.00			0.29	0.13	0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1026	057	0	1	01	01	H1026_057_0	3	5	Specialty Tier	1	4	110001	1	1		010	01	010		1				31				31						31		31											721.24	33						721.24	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	058	0	1	01	01	H1026_058_0	5	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31								7.00		21.00					2.00		6.00					2.00		6.00																7.00				2.00			0.23	0.06	0.06			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	058	0	1	01	01	H1026_058_0	5	2	Generic	1	4	000100	1	2		110	01	110		1				31		90	1	31		90				31		31								15.00		45.00					10.00		30.00					10.00		30.00																15.00				10.00			0.48	0.32	0.32			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	058	0	1	01	01	H1026_058_0	5	3	Preferred Brand	1	4	010001	1	2		110	01	110		1				31		90	1	31		90				31		31								47.00		141.00					42.00		126.00					42.00		126.00																47.00				42.00			1.52	1.35	1.35			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	058	0	1	01	01	H1026_058_0	5	4	Non-Preferred Brand	1	4	110000	1	2		110	01	110		1				31		90	1	31		90				31		31								100.00		300.00					95.00		285.00					95.00		285.00																100.00				95.00			3.23	3.06	3.06			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	058	0	1	01	01	H1026_058_0	5	5	Specialty Tier	1	4	110001	1	1		010	01	010		1				31				31						31		31											528.24	33						528.24	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	058	0	1	01	01	H1026_058_0	5	1	Preferred Generic	3	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31								7.00		21.00					2.00		6.00					2.00		6.00																7.00				2.00			0.23	0.06	0.06			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1026	058	0	1	01	01	H1026_058_0	5	2	Generic	3	4	000100	1	2		110	01	110		1				31		90	1	31		90				31		31								15.00		45.00					10.00		30.00					10.00		30.00																15.00				10.00			0.48	0.32	0.32			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1032	032	0	1	01	01	H1032_032_0	4	4	Non-Preferred Brand	1	4	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				41.30	44		44																								44		44				44		44			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	032	0	1	01	01	H1032_032_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	38.00		114.00																									38.00		114.00				38.00		95.00				38.00				38.00		1.27				1.27	1.27	1.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	032	0	1	01	01	H1032_032_0	4	2	Generic	1	4	000100	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	032	0	1	01	01	H1032_032_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	032	0	1	01	01	H1032_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	040	0	1	01	01	H1032_040_0	4	4	Non-Preferred Brand	1	4	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				35.90	30		30																								30		30				30		30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	040	0	1	01	01	H1032_040_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	32.00		96.00																									32.00		96.00				32.00		80.00				32.00				32.00		1.07				1.07	1.07	1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	040	0	1	01	01	H1032_040_0	4	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	14.00		42.00																									14.00		42.00				14.00		35.00				14.00				14.00		0.47				0.47	0.47	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	040	0	1	01	01	H1032_040_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	040	0	1	01	01	H1032_040_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	061	0	1	01	01	H1032_061_0	5	1	Preferred Generic	1	3	001000	1	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	061	0	1	01	01	H1032_061_0	5	2	Generic	1	3	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	11.00		33.00																									11.00		33.00				11.00		27.50				11.00				11.00		0.37				0.37	0.37	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	061	0	1	01	01	H1032_061_0	5	3	Preferred Brand	1	3	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	061	0	1	01	01	H1032_061_0	5	4	Non-Preferred Brand	1	3	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				70.80	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	061	0	1	01	01	H1032_061_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	073	0	1	01	01	H1032_073_0	5	1	Preferred Generic	1	4	001000	1	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	073	0	1	01	01	H1032_073_0	5	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	14.00		42.00																									14.00		42.00				14.00		35.00				14.00				14.00		0.47				0.47	0.47	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	073	0	1	01	01	H1032_073_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	44.00		132.00																									44.00		132.00				44.00		110.00				44.00				44.00		1.47				1.47	1.47	1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	073	0	1	01	01	H1032_073_0	5	4	Non-Preferred Brand	1	4	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				55.10	47		47																								47		47				47		47			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	073	0	1	01	01	H1032_073_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	079	0	1	02	01	H1032_079_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		110	1	30		90				1				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	079	0	1	02	01	H1032_079_0	4	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		37.50				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	079	0	1	02	01	H1032_079_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		112.50				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	079	0	1	02	01	H1032_079_0	4	4	Non-Preferred Brand	1	4	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				51.40	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	079	0	1	02	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	091	0	1	02	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	091	0	1	02	01	H1032_091_0	4	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	13.00		39.00																									13.00		39.00				13.00		32.50				13.00				13.00		0.43				0.43	0.43	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	091	0	1	02	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	091	0	1	02	01	H1032_091_0	4	4	Non-Preferred Brand	1	4	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				41.80	38		38																								38		38				38		38			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	091	0	1	02	01	H1032_091_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	36.00		108.00																									36.00		108.00				36.00		90.00				36.00				36.00		1.20				1.20	1.20	1.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	124	0	1	01	01	H1032_124_0	5	3	Preferred Brand	1	3	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	124	0	1	01	01	H1032_124_0	5	2	Generic	1	3	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		30.00				12.00				12.00		0.40				0.40	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	124	0	1	01	01	H1032_124_0	5	1	Preferred Generic	1	3	001000	1	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	124	0	1	01	01	H1032_124_0	5	4	Non-Preferred Brand	1	3	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				70.10	49		49																								49		49				49		49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	124	0	1	01	01	H1032_124_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	133	0	1	02	01	H1032_133_0	5	4	Non-Preferred Brand	1	4	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				54.50	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	133	0	1	02	01	H1032_133_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		112.50				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	133	0	1	02	01	H1032_133_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	133	0	1	02	01	H1032_133_0	5	1	Preferred Generic	1	4	001000	1	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	133	0	1	02	01	H1032_133_0	5	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		37.50				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	170	0	1	01	01	H1032_170_0	5	4	Non-Preferred Brand	1	4	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				81.40	46		46																								46		46				46		46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	170	0	1	01	01	H1032_170_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	170	0	1	01	01	H1032_170_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	170	0	1	01	01	H1032_170_0	5	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	170	0	1	01	01	H1032_170_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	174	0	1	02	01	H1032_174_0	4	2	Generic	1	4	000100	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	174	0	1	02	01	H1032_174_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	30.00		90.00																									30.00		90.00				30.00		75.00				30.00				30.00		1.00				1.00	1.00	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	174	0	1	02	01	H1032_174_0	4	4	Non-Preferred Brand	1	4	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				40.10	38		38																								38		38				38		38			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	174	0	1	02	01	H1032_174_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	174	0	1	02	01	H1032_174_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	175	0	1	01	01	H1032_175_0	5	2	Generic	1	3	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	13.00		39.00																									13.00		39.00				13.00		32.50				13.00				13.00		0.43				0.43	0.43	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	175	0	1	01	01	H1032_175_0	5	3	Preferred Brand	1	3	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	175	0	1	01	01	H1032_175_0	5	4	Non-Preferred Brand	1	3	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				75.40	49		49																								49		49				49		49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	175	0	1	01	01	H1032_175_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	175	0	1	01	01	H1032_175_0	5	1	Preferred Generic	1	3	001000	1	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	176	0	1	01	01	H1032_176_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	176	0	1	01	01	H1032_176_0	5	4	Non-Preferred Brand	1	3	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				89.40	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	176	0	1	01	01	H1032_176_0	5	3	Preferred Brand	1	3	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	176	0	1	01	01	H1032_176_0	5	2	Generic	1	3	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	176	0	1	01	01	H1032_176_0	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	179	0	1	01	01	H1032_179_0	5	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		12.50				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	179	0	1	01	01	H1032_179_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	42.00		126.00																									42.00		126.00				42.00		105.00				42.00				42.00		1.40				1.40	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	179	0	1	01	01	H1032_179_0	5	4	Non-Preferred Brand	1	4	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				42.40	46		46																								46		46				46		46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	179	0	1	01	01	H1032_179_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	179	0	1	01	01	H1032_179_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	180	0	1	01	01	H1032_180_0	6	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		37.50				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	180	0	1	01	01	H1032_180_0	6	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	42.00		126.00																									42.00		126.00				42.00		105.00				42.00				42.00		1.40				1.40	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	180	0	1	01	01	H1032_180_0	6	4	Non-Preferred Brand	1	4	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				37.80	46		46																								46		46				46		46			46			46								Preferred Generic, 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	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, 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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	182	0	1	01	01	H1032_182_0	6	1	Preferred Generic	1	3	001000	1	2	110		01		110	1	30		90				1				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	182	0	1	01	01	H1032_182_0	6	2	Generic	1	3	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		15.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	182	0	1	01	01	H1032_182_0	6	3	Preferred Brand	1	3	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	44.00		132.00																									44.00		132.00				44.00		110.00				44.00				44.00		1.47				1.47	1.47	1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	182	0	1	01	01	H1032_182_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	182	0	1	01	01	H1032_182_0	6	4	Non-Preferred Brand	1	3	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				59.40	49		49																								49		49				49		49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	183	0	1	01	01	H1032_183_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	183	0	1	01	01	H1032_183_0	7	2	Generic	1	3	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		15.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	183	0	1	01	01	H1032_183_0	7	3	Preferred Brand	1	3	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		112.50				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	183	0	1	01	01	H1032_183_0	7	4	Non-Preferred Brand	1	3	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				61.60	49		49																								49		49				49		49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	183	0	1	01	01	H1032_183_0	7	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	002	0	1	02	01	H1035_002_0	4	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				31		93	1			93				31		31								10.00		30.00					0.00		0.00							0.00																10.00				10.00			0.32	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H1035	002	0	1	02	01	H1035_002_0	4	2	Generic	1	4	000100	1	2		110	01	100		1				31		93	1			93				31		31								20.00		60.00					7.00		21.00							18.00																20.00				20.00			0.65	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H1035	002	0	1	02	01	H1035_002_0	4	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				31		93	1			93				31		31								10.00		30.00					0.00		0.00							0.00																10.00				10.00			.32	0.00				.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs										1		
H1035	002	0	1	02	01	H1035_002_0	4	6	Injectable Drugs	1	4	010010	1	1		010	01			1				31										31		31											83.81	33						62.35	25																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H1035	002	0	1	02	01	H1035_002_0	4	5	Specialty Tier	1	4	010010	1	1		010	01			1				31										31		31											873.96	33						671.79	33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H1035	002	0	1	02	01	H1035_002_0	4	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				31		93	1			93				31		31								95.00		285.00					80.00		240.00							237.00																95.00				95.00			3.06	2.58				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H1035	002	0	1	02	01	H1035_002_0	4	3	Preferred Brand	1	4	000001	1	1		110	01	100		1				31		93	1			93				31		31											43.48	25		25				39.48	25		25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H1035	006	0	1	01	01	H1035_006_0	5	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				31		93	1			93				31		31								95.00		285.00					80.00		240.00							237.00																95.00				95.00			3.06	2.58				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H1035	006	0	1	01	01	H1035_006_0	5	5	Specialty Tier	1	4	010010	1	1		010	01			1				31										31		31											863.41	29						742.57	29																							29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H1035	006	0	1	01	01	H1035_006_0	5	6	Injectable Drugs	1	4	010010	1	1		010	01			1				31										31		31											83.84	29						57.11	25																							29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H1035	006	0	1	01	01	H1035_006_0	5	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				31		93	1			93				31		31								45.00		135.00					40.00		120.00							117.00																45.00				45.00			1.45	1.29				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H1035	006	0	1	01	01	H1035_006_0	5	2	Generic	1	4	000100	1	2		110	01	100		1				31		93	1			93				31		31								17.00		51.00					7.00		21.00							18.00																17.00				17.00			.55	.23				.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H1035	006	0	1	01	01	H1035_006_0	5	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				31		93	1			93				31		31								10.00		30.00					2.00		6.00							3.00																10.00				10.00			.32	.06				.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H1035	010	0	1	01	01	H1035_010_0	4	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				31		93	1			93				31		31								10.00		30.00					2.00		6.00							3.00																10.00				10.00			.32	.06				.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H1035	010	0	1	01	01	H1035_010_0	4	6	Injectable Drugs	1	4	010010	1	1		010	01			1				31										31		31											83.83	25						62.37	25																							25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H1035	010	0	1	01	01	H1035_010_0	4	5	Specialty Tier	1	4	010010	1	1		010	01			1				31										31		31											874.65	33						672.19	33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H1035	010	0	1	01	01	H1035_010_0	4	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				31		93	1			93				31		31								95.00		285.00					80.00		240.00							237.00																95.00				95.00			3.06	2.58				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H1035	010	0	1	01	01	H1035_010_0	4	2	Generic	1	4	000100	1	2		110	01	100		1				31		93	1			93				31		31								17.00		51.00					7.00		21.00							18.00																17.00				17.00			.55	.23				.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H1035	010	0	1	01	01	H1035_010_0	4	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				31		93	1			93				31		31								45.00		135.00					40.00		120.00							117.00																45.00				45.00			1.45	1.29				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H1035	011	0	1	02	01	H1035_011_0	4	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				31		93	1			93				31		31								10.00		30.00					0.00		0.00							0.00																10.00				10.00			0.32	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H1035	011	0	1	02	01	H1035_011_0	4	2	Generic	3	4	000100	1	2		110	01	100		1				31		93	1			93				31		31								17.00		51.00					7.00		21.00							18.00																17.00				17.00			.55	.13				.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs										1		
H1035	011	0	1	02	01	H1035_011_0	4	2	Generic	1	4	000100	1	2		110	01	100		1				31		93	1			93				31		31								17.00		51.00					7.00		21.00							18.00																17.00				17.00			.55	.13				.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H1035	011	0	1	02	01	H1035_011_0	4	6	Injectable Drugs	1	4	010010	1	1		010	01			1				31										31		31											83.81	25						62.36	25																							25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H1035	011	0	1	02	01	H1035_011_0	4	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				31		93	1			93				31		31								10.00		30.00					0.00		0.00							0.00																10.00				10.00			.32	0.00				.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs										1		
H1035	011	0	1	02	01	H1035_011_0	4	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				31		93	1			93				31		31								45.00		135.00					40.00		120.00							117.00																45.00				45.00			1.45	1.29				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H1035	011	0	1	02	01	H1035_011_0	4	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				31		93	1			93				31		31								95.00		285.00					80.00		240.00							237.00																95.00				95.00			3.06	2.58				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H1035	011	0	1	02	01	H1035_011_0	4	5	Specialty Tier	1	4	010010	1	1		010	01			1				31										31		31											974.15	33						671.90	33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H1035	012	0	1	01	01	H1035_012_0	6	2	Generic	1	4	000100	1	2	110		01	110		1	31		90				1	31		90				31		31	7.00		21.00																			7.00		21.00																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	012	0	1	01	01	H1035_012_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	31		90				1	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	012	0	1	01	01	H1035_012_0	6	3	Preferred Brand	1	4	010001	1	2	110		01	110		1	31		90				1	31		90				31		31	35.00		105.00																			35.00		105.00																35.00				35.00		1.13			1.13			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	012	0	1	01	01	H1035_012_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01	110		1	31		90				1	31		90				31		31	85.00		255.00																			85.00		255.00																85.00				85.00		2.74			2.74			2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	012	0	1	01	01	H1035_012_0	6	5	Specialty Tier	1	4	010010	1	1	110		01	110		1	31		90				1	31		90				31		31				445.00	33		33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	012	0	1	01	01	H1035_012_0	6	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	31		90				1	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1036	025	0	1	01	01	H1036_025_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	025	0	1	01	01	H1036_025_0	3	2	Generic	1	4	000101	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, 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	15.00		45.00																									15.00		45.00				15.00		35.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, 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	60.00		180.00																									60.00		180.00				60.00		170.00				60.00				60.00		2.00				2.00	2.00	1.93	Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	025	0	1	01	01	H1036_025_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1036	025	0	1	01	01	H1036_025_0	3	2	Generic	3	4	000101	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
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	15.00		45.00																									15.00		45.00				15.00		35.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, 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	60.00		180.00																									60.00		180.00				60.00		170.00				60.00				60.00		2.00				2.00	2.00	1.93	Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	040	0	1	01	01	H1036_040_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, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	55.00		165.00																									55.00		165.00				55.00		155.00				55.00				55.00		1.83				1.83	1.83	1.77	Preferred Generic, 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	10.00		30.00																									10.00		30.00				10.00		20.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	040	0	1	01	01	H1036_040_0	3	2	Generic	1	4	000101	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	040	0	1	01	01	H1036_040_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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, 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	55.00		165.00																									55.00		165.00				55.00		155.00				55.00				55.00		1.83				1.83	1.83	1.77	Preferred Generic, 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	10.00		30.00																									10.00		30.00				10.00		20.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	040	0	1	01	01	H1036_040_0	3	2	Generic	3	4	000101	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H1036	044	0	1	01	01	H1036_044_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	044	0	1	01	01	H1036_044_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	044	0	1	01	01	H1036_044_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	85.00		255.00																									85.00		255.00				85.00		245.00				85.00				85.00		2.83				2.83	2.83	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	044	0	1	01	01	H1036_044_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	044	0	1	01	01	H1036_044_0	4	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	044	0	1	01	01	H1036_044_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	044	0	1	01	01	H1036_044_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	044	0	1	01	01	H1036_044_0	4	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	044	0	1	01	01	H1036_044_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	044	0	1	01	01	H1036_044_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	85.00		255.00																									85.00		255.00				85.00		245.00				85.00				85.00		2.83				2.83	2.83	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	052	0	1	01	01	H1036_052_0	3	2	Generic	3	4	000101	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H1036	052	0	1	01	01	H1036_052_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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, 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	60.00		180.00																									60.00		180.00				60.00		170.00				60.00				60.00		2.00				2.00	2.00	1.93	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	15.00		45.00																									15.00		45.00				15.00		35.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	052	0	1	01	01	H1036_052_0	3	2	Generic	1	4	000101	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	052	0	1	01	01	H1036_052_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, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	60.00		180.00																									60.00		180.00				60.00		170.00				60.00				60.00		2.00				2.00	2.00	1.93	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	15.00		45.00																									15.00		45.00				15.00		35.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, 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	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, 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	10.00		30.00																									10.00		30.00				10.00		20.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	054	0	1	01	01	H1036_054_0	4	2	Generic	3	4	000101	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H1036	054	0	1	01	01	H1036_054_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										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, 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	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, 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	10.00		30.00																									10.00		30.00				10.00		20.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	054	0	1	01	01	H1036_054_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	054	0	1	01	01	H1036_054_0	4	2	Generic	1	4	000101	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	062	0	1	01	01	H1036_062_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	062	0	1	01	01	H1036_062_0	4	2	Generic	1	4	000101	3	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	062	0	1	01	01	H1036_062_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	062	0	1	01	01	H1036_062_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	062	0	1	01	01	H1036_062_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	062	0	1	01	01	H1036_062_0	4	2	Generic	3	4	000101	3	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H1036	062	0	1	01	01	H1036_062_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1036	062	0	1	01	01	H1036_062_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	062	0	1	01	01	H1036_062_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	062	0	1	01	01	H1036_062_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	065	0	1	01	01	H1036_065_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	40.00		120.00																									40.00		120.00				40.00		110.00				40.00				40.00		1.33				1.33	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	065	0	1	01	01	H1036_065_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	85.00		255.00																									85.00		255.00				85.00		245.00				85.00				85.00		2.83				2.83	2.83	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	065	0	1	01	01	H1036_065_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1036	065	0	1	01	01	H1036_065_0	5	2	Generic	3	4	000101	3	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H1036	065	0	1	01	01	H1036_065_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	065	0	1	01	01	H1036_065_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	85.00		255.00																									85.00		255.00				85.00		245.00				85.00				85.00		2.83				2.83	2.83	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	065	0	1	01	01	H1036_065_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	40.00		120.00																									40.00		120.00				40.00		110.00				40.00				40.00		1.33				1.33	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	065	0	1	01	01	H1036_065_0	5	2	Generic	1	4	000101	3	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	065	0	1	01	01	H1036_065_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	065	0	1	01	01	H1036_065_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					33																										33						33					33			33								Preferred Generic, 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	55.00		165.00																									55.00		165.00				55.00		155.00				55.00				55.00		1.83				1.83	1.83	1.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	10.00		30.00																									10.00		30.00				10.00		20.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	067	0	1	01	01	H1036_067_0	3	2	Generic	3	4	000101	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H1036	067	0	1	01	01	H1036_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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	55.00		165.00																									55.00		165.00				55.00		155.00				55.00				55.00		1.83				1.83	1.83	1.77	Preferred Generic, 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	10.00		30.00																									10.00		30.00				10.00		20.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	067	0	1	01	01	H1036_067_0	3	2	Generic	1	4	000101	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	067	0	1	01	01	H1036_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	068	0	1	01	01	H1036_068_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	40.00		120.00																									40.00		120.00				40.00		110.00				40.00				40.00		1.33				1.33	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	068	0	1	01	01	H1036_068_0	4	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	068	0	1	01	01	H1036_068_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	068	0	1	01	01	H1036_068_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1036	068	0	1	01	01	H1036_068_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	068	0	1	01	01	H1036_068_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	068	0	1	01	01	H1036_068_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	89.00		267.00																									89.00		267.00				89.00		257.00				89.00				89.00		2.96				2.96	2.96	2.87	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	068	0	1	01	01	H1036_068_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	89.00		267.00																									89.00		267.00				89.00		257.00				89.00				89.00		2.96				2.96	2.96	2.87	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	068	0	1	01	01	H1036_068_0	4	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1036	068	0	1	01	01	H1036_068_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	40.00		120.00																									40.00		120.00				40.00		110.00				40.00				40.00		1.33				1.33	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	074	0	1	01	01	H1036_074_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	074	0	1	01	01	H1036_074_0	3	2	Generic	1	4	000101	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	074	0	1	01	01	H1036_074_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		35.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	074	0	1	01	01	H1036_074_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	60.00		180.00																									60.00		180.00				60.00		170.00				60.00				60.00		2.00				2.00	2.00	1.93	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	074	0	1	01	01	H1036_074_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	074	0	1	01	01	H1036_074_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1036	074	0	1	01	01	H1036_074_0	3	2	Generic	3	4	000101	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H1036	074	0	1	01	01	H1036_074_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		35.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	074	0	1	01	01	H1036_074_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	60.00		180.00																									60.00		180.00				60.00		170.00				60.00				60.00		2.00				2.00	2.00	1.93	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	074	0	1	01	01	H1036_074_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	077	0	1	01	01	H1036_077_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	077	0	1	01	01	H1036_077_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	077	0	1	01	01	H1036_077_0	6	2	Generic	1	4	000101	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	077	0	1	01	01	H1036_077_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	077	0	1	01	01	H1036_077_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	081	0	1	01	01	H1036_081_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	081	0	1	01	01	H1036_081_0	4	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	081	0	1	01	01	H1036_081_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	081	0	1	01	01	H1036_081_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	89.00		267.00																									89.00		267.00				89.00		257.00				89.00				89.00		2.96				2.96	2.96	2.87	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	081	0	1	01	01	H1036_081_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	081	0	1	01	01	H1036_081_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1036	081	0	1	01	01	H1036_081_0	4	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1036	081	0	1	01	01	H1036_081_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	081	0	1	01	01	H1036_081_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	89.00		267.00																									89.00		267.00				89.00		257.00				89.00				89.00		2.96				2.96	2.96	2.87	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	081	0	1	01	01	H1036_081_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	102	0	1	01	01	H1036_102_0	3	2	Generic	1	4	000101	3	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	102	0	1	01	01	H1036_102_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	102	0	1	01	01	H1036_102_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	102	0	1	01	01	H1036_102_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	102	0	1	01	01	H1036_102_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	103	0	1	01	01	H1036_103_0	5	2	Generic	1	4	000101	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	103	0	1	01	01	H1036_103_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, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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, 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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	104	0	1	01	01	H1036_104_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	104	0	1	01	01	H1036_104_0	5	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	104	0	1	01	01	H1036_104_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	104	0	1	01	01	H1036_104_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	104	0	1	01	01	H1036_104_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	121	0	1	01	01	H1036_121_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	121	0	1	01	01	H1036_121_0	5	2	Generic	1	4	000101	3	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	121	0	1	01	01	H1036_121_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	40.00		120.00																									40.00		120.00				40.00		110.00				40.00				40.00		1.33				1.33	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	121	0	1	01	01	H1036_121_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	85.00		255.00																									85.00		255.00				85.00		245.00				85.00				85.00		2.83				2.83	2.83	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	121	0	1	01	01	H1036_121_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	121	0	1	01	01	H1036_121_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1036	121	0	1	01	01	H1036_121_0	5	2	Generic	3	4	000101	3	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H1036	121	0	1	01	01	H1036_121_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	40.00		120.00																									40.00		120.00				40.00		110.00				40.00				40.00		1.33				1.33	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	121	0	1	01	01	H1036_121_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	85.00		255.00																									85.00		255.00				85.00		245.00				85.00				85.00		2.83				2.83	2.83	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	121	0	1	01	01	H1036_121_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	130	0	1	01	01	H1036_130_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	130	0	1	01	01	H1036_130_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	130	0	1	01	01	H1036_130_0	4	2	Generic	1	4	000101	3	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	130	0	1	01	01	H1036_130_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	130	0	1	01	01	H1036_130_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	130	0	1	01	01	H1036_130_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1036	130	0	1	01	01	H1036_130_0	4	2	Generic	3	4	000101	3	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H1036	130	0	1	01	01	H1036_130_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	130	0	1	01	01	H1036_130_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	130	0	1	01	01	H1036_130_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	137	0	1	01	01	H1036_137_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	137	0	1	01	01	H1036_137_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	137	0	1	01	01	H1036_137_0	4	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	137	0	1	01	01	H1036_137_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	137	0	1	01	01	H1036_137_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	137	0	1	01	01	H1036_137_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	137	0	1	01	01	H1036_137_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	137	0	1	01	01	H1036_137_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	137	0	1	01	01	H1036_137_0	4	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	137	0	1	01	01	H1036_137_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	138	0	1	01	01	H1036_138_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	138	0	1	01	01	H1036_138_0	4	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	138	0	1	01	01	H1036_138_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	138	0	1	01	01	H1036_138_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	138	0	1	01	01	H1036_138_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	138	0	1	01	01	H1036_138_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	138	0	1	01	01	H1036_138_0	4	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	138	0	1	01	01	H1036_138_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	138	0	1	01	01	H1036_138_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	138	0	1	01	01	H1036_138_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	140	0	1	01	01	H1036_140_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	140	0	1	01	01	H1036_140_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	140	0	1	01	01	H1036_140_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	140	0	1	01	01	H1036_140_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	75.00		225.00																									75.00		225.00				75.00		215.00				75.00				75.00		2.50				2.50	2.50	2.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	140	0	1	01	01	H1036_140_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	140	0	1	01	01	H1036_140_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	140	0	1	01	01	H1036_140_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	140	0	1	01	01	H1036_140_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	140	0	1	01	01	H1036_140_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	75.00		225.00																									75.00		225.00				75.00		215.00				75.00				75.00		2.50				2.50	2.50	2.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	140	0	1	01	01	H1036_140_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	141	0	1	01	01	H1036_141_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, 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	95.00		285.00																									95.00		285.00				95.00		275.00				95.00				95.00		3.16				3.16	3.16	3.06	Preferred Generic, 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	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	141	0	1	01	01	H1036_141_0	3	2	Generic	3	4	000101	3	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	3
H1036	141	0	1	01	01	H1036_141_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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, 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	95.00		285.00																									95.00		285.00				95.00		275.00				95.00				95.00		3.16				3.16	3.16	3.06	Preferred Generic, 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	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	141	0	1	01	01	H1036_141_0	3	2	Generic	1	4	000101	3	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	141	0	1	01	01	H1036_141_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	143	0	1	01	01	H1036_143_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	85.00		255.00																									85.00		255.00				85.00		245.00				85.00				85.00		2.83				2.83	2.83	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	143	0	1	01	01	H1036_143_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	143	0	1	01	01	H1036_143_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	143	0	1	01	01	H1036_143_0	4	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	143	0	1	01	01	H1036_143_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	143	0	1	01	01	H1036_143_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	85.00		255.00																									85.00		255.00				85.00		245.00				85.00				85.00		2.83				2.83	2.83	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	143	0	1	01	01	H1036_143_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	143	0	1	01	01	H1036_143_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	143	0	1	01	01	H1036_143_0	4	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	143	0	1	01	01	H1036_143_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	85.00		255.00																									85.00		255.00				85.00		245.00				85.00				85.00		2.83				2.83	2.83	2.74	Preferred Generic, 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	35.00		105.00																									35.00		105.00				35.00		95.00				35.00				35.00		1.16				1.16	1.16	1.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	146	0	1	01	01	H1036_146_0	3	2	Generic	1	4	000101	3	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1036	146	0	1	01	01	H1036_146_0	3	2	Generic	3	4	000101	3	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
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	35.00		105.00																									35.00		105.00				35.00		95.00				35.00				35.00		1.16				1.16	1.16	1.12	Preferred Generic, 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	85.00		255.00																									85.00		255.00				85.00		245.00				85.00				85.00		2.83				2.83	2.83	2.74	Preferred Generic, 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, 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	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	151	0	1	01	01	H1036_151_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, 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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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					25																										25						25					25			25								Preferred Generic, 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	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	151	0	1	01	01	H1036_151_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	3.00		9.00																									3.00		9.00				3.00		0.00				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	153	0	1	01	01	H1036_153_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, 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	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, 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	95.00		285.00																									95.00		285.00				95.00		275.00				95.00				95.00		3.16				3.16	3.16	3.06	Preferred Generic, 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, 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	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	153	0	1	01	01	H1036_153_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, 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	3.00		9.00																									3.00		9.00				3.00		0.00				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	95.00		285.00																									95.00		285.00				95.00		275.00				95.00				95.00		3.16				3.16	3.16	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	156	0	1	01	01	H1036_156_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1036	156	0	1	01	01	H1036_156_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H1036	156	0	1	01	01	H1036_156_0	5	2	Generic	3	4	000101	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	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	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
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	85.00		255.00																									85.00		255.00				85.00		245.00				85.00				85.00		2.83				2.83	2.83	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
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					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H1036	156	0	1	01	01	H1036_156_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1036	156	0	1	01	01	H1036_156_0	5	2	Generic	1	4	000101	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
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	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, 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	85.00		255.00																									85.00		255.00				85.00		245.00				85.00				85.00		2.83				2.83	2.83	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1036	157	0	1	01	01	H1036_157_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	157	0	1	01	01	H1036_157_0	4	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.66				0.66	0.66	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	157	0	1	01	01	H1036_157_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	157	0	1	01	01	H1036_157_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	95.00		285.00																									95.00		285.00				95.00		275.00				95.00				95.00		3.16				3.16	3.16	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	157	0	1	01	01	H1036_157_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	157	0	1	01	01	H1036_157_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	157	0	1	01	01	H1036_157_0	4	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.66				0.66	0.66	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	157	0	1	01	01	H1036_157_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	157	0	1	01	01	H1036_157_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	95.00		285.00																									95.00		285.00				95.00		275.00				95.00				95.00		3.16				3.16	3.16	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	157	0	1	01	01	H1036_157_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	160	0	1	01	01	H1036_160_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1036	160	0	1	01	01	H1036_160_0	3	2	Generic	1	4	000101	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, 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, 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	3	4	010010	1	1	010		01		010	1	30										30			30		31					33																										33						33					33			33								Preferred Generic, 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	60.00		180.00																									60.00		180.00				60.00		170.00				60.00				60.00		2.00				2.00	2.00	1.93	Preferred Generic, 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	15.00		45.00																									15.00		45.00				15.00		35.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H1036	160	0	1	01	01	H1036_160_0	3	2	Generic	3	4	000101	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	3
H1036	160	0	1	01	01	H1036_160_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
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	60.00		180.00																									60.00		180.00				60.00		170.00				60.00				60.00		2.00				2.00	2.00	1.93	Preferred Generic, 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	15.00		45.00																									15.00		45.00				15.00		35.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1036	167	0	1	01	01	H1036_167_0	4	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	167	0	1	01	01	H1036_167_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	167	0	1	01	01	H1036_167_0	4	2	Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	167	0	1	01	01	H1036_167_0	4	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	167	0	1	01	01	H1036_167_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	168	0	1	01	01	H1036_168_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	168	0	1	01	01	H1036_168_0	4	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	168	0	1	01	01	H1036_168_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	168	0	1	01	01	H1036_168_0	4	2	Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	168	0	1	01	01	H1036_168_0	4	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, 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	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	171	0	1	01	01	H1036_171_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		0.00				12.00				12.00		0.40				0.40	0.40	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	171	0	1	01	01	H1036_171_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		0.00				12.00				12.00		0.40				0.40	0.40	0.38	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	175	0	1	01	01	H1036_175_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H1036	175	0	1	01	01	H1036_175_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H1036	175	0	1	01	01	H1036_175_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	89.00		267.00																									89.00		267.00				89.00		257.00				89.00				89.00		2.96				2.96	2.96	2.87	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H1036	175	0	1	01	01	H1036_175_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H1036	175	0	1	01	01	H1036_175_0	4	2	Generic	3	4	000101	3	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	3
H1036	175	0	1	01	01	H1036_175_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H1036	175	0	1	01	01	H1036_175_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1036	175	0	1	01	01	H1036_175_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1036	175	0	1	01	01	H1036_175_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	89.00		267.00																									89.00		267.00				89.00		257.00				89.00				89.00		2.96				2.96	2.96	2.87	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1036	175	0	1	01	01	H1036_175_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1036	175	0	1	01	01	H1036_175_0	4	2	Generic	1	4	000101	3	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1036	175	0	1	01	01	H1036_175_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1036	178	0	1	01	01	H1036_178_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H1036	178	0	1	01	01	H1036_178_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H1036	178	0	1	01	01	H1036_178_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H1036	178	0	1	01	01	H1036_178_0	4	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		0.00				12.00				12.00		0.40				0.40	0.40	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H1036	178	0	1	01	01	H1036_178_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H1036	178	0	1	01	01	H1036_178_0	4	6	Select Care Drugs	3	4	010010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H1036	178	0	1	01	01	H1036_178_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1036	178	0	1	01	01	H1036_178_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1036	178	0	1	01	01	H1036_178_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1036	178	0	1	01	01	H1036_178_0	4	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		0.00				12.00				12.00		0.40				0.40	0.40	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1036	178	0	1	01	01	H1036_178_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1036	178	0	1	01	01	H1036_178_0	4	6	Select Care Drugs	1	4	010010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1036	179	0	1	01	01	H1036_179_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H1036	179	0	1	01	01	H1036_179_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H1036	179	0	1	01	01	H1036_179_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H1036	179	0	1	01	01	H1036_179_0	4	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H1036	179	0	1	01	01	H1036_179_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H1036	179	0	1	01	01	H1036_179_0	4	6	Select Care Drugs	1	4	010010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1036	179	0	1	01	01	H1036_179_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1036	179	0	1	01	01	H1036_179_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1036	179	0	1	01	01	H1036_179_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1036	179	0	1	01	01	H1036_179_0	4	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1036	179	0	1	01	01	H1036_179_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1036	179	0	1	01	01	H1036_179_0	4	6	Select Care Drugs	3	4	010010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H1036	184	0	1	01	01	H1036_184_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H1036	184	0	1	01	01	H1036_184_0	5	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H1036	184	0	1	01	01	H1036_184_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H1036	184	0	1	01	01	H1036_184_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H1036	184	0	1	01	01	H1036_184_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H1036	184	0	1	01	01	H1036_184_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1036	184	0	1	01	01	H1036_184_0	5	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1036	184	0	1	01	01	H1036_184_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1036	184	0	1	01	01	H1036_184_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1036	184	0	1	01	01	H1036_184_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1036	184	0	1	01	01	H1036_184_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1036	186	0	1	01	01	H1036_186_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	186	0	1	01	01	H1036_186_0	5	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	186	0	1	01	01	H1036_186_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	40.00		120.00																									40.00		120.00				40.00		110.00				40.00				40.00		1.33				1.33	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	186	0	1	01	01	H1036_186_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	85.00		255.00																									85.00		255.00				85.00		245.00				85.00				85.00		2.83				2.83	2.83	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	186	0	1	01	01	H1036_186_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	186	0	1	01	01	H1036_186_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	186	0	1	01	01	H1036_186_0	5	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	186	0	1	01	01	H1036_186_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	40.00		120.00																									40.00		120.00				40.00		110.00				40.00				40.00		1.33				1.33	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	186	0	1	01	01	H1036_186_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	85.00		255.00																									85.00		255.00				85.00		245.00				85.00				85.00		2.83				2.83	2.83	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	186	0	1	01	01	H1036_186_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	188	0	1	01	01	H1036_188_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	188	0	1	01	01	H1036_188_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	188	0	1	01	01	H1036_188_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		20.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	188	0	1	01	01	H1036_188_0	5	2	Generic	3	4	000101	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H1036	188	0	1	01	01	H1036_188_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1036	188	0	1	01	01	H1036_188_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	188	0	1	01	01	H1036_188_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	188	0	1	01	01	H1036_188_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	188	0	1	01	01	H1036_188_0	5	2	Generic	1	4	000101	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	188	0	1	01	01	H1036_188_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		20.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	189	0	1	01	01	H1036_189_0	6	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	189	0	1	01	01	H1036_189_0	6	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		20.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	189	0	1	01	01	H1036_189_0	6	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1036	189	0	1	01	01	H1036_189_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1036	189	0	1	01	01	H1036_189_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	189	0	1	01	01	H1036_189_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	189	0	1	01	01	H1036_189_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		20.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	189	0	1	01	01	H1036_189_0	6	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	189	0	1	01	01	H1036_189_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	189	0	1	01	01	H1036_189_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	35.00		105.00																									35.00		105.00				35.00		95.00				35.00				35.00		1.16				1.16	1.16	1.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H1036	193	0	1	01	01	H1036_193_0	3	2	Generic	3	4	000101	3	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	3
H1036	193	0	1	01	01	H1036_193_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, 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	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
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, 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	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
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	35.00		105.00																									35.00		105.00				35.00		95.00				35.00				35.00		1.16				1.16	1.16	1.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1036	193	0	1	01	01	H1036_193_0	3	2	Generic	1	4	000101	3	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, 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	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
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	85.00		255.00																									85.00		255.00				85.00		245.00				85.00				85.00		2.83				2.83	2.83	2.74	Preferred Generic, 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, 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	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	85.00		255.00																									85.00		255.00				85.00		245.00				85.00				85.00		2.83				2.83	2.83	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
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	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H1036	194	0	1	01	01	H1036_194_0	3	2	Generic	3	4	000101	3	2	110		01		110	1	30		90				2				30		90	30		31	9.00		27.00																									9.00		27.00				9.00		0.00				9.00				9.00		0.30				0.30	0.30	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	3
H1036	194	0	1	01	01	H1036_194_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, 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	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
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, 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	85.00		255.00																									85.00		255.00				85.00		245.00				85.00				85.00		2.83				2.83	2.83	2.74	Preferred Generic, 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	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1036	194	0	1	01	01	H1036_194_0	3	2	Generic	1	4	000101	3	2	110		01		110	1	30		90				2				30		90	30		31	9.00		27.00																									9.00		27.00				9.00		0.00				9.00				9.00		0.30				0.30	0.30	0.29	Preferred Generic, 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	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, 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	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	85.00		255.00																									85.00		255.00				85.00		245.00				85.00				85.00		2.83				2.83	2.83	2.74	Preferred Generic, 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, 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	3	4	010010	1	1	010		01		010	1	30										30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H1036	196	0	1	01	01	H1036_196_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	196	0	1	01	01	H1036_196_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.66				0.66	0.66	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	196	0	1	01	01	H1036_196_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	196	0	1	01	01	H1036_196_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	95.00		285.00																									95.00		285.00				95.00		275.00				95.00				95.00		3.16				3.16	3.16	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	196	0	1	01	01	H1036_196_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	196	0	1	01	01	H1036_196_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.66				0.66	0.66	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	196	0	1	01	01	H1036_196_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	196	0	1	01	01	H1036_196_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	196	0	1	01	01	H1036_196_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	95.00		285.00																									95.00		285.00				95.00		275.00				95.00				95.00		3.16				3.16	3.16	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	196	0	1	01	01	H1036_196_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	199	0	1	01	01	H1036_199_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	199	0	1	01	01	H1036_199_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	199	0	1	01	01	H1036_199_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	199	0	1	01	01	H1036_199_0	4	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	199	0	1	01	01	H1036_199_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	199	0	1	01	01	H1036_199_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	199	0	1	01	01	H1036_199_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	199	0	1	01	01	H1036_199_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	199	0	1	01	01	H1036_199_0	4	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	199	0	1	01	01	H1036_199_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	209	0	1	01	01	H1036_209_0	3	2	Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	209	0	1	01	01	H1036_209_0	3	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	209	0	1	01	01	H1036_209_0	3	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	209	0	1	01	01	H1036_209_0	3	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	209	0	1	01	01	H1036_209_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	210	0	1	01	01	H1036_210_0	3	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	210	0	1	01	01	H1036_210_0	3	2	Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	210	0	1	01	01	H1036_210_0	3	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	210	0	1	01	01	H1036_210_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	210	0	1	01	01	H1036_210_0	3	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	213	0	1	01	01	H1036_213_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	213	0	1	01	01	H1036_213_0	3	2	Generic	1	4	000101	3	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	213	0	1	01	01	H1036_213_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	213	0	1	01	01	H1036_213_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	213	0	1	01	01	H1036_213_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	214	0	1	01	01	H1036_214_0	3	2	Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	214	0	1	01	01	H1036_214_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	214	0	1	01	01	H1036_214_0	3	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	214	0	1	01	01	H1036_214_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	214	0	1	01	01	H1036_214_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	215	0	1	01	01	H1036_215_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	215	0	1	01	01	H1036_215_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.66				0.66	0.66	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	215	0	1	01	01	H1036_215_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	215	0	1	01	01	H1036_215_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	215	0	1	01	01	H1036_215_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	215	0	1	01	01	H1036_215_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	215	0	1	01	01	H1036_215_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.66				0.66	0.66	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	215	0	1	01	01	H1036_215_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	215	0	1	01	01	H1036_215_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	215	0	1	01	01	H1036_215_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	217	0	1	01	01	H1036_217_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.66				0.66	0.66	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	217	0	1	01	01	H1036_217_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	217	0	1	01	01	H1036_217_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	217	0	1	01	01	H1036_217_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	217	0	1	01	01	H1036_217_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	95.00		285.00																									95.00		285.00				95.00		275.00				95.00				95.00		3.16				3.16	3.16	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	217	0	1	01	01	H1036_217_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	217	0	1	01	01	H1036_217_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.66				0.66	0.66	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	217	0	1	01	01	H1036_217_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	217	0	1	01	01	H1036_217_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	217	0	1	01	01	H1036_217_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	95.00		285.00																									95.00		285.00				95.00		275.00				95.00				95.00		3.16				3.16	3.16	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	218	0	1	01	01	H1036_218_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	218	0	1	01	01	H1036_218_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.66				0.66	0.66	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	218	0	1	01	01	H1036_218_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	218	0	1	01	01	H1036_218_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	95.00		285.00																									95.00		285.00				95.00		275.00				95.00				95.00		3.16				3.16	3.16	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	218	0	1	01	01	H1036_218_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	218	0	1	01	01	H1036_218_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.66				0.66	0.66	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	218	0	1	01	01	H1036_218_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	218	0	1	01	01	H1036_218_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	218	0	1	01	01	H1036_218_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	95.00		285.00																									95.00		285.00				95.00		275.00				95.00				95.00		3.16				3.16	3.16	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	218	0	1	01	01	H1036_218_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, 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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, 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	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, 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	95.00		285.00																									95.00		285.00				95.00		275.00				95.00				95.00		3.16				3.16	3.16	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	219	0	1	01	01	H1036_219_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, 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	95.00		285.00																									95.00		285.00				95.00		275.00				95.00				95.00		3.16				3.16	3.16	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	219	0	1	01	01	H1036_219_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, 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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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, 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	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	222	0	1	01	01	H1036_222_0	3	2	Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	223	0	1	01	01	H1036_223_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	223	0	1	01	01	H1036_223_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, 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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	226	0	1	01	01	H1036_226_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	226	0	1	01	01	H1036_226_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	226	0	1	01	01	H1036_226_0	3	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	226	0	1	01	01	H1036_226_0	3	2	Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00		9.00																									3.00		9.00				3.00		0.00				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	226	0	1	01	01	H1036_226_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, 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	95.00		285.00																									95.00		285.00				95.00		275.00				95.00				95.00		3.16				3.16	3.16	3.06	Preferred Generic, 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	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	227	0	1	01	01	H1036_227_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, 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	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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					25																										25						25					25			25								Preferred Generic, 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					25																										25						25					25			25								Preferred Generic, 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	95.00		285.00																									95.00		285.00				95.00		275.00				95.00				95.00		3.16				3.16	3.16	3.06	Preferred Generic, 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	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	227	0	1	01	01	H1036_227_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, 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	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	229	0	1	01	01	H1036_229_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.66				0.66	0.66	0.64	Preferred Generic, 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	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, 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	95.00		285.00																									95.00		285.00				95.00		275.00				95.00				95.00		3.16				3.16	3.16	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	229	0	1	01	01	H1036_229_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					28																										28						28					28			28								Preferred Generic, 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	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	229	0	1	01	01	H1036_229_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.66				0.66	0.66	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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					28																										28						28					28			28								Preferred Generic, 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	95.00		285.00																									95.00		285.00				95.00		275.00				95.00				95.00		3.16				3.16	3.16	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	230	0	1	01	01	H1036_230_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	230	0	1	01	01	H1036_230_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	230	0	1	01	01	H1036_230_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	230	0	1	01	01	H1036_230_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	230	0	1	01	01	H1036_230_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	95.00		285.00																									95.00		285.00				95.00		275.00				95.00				95.00		3.16				3.16	3.16	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	230	0	1	01	01	H1036_230_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	230	0	1	01	01	H1036_230_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	230	0	1	01	01	H1036_230_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	230	0	1	01	01	H1036_230_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	230	0	1	01	01	H1036_230_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	95.00		285.00																									95.00		285.00				95.00		275.00				95.00				95.00		3.16				3.16	3.16	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	231	0	1	01	01	H1036_231_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	231	0	1	01	01	H1036_231_0	3	2	Generic	1	4	000101	3	2	110		01		110	1	30		90				2				30		90	30		31	1.00		3.00																									1.00		3.00				1.00		0.00				1.00				1.00		0.03				0.03	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	231	0	1	01	01	H1036_231_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	231	0	1	01	01	H1036_231_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	231	0	1	01	01	H1036_231_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	233	0	1	01	01	H1036_233_0	4	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	233	0	1	01	01	H1036_233_0	4	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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					26																										26						26					26			26								Preferred Generic, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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					26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	234	0	1	01	01	H1036_234_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H1036	234	0	1	01	01	H1036_234_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H1036	234	0	1	01	01	H1036_234_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H1036	234	0	1	01	01	H1036_234_0	4	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	14.00		42.00																									14.00		42.00				14.00		0.00				14.00				14.00		0.46				0.46	0.46	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H1036	234	0	1	01	01	H1036_234_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H1036	234	0	1	01	01	H1036_234_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1036	234	0	1	01	01	H1036_234_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1036	234	0	1	01	01	H1036_234_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1036	234	0	1	01	01	H1036_234_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1036	234	0	1	01	01	H1036_234_0	4	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	14.00		42.00																									14.00		42.00				14.00		0.00				14.00				14.00		0.46				0.46	0.46	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1036	234	0	1	01	01	H1036_234_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1036	235	0	1	01	01	H1036_235_0	3	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	235	0	1	01	01	H1036_235_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	235	0	1	01	01	H1036_235_0	3	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	235	0	1	01	01	H1036_235_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	235	0	1	01	01	H1036_235_0	3	2	Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	14.00		42.00																									14.00		42.00				14.00		0.00				14.00				14.00		0.46				0.46	0.46	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	236	0	1	01	01	H1036_236_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	236	0	1	01	01	H1036_236_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	236	0	1	01	01	H1036_236_0	4	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	14.00		42.00																									14.00		42.00				14.00		0.00				14.00				14.00		0.46				0.46	0.46	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	236	0	1	01	01	H1036_236_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	236	0	1	01	01	H1036_236_0	4	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	14.00		42.00																									14.00		42.00				14.00		0.00				14.00				14.00		0.46				0.46	0.46	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1036	236	0	1	01	01	H1036_236_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	236	0	1	01	01	H1036_236_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	236	0	1	01	01	H1036_236_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	236	0	1	01	01	H1036_236_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	236	0	1	01	01	H1036_236_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	237	1	1	01	01	H1036_237_1	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	237	1	1	01	01	H1036_237_1	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	237	1	1	01	01	H1036_237_1	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	237	1	1	01	01	H1036_237_1	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	237	1	1	01	01	H1036_237_1	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	237	1	1	01	01	H1036_237_1	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	237	1	1	01	01	H1036_237_1	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	237	1	1	01	01	H1036_237_1	4	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	237	1	1	01	01	H1036_237_1	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	237	1	1	01	01	H1036_237_1	4	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	237	2	1	01	01	H1036_237_2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	237	2	1	01	01	H1036_237_2	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	237	2	1	01	01	H1036_237_2	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	237	2	1	01	01	H1036_237_2	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	237	2	1	01	01	H1036_237_2	4	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	237	2	1	01	01	H1036_237_2	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	237	2	1	01	01	H1036_237_2	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	237	2	1	01	01	H1036_237_2	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1036	237	2	1	01	01	H1036_237_2	4	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	237	2	1	01	01	H1036_237_2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	239	0	1	01	01	H1036_239_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	239	0	1	01	01	H1036_239_0	4	2	Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	239	0	1	01	01	H1036_239_0	4	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	239	0	1	01	01	H1036_239_0	4	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	239	0	1	01	01	H1036_239_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	240	0	1	01	01	H1036_240_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1036	240	0	1	01	01	H1036_240_0	5	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1036	240	0	1	01	01	H1036_240_0	5	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H1036	240	0	1	01	01	H1036_240_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H1036	240	0	1	01	01	H1036_240_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H1036	240	0	1	01	01	H1036_240_0	5	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H1036	240	0	1	01	01	H1036_240_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1036	240	0	1	01	01	H1036_240_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1036	240	0	1	01	01	H1036_240_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1036	240	0	1	01	01	H1036_240_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1036	240	0	1	01	01	H1036_240_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H1036	241	0	1	01	01	H1036_241_0	3	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	241	0	1	01	01	H1036_241_0	3	2	Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	9.00		27.00																									9.00		27.00				9.00		0.00				9.00				9.00		0.30				0.30	0.30	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	241	0	1	01	01	H1036_241_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	241	0	1	01	01	H1036_241_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	241	0	1	01	01	H1036_241_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	243	0	1	01	01	H1036_243_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	243	0	1	01	01	H1036_243_0	3	2	Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	243	0	1	01	01	H1036_243_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	243	0	1	01	01	H1036_243_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	243	0	1	01	01	H1036_243_0	3	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	245	0	1	01	01	H1036_245_0	3	2	Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	245	0	1	01	01	H1036_245_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	245	0	1	01	01	H1036_245_0	3	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	245	0	1	01	01	H1036_245_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	245	0	1	01	01	H1036_245_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	247	0	1	01	01	H1036_247_0	3	2	Generic	1	4	000101	3	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	247	0	1	01	01	H1036_247_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	247	0	1	01	01	H1036_247_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	247	0	1	01	01	H1036_247_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	247	0	1	01	01	H1036_247_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	249	0	1	01	01	H1036_249_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	249	0	1	01	01	H1036_249_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	249	0	1	01	01	H1036_249_0	3	2	Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	249	0	1	01	01	H1036_249_0	3	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	249	0	1	01	01	H1036_249_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	251	0	1	01	01	H1036_251_0	3	2	Generic	1	4	000101	3	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	251	0	1	01	01	H1036_251_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	251	0	1	01	01	H1036_251_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	251	0	1	01	01	H1036_251_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	251	0	1	01	01	H1036_251_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	253	0	1	01	01	H1036_253_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	253	0	1	01	01	H1036_253_0	3	2	Generic	1	4	000101	3	2	110		01		110	1	30		90				2				30		90	30		31	2.00		6.00																									2.00		6.00				2.00		0.00				2.00				2.00		0.06				0.06	0.06	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	253	0	1	01	01	H1036_253_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	253	0	1	01	01	H1036_253_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	253	0	1	01	01	H1036_253_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	255	0	1	01	01	H1036_255_0	6	2	Generic	1	4	000101	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	255	0	1	01	01	H1036_255_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	255	0	1	01	01	H1036_255_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	255	0	1	01	01	H1036_255_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	255	0	1	01	01	H1036_255_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	257	0	1	01	01	H1036_257_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	257	0	1	01	01	H1036_257_0	6	2	Generic	1	4	000101	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	257	0	1	01	01	H1036_257_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	257	0	1	01	01	H1036_257_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	257	0	1	01	01	H1036_257_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	259	0	1	01	01	H1036_259_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	259	0	1	01	01	H1036_259_0	5	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	259	0	1	01	01	H1036_259_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	259	0	1	01	01	H1036_259_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1036	259	0	1	01	01	H1036_259_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	001	0	1	02	01	H1045_001_0	6	2	Generic	1	4	000100	3	2	110		01		100	1	30		90				1						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	001	0	1	02	01	H1045_001_0	6	3	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	001	0	1	02	01	H1045_001_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	35.00		105.00																											105.00						95.00				35.00				35.00		1.16						1.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	001	0	1	02	01	H1045_001_0	6	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	001	0	1	02	01	H1045_001_0	6	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				804.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	001	0	1	02	01	H1045_001_0	6	1	Preferred Generic	3	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1045	001	0	1	02	01	H1045_001_0	6	2	Generic	3	4	000100	3	2	110		01		100	1	30		90				1						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H1045	005	0	1	01	01	H1045_005_0	4	3	Preferred Brand	1	4	010001	3	2	110		01		100	1	30		90				1						90	30		31	20.00		60.00																											60.00						50.00				20.00				20.00		0.66						0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	005	0	1	01	01	H1045_005_0	4	2	Generic	1	4	000100	3	2	110		01		100	1	30		90				1						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	005	0	1	01	01	H1045_005_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	005	0	1	01	01	H1045_005_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	50.00		150.00																											150.00						140.00				50.00				50.00		1.66						1.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	005	0	1	01	01	H1045_005_0	4	2	Generic	3	4	000100	3	2	110		01		100	1	30		90				1						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H1045	005	0	1	01	01	H1045_005_0	4	1	Preferred Generic	3	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1045	005	0	1	01	01	H1045_005_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				575.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	012	0	1	01	01	H1045_012_0	4	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	012	0	1	01	01	H1045_012_0	4	2	Generic	1	4	000100	3	2	110		01	100		1	30		90				1			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	012	0	1	01	01	H1045_012_0	4	3	Preferred Brand	1	4	010001	3	1	110		01	100		1	30		90				1			90				30		31				38.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	012	0	1	01	01	H1045_012_0	4	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1045	012	0	1	01	01	H1045_012_0	4	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31				441.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	012	0	1	01	01	H1045_012_0	4	4	Non-Preferred Brand	1	4	110000	1	1	110		01	100		1	30		90				1			90				30		31				33.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	012	0	1	01	01	H1045_012_0	4	2	Generic	3	4	000100	3	2	110		01	100		1	30		90				1			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H1045	016	0	1	01	01	H1045_016_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	25.00		75.00																											75.00						65.00				25.00				25.00		0.83						0.80	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	016	0	1	01	01	H1045_016_0	5	3	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	016	0	1	01	01	H1045_016_0	5	2	Generic	1	4	000100	3	2	110		01		100	1	30		90				1						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	016	0	1	01	01	H1045_016_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	016	0	1	01	01	H1045_016_0	5	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				728.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	016	0	1	01	01	H1045_016_0	5	3	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H1045	016	0	1	01	01	H1045_016_0	5	2	Generic	3	4	000100	3	2	110		01		100	1	30		90				1						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H1045	016	0	1	01	01	H1045_016_0	5	1	Preferred Generic	3	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1045	018	0	1	01	01	H1045_018_0	5	3	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	018	0	1	01	01	H1045_018_0	5	2	Generic	1	4	000100	3	2	110		01		100	1	30		90				1						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	018	0	1	01	01	H1045_018_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	018	0	1	01	01	H1045_018_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	25.00		75.00																											75.00						65.00				25.00				25.00		0.83						0.80	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	018	0	1	01	01	H1045_018_0	5	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				689.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	018	0	1	01	01	H1045_018_0	5	1	Preferred Generic	3	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1045	018	0	1	01	01	H1045_018_0	5	2	Generic	3	4	000100	3	2	110		01		100	1	30		90				1						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H1045	018	0	1	01	01	H1045_018_0	5	3	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H1045	023	0	1	01	01	H1045_023_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	023	0	1	01	01	H1045_023_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	7.00		21.00																											21.00						0.00				7.00				7.00		0.23						0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	023	0	1	01	01	H1045_023_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	023	0	1	01	01	H1045_023_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	023	0	1	01	01	H1045_023_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				615.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	025	0	1	01	01	H1045_025_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	025	0	1	01	01	H1045_025_0	3	2	Generic	1	4	000100	3	2	110		01		100	1	30		90				1						90	30		31	7.00		21.00																											21.00						0.00				7.00				7.00		0.23						0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	025	0	1	01	01	H1045_025_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	025	0	1	01	01	H1045_025_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	025	0	1	01	01	H1045_025_0	3	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	026	0	1	01	01	H1045_026_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	026	0	1	01	01	H1045_026_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	026	0	1	01	01	H1045_026_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	026	0	1	01	01	H1045_026_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	026	0	1	01	01	H1045_026_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				559.00	26		26																										26						26			26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	027	0	1	01	01	H1045_027_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	027	0	1	01	01	H1045_027_0	3	2	Generic	1	4	000100	3	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		.26						.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	027	0	1	01	01	H1045_027_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	027	0	1	01	01	H1045_027_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	027	0	1	01	01	H1045_027_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				606.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	028	0	1	01	01	H1045_028_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	028	0	1	01	01	H1045_028_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	028	0	1	01	01	H1045_028_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		.26						.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	028	0	1	01	01	H1045_028_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	028	0	1	01	01	H1045_028_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				534.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	029	0	1	01	01	H1045_029_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	029	0	1	01	01	H1045_029_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		.26						.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	029	0	1	01	01	H1045_029_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	029	0	1	01	01	H1045_029_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	029	0	1	01	01	H1045_029_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				520.00	26		26																										26						26			26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	030	0	1	01	01	H1045_030_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	9.00		27.00																											27.00						0.00				9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	030	0	1	01	01	H1045_030_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	030	0	1	01	01	H1045_030_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	030	0	1	01	01	H1045_030_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				577.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	030	0	1	01	01	H1045_030_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	031	0	1	01	01	H1045_031_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	031	0	1	01	01	H1045_031_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		.26						.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	031	0	1	01	01	H1045_031_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	031	0	1	01	01	H1045_031_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	031	0	1	01	01	H1045_031_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				530.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	032	0	1	01	01	H1045_032_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	032	0	1	01	01	H1045_032_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		.26						.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	032	0	1	01	01	H1045_032_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	032	0	1	01	01	H1045_032_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	032	0	1	01	01	H1045_032_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				530.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	033	0	1	01	01	H1045_033_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	033	0	1	01	01	H1045_033_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	033	0	1	01	01	H1045_033_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		.26						.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	033	0	1	01	01	H1045_033_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	033	0	1	01	01	H1045_033_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				530.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	034	0	1	01	01	H1045_034_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	034	0	1	01	01	H1045_034_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	034	0	1	01	01	H1045_034_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		.26						.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	034	0	1	01	01	H1045_034_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	034	0	1	01	01	H1045_034_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				530.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	035	0	1	01	01	H1045_035_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	035	0	1	01	01	H1045_035_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		.26						.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	035	0	1	01	01	H1045_035_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	035	0	1	01	01	H1045_035_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	035	0	1	01	01	H1045_035_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				530.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	036	0	1	01	01	H1045_036_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	036	0	1	01	01	H1045_036_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	036	0	1	01	01	H1045_036_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	036	0	1	01	01	H1045_036_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	036	0	1	01	01	H1045_036_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				586.00	25		25																										25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	037	0	1	01	01	H1045_037_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	037	0	1	01	01	H1045_037_0	5	2	Generic	1	4	000100	3	2	110		01		100	1	30		90				1						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	037	0	1	01	01	H1045_037_0	5	3	Preferred Brand	1	4	010001	3	2	110		01		100	1	30		90				1						90	30		31	20.00		60.00																											60.00						50.00				20.00				20.00		0.66						0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	037	0	1	01	01	H1045_037_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	50.00		150.00																											150.00						140.00				50.00				50.00		1.66						1.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	037	0	1	01	01	H1045_037_0	5	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				575.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	037	0	1	01	01	H1045_037_0	5	1	Preferred Generic	3	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1045	037	0	1	01	01	H1045_037_0	5	2	Generic	3	4	000100	3	2	110		01		100	1	30		90				1						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H1045	038	0	1	01	01	H1045_038_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	038	0	1	01	01	H1045_038_0	4	2	Generic	1	4	000100	3	2	110		01	100		1	30		90				1			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	038	0	1	01	01	H1045_038_0	4	3	Preferred Brand	1	4	010001	3	1	110		01	100		1	30		90				1			90				30		31				38.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	038	0	1	01	01	H1045_038_0	4	4	Non-Preferred Brand	1	4	110000	1	1	110		01	100		1	30		90				1			90				30		31				33.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	038	0	1	01	01	H1045_038_0	4	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31				441.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1045	038	0	1	01	01	H1045_038_0	4	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1045	038	0	1	01	01	H1045_038_0	4	2	Generic	3	4	000100	3	2	110		01	100		1	30		90				1			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H1099	001	0	1	02	01	H1099_001_0	9	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1099	001	0	1	02	01	H1099_001_0	9	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	10.00		30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1099	001	0	1	02	01	H1099_001_0	9	3	Preferred Brand	1	4	000101	1	2	110		01	100		1	30		90				1			90				30		31	45.00		135.00																					112.50																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1099	001	0	1	02	01	H1099_001_0	9	4	Non-Preferred Brand	1	4	100100	1	2	110		01	100		1	30		90				1			90				30		31	90.00		270.00																					225.00																90.00				90.00		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1099	001	0	1	02	01	H1099_001_0	9	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31				1129.67	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1099	001	0	1	02	01	H1099_001_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1099	001	0	1	02	01	H1099_001_0	9	2	Generic	3	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	10.00		30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1099	006	0	1	01	01	H1099_006_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1099	006	0	1	01	01	H1099_006_0	6	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	10.00		30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1099	006	0	1	01	01	H1099_006_0	6	3	Preferred Brand	1	4	000101	1	2	110		01	100		1	30		90				1			90				30		31	45.00		135.00																					112.50																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1099	006	0	1	01	01	H1099_006_0	6	4	Non-Preferred Brand	1	4	100100	1	2	110		01	100		1	30		90				1			90				30		31	90.00		270.00																					225.00																90.00				90.00		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1099	006	0	1	01	01	H1099_006_0	6	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31				1501.88	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1099	006	0	1	01	01	H1099_006_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1099	014	0	1	01	01	H1099_014_0	6	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	10.00		30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1099	014	0	1	01	01	H1099_014_0	6	3	Preferred Brand	1	4	000101	1	2	110		01	100		1	30		90				1			90				30		31	45.00		135.00																					112.50																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1099	014	0	1	01	01	H1099_014_0	6	4	Non-Preferred Brand	1	4	100100	1	2	110		01	100		1	30		90				1			90				30		31	95.00		285.00																					237.50																95.00				95.00		3.17						3.06	Preferred Generic, 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				1547.36	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1099	016	0	1	02	01	H1099_016_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	2.00		6.00																					0.00																2.00				2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1099	016	0	1	02	01	H1099_016_0	7	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	2.00		6.00																					0.00																2.00				2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1099	016	0	1	02	01	H1099_016_0	7	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31				1569.34	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1099	016	0	1	02	01	H1099_016_0	7	4	Non-Preferred Brand	1	4	100100	1	2	110		01	100		1	30		90				1			90				30		31	90.00		270.00																					180.00																90.00				90.00		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1099	016	0	1	02	01	H1099_016_0	7	3	Preferred Brand	1	4	000101	1	2	110		01	100		1	30		90				1			90				30		31	45.00		135.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1099	016	0	1	02	01	H1099_016_0	7	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	5.00		15.00																					0.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1099	017	0	1	02	01	H1099_017_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1099	017	0	1	02	01	H1099_017_0	7	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1099	017	0	1	02	01	H1099_017_0	7	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31				1599.44	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1099	017	0	1	02	01	H1099_017_0	7	4	Non-Preferred Brand	1	4	100100	1	2	110		01	100		1	30		90				1			90				30		31	90.00		270.00																					180.00																90.00				90.00		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1099	017	0	1	02	01	H1099_017_0	7	3	Preferred Brand	1	4	000101	1	2	110		01	100		1	30		90				1			90				30		31	45.00		135.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1099	017	0	1	02	01	H1099_017_0	7	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	2.00		6.00																					0.00																2.00				2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1099	017	0	1	02	01	H1099_017_0	7	2	Generic	3	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	2.00		6.00																					0.00																2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1109	005	0	1	01	01	H1109_005_0	7	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					4.00	8.00	12.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.13	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1109	005	0	1	01	01	H1109_005_0	7	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					15.00	30.00	45.00					20.00	40.00	60.00																	20.00			20.00			.67	.50	.67			.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1109	005	0	1	01	01	H1109_005_0	7	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					45.00	90.00	135.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.50	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1109	005	0	1	01	01	H1109_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											52.52	50	50	50				44.71	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1109	005	0	1	01	01	H1109_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1111	006	0	1	01	01	H1111_006_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				554.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1111	006	0	1	01	01	H1111_006_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1111	006	0	1	01	01	H1111_006_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1111	006	0	1	01	01	H1111_006_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1111	006	0	1	01	01	H1111_006_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		.26						.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1111	007	0	1	01	01	H1111_007_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		.26						.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1111	007	0	1	01	01	H1111_007_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1111	007	0	1	01	01	H1111_007_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1111	007	0	1	01	01	H1111_007_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				602.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1111	007	0	1	01	01	H1111_007_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1112	006	0	1	01	01	H1112_006_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1112	006	0	1	01	01	H1112_006_0	5	4	Non-Preferred Brand	1	3	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				60.60	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1112	006	0	1	01	01	H1112_006_0	5	3	Preferred Brand	1	3	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1112	006	0	1	01	01	H1112_006_0	5	2	Generic	1	3	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1112	006	0	1	01	01	H1112_006_0	5	1	Preferred Generic	1	3	001000	1	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1112	027	0	1	01	01	H1112_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1112	027	0	1	01	01	H1112_027_0	5	4	Non-Preferred Brand	1	4	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				52.40	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1112	027	0	1	01	01	H1112_027_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1112	027	0	1	01	01	H1112_027_0	5	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		37.50				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1112	027	0	1	01	01	H1112_027_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1112	032	0	1	02	01	H1112_032_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1112	032	0	1	02	01	H1112_032_0	6	4	Non-Preferred Brand	1	4	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				44.60	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1112	032	0	1	02	01	H1112_032_0	6	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1112	032	0	1	02	01	H1112_032_0	6	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		37.50				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1112	032	0	1	02	01	H1112_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1170	002	0	1	01	01	H1170_002_0	6	6	Vaccines	3	4	000001	1	2	010		01			1	30													30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1170	002	0	1	01	01	H1170_002_0	6	2	Generic	3	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		.50			.50			.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1170	002	0	1	01	01	H1170_002_0	6	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	5.00		15.00																			5.00		0.00																5.00				5.00		.16			.16			.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1170	002	0	1	01	01	H1170_002_0	6	6	Vaccines	1	4	000001	1	2	010		01			1	30													30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	002	0	1	01	01	H1170_002_0	6	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		90				2	30		90				30		31				1912.00	33		33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	002	0	1	01	01	H1170_002_0	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				2	30		90				30		31	85.00		255.00																			85.00		170.00																85.00				85.00		2.83			2.83			2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	002	0	1	01	01	H1170_002_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				2	30		90				30		31	44.00		132.00																			44.00		88.00																44.00				44.00		1.46			1.46			1.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	002	0	1	01	01	H1170_002_0	6	2	Generic	1	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		.50			.50			.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	002	0	1	01	01	H1170_002_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	5.00		15.00																			5.00		0.00																5.00				5.00		.16			.16			.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	008	0	1	01	01	H1170_008_0	8	4	Non-Preferred Brand	1	3	100000	1	2	110		01	110		1	30		90				2	30		90				30		31	95.00		285.00																			95.00		190.00																95.00				95.00		3.16			3.16			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	008	0	1	01	01	H1170_008_0	8	3	Preferred Brand	1	3	000001	1	2	110		01	110		1	30		90				2	30		90				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	008	0	1	01	01	H1170_008_0	8	2	Generic	1	3	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	17.00		51.00																			17.00		34.00																17.00				17.00		.56			.56			.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	008	0	1	01	01	H1170_008_0	8	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	008	0	1	01	01	H1170_008_0	8	1	Preferred Generic	1	3	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	6.00		18.00																			6.00		0.00																6.00				6.00		.20			.20			.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	008	0	1	01	01	H1170_008_0	8	5	Specialty Tier	1	3	100001	1	1	110		01	110		1	30		90				2	30		90				30		31				1523.00	33		33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	009	0	1	01	01	H1170_009_0	5	2	Generic	3	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		0.50			0.50			.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1170	009	0	1	01	01	H1170_009_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1170	009	0	1	01	01	H1170_009_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	7.00		21.00																			7.00		0.00																7.00				7.00		0.23			0.23			.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1170	009	0	1	01	01	H1170_009_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	009	0	1	01	01	H1170_009_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				2	30		90				30		31	95.00		285.00																			95.00		190.00																95.00				95.00		3.16			3.16			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	009	0	1	01	01	H1170_009_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				2	30		90				30		31	44.00		132.00																			44.00		88.00																44.00				44.00		1.46			1.46			1.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	009	0	1	01	01	H1170_009_0	5	2	Generic	1	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		.50			.50			.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	009	0	1	01	01	H1170_009_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	7.00		21.00																			7.00		0.00																7.00				7.00		.23			.23			.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	009	0	1	01	01	H1170_009_0	5	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		90				2	30		90				30		31				1575.00	33		33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1189	001	0	1	01	01	H1189_001_0	6	2	Generic	1	3	000100	1	2	110		01	100		1	31		90				1			90				31		34	10.00		30.00																					20.00																10.00				10.00		0.32						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1189	001	0	1	01	01	H1189_001_0	6	3	Preferred Brand	1	3	000001	1	2	110		01	100		1	31		90				1			90				31		34	35.00		105.00																					70.00																35.00				35.00		1.13						1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1189	001	0	1	01	01	H1189_001_0	6	4	Non-Preferred Brand	1	3	100000	1	2	110		01	100		1	31		90				1			90				31		34	90.00		270.00																					180.00																90.00				90.00		2.90						2.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1189	001	0	1	01	01	H1189_001_0	6	5	Specialty Tier	1	3	101101	1	1	110		01	100		1	31		90				1			90				31		34				1218.02	29		29																				29															29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1189	001	0	1	01	01	H1189_001_0	6	1	Preferred Generic	1	3	001000	1	2	110		01	100		1	31		90				1			90				31		34	4.00		12.00																					8.00																4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	75.00		225.00																			75.00		150.00																75.00				75.00		2.50			2.50			2.41	Preferred Generic, 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	6.00		18.00																			6.00		12.00																6.00				6.00		.20			.20			.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	001	0	1	01	01	H1230_001_0	6	2	Generic	1	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		.33			.33			.32	Preferred Generic, 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	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, 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, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	001	0	1	01	01	H1230_001_0	6	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	6.00		18.00																			6.00		12.00																6.00				6.00		.20			.20			.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1230	001	0	1	01	01	H1230_001_0	6	2	Generic	3	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		.33			.33			.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
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				968.00	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	003	0	1	01	01	H1230_003_0	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				2	30		90				30		31	75.00		225.00																			75.00		150.00																75.00				75.00		2.50			2.50			2.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	003	0	1	01	01	H1230_003_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				2	30		90				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	003	0	1	01	01	H1230_003_0	6	2	Generic	1	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		.33			.33			.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	003	0	1	01	01	H1230_003_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	6.00		18.00																			6.00		12.00																6.00				6.00		.20			.20			.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	003	0	1	01	01	H1230_003_0	6	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		90				2	30		90				30		31				998.00	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	003	0	1	01	01	H1230_003_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1230	003	0	1	01	01	H1230_003_0	6	2	Generic	3	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		.33			.33			.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1230	003	0	1	01	01	H1230_003_0	6	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	6.00		18.00																			6.00		12.00																6.00				6.00		.20			.20			.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1230	003	0	1	01	01	H1230_003_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	005	0	1	01	01	H1230_005_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		.33			.33			.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	005	0	1	01	01	H1230_005_0	6	2	Generic	1	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	20.00		60.00																			20.00		40.00																20.00				20.00		.66			.66			.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	005	0	1	01	01	H1230_005_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				2	30		90				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	005	0	1	01	01	H1230_005_0	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				2	30		90				30		31	95.00		285.00																			95.00		190.00																95.00				95.00		3.16			3.16			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	005	0	1	01	01	H1230_005_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1230	005	0	1	01	01	H1230_005_0	6	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		.33			.33			.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1230	005	0	1	01	01	H1230_005_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	005	0	1	01	01	H1230_005_0	6	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		90				2	30		90				30		31				1463.00	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	005	0	1	01	01	H1230_005_0	6	2	Generic	3	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	20.00		60.00																			20.00		40.00																20.00				20.00		.66			.66			.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1230	006	0	1	01	01	H1230_006_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				2	30		90				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	006	0	1	01	01	H1230_006_0	6	2	Generic	1	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		.33			.33			.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	006	0	1	01	01	H1230_006_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	6.00		18.00																			6.00		12.00																6.00				6.00		.20			.20			.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	006	0	1	01	01	H1230_006_0	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				2	30		90				30		31	75.00		225.00																			75.00		150.00																75.00				75.00		2.50			2.50			2.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	006	0	1	01	01	H1230_006_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1230	006	0	1	01	01	H1230_006_0	6	2	Generic	3	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		.33			.33			.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1230	006	0	1	01	01	H1230_006_0	6	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	6.00		18.00																			6.00		12.00																6.00				6.00		.20			.20			.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1230	006	0	1	01	01	H1230_006_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	006	0	1	01	01	H1230_006_0	6	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		90				2	30		90				30		31				1515.00	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	008	0	1	01	01	H1230_008_0	6	1	Preferred Generic	1	3	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	008	0	1	01	01	H1230_008_0	6	2	Generic	1	3	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	008	0	1	01	01	H1230_008_0	6	3	Preferred Brand	1	3	000001	1	2	110		01	110		1	30		90				2	30		90				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	008	0	1	01	01	H1230_008_0	6	4	Non-Preferred Brand	1	3	100000	1	2	110		01	110		1	30		90				2	30		90				30		31	95.00		285.00																			95.00		190.00																95.00				95.00		3.16			3.16			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	008	0	1	01	01	H1230_008_0	6	5	Specialty Tier	1	3	100001	1	1	110		01	110		1	30		90				2	30		90				30		31				876.00	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	008	0	1	01	01	H1230_008_0	6	6	Vaccines	1	3	000001	1	2	010		01			1	30													30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1264	004	0	1	02	01	H1264_004_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		110	1	30		90				1				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1264	004	0	1	02	01	H1264_004_0	4	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1264	004	0	1	02	01	H1264_004_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1264	004	0	1	02	01	H1264_004_0	4	4	Non-Preferred Brand	1	4	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				67.50	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1264	004	0	1	02	01	H1264_004_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1264	007	0	1	01	01	H1264_007_0	3	1	Preferred Generic	1	2	001000	1	2	110		01		110	1	30		90				1				30		90	30		31	2.00		6.00																									2.00		6.00				2.00		0.00				2.00				2.00		0.07				0.07	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1264	007	0	1	01	01	H1264_007_0	3	2	Generic	1	2	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		15.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1264	007	0	1	01	01	H1264_007_0	3	5	Specialty Tier	1	2	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1264	007	0	1	01	01	H1264_007_0	3	4	Non-Preferred Brand	1	2	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				73.30	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1264	007	0	1	01	01	H1264_007_0	3	3	Preferred Brand	1	2	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	32.00		96.00																									32.00		96.00				32.00		80.00				32.00				32.00		1.07				1.07	1.07	1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1264	008	0	1	01	01	H1264_008_0	4	4	Non-Preferred Brand	1	4	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				58.80	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1264	008	0	1	01	01	H1264_008_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1264	008	0	1	01	01	H1264_008_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1264	008	0	1	01	01	H1264_008_0	4	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1264	008	0	1	01	01	H1264_008_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1264	018	0	1	01	01	H1264_018_0	3	2	Generic	1	2	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		25.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1264	018	0	1	01	01	H1264_018_0	3	1	Preferred Generic	1	2	001000	1	2	110		01		110	1	30		90				1				30		90	30		31	2.00		6.00																									2.00		6.00				2.00		0.00				2.00				2.00		0.07				0.07	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1264	018	0	1	01	01	H1264_018_0	3	3	Preferred Brand	1	2	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	34.00		102.00																									34.00		102.00				34.00		85.00				34.00				34.00		1.13				1.13	1.13	1.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1264	018	0	1	01	01	H1264_018_0	3	5	Specialty Tier	1	2	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1264	018	0	1	01	01	H1264_018_0	3	4	Non-Preferred Brand	1	2	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				61.20	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1264	019	0	1	02	01	H1264_019_0	4	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		30.00				12.00				12.00		0.40				0.40	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1264	019	0	1	02	01	H1264_019_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1264	019	0	1	02	01	H1264_019_0	4	4	Non-Preferred Brand	1	4	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				53.10	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1264	019	0	1	02	01	H1264_019_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1264	019	0	1	02	01	H1264_019_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1286	002	0	1	01	01	H1286_002_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1286	002	0	1	01	01	H1286_002_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1286	002	0	1	01	01	H1286_002_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1286	002	0	1	01	01	H1286_002_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				467.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1286	002	0	1	01	01	H1286_002_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1286	009	0	1	01	01	H1286_009_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1286	009	0	1	01	01	H1286_009_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				494.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1286	009	0	1	01	01	H1286_009_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1286	009	0	1	01	01	H1286_009_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1286	009	0	1	01	01	H1286_009_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1291	001	0	1	09	04	H1291_001_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	18.00		54.00																									18.00		54.00				18.00		0.00				18.00				18.00		0.60				0.60	0.60	0.58	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1291	001	0	1	09	04	H1291_001_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	18.00		54.00																									18.00		54.00				18.00		0.00				18.00				18.00		0.60				0.60	0.60	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	9.00		27.00																									9.00		27.00				9.00		0.00				9.00				9.00		0.30				0.30	0.30	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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, 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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	9.00		27.00																									9.00		27.00				9.00		0.00				9.00				9.00		0.30				0.30	0.30	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1302	007	1	1	04	01	H1302_007_1	5	2	Generic	1	3	000100	1	2		110	01	100		1				30		90	1			90				30		31								20.00		60.00					12.00		36.00							36.00																20.00				12.00			0.67	0.40				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1302	007	1	1	04	01	H1302_007_1	5	1	Preferred Generic	1	3	001000	1	2		110	01	100		1				30		90	1			90				30		31								10.00		30.00					0.00		0.00							0.00																10.00				0.00			0.33	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1302	007	1	1	04	01	H1302_007_1	5	3	Preferred Brand	1	3	000001	1	2		110	01	100		1				30		90	1			90				30		31								47.00		141.00					37.00		111.00							111.00																47.00				37.00			1.57	1.23				1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1302	007	1	1	04	01	H1302_007_1	5	4	Non-Preferred Brand	1	3	100000	1	2		110	01	100		1				30		90	1			90				30		31								100.00		300.00					90.00		270.00							270.00																100.00				90.00			3.33	3.00				2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1302	007	1	1	04	01	H1302_007_1	5	5	Specialty Tier	1	3	101101	1	1		110	01	010		1				30		90	1	30						30		31											990.00	25		25				990.00	25		25				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1302	007	2	1	04	01	H1302_007_2	5	2	Generic	1	3	000100	1	2		110	01	100		1				30		90	1			90				30		31								20.00		60.00					12.00		36.00							36.00																20.00				12.00			0.67	0.40				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1302	007	2	1	04	01	H1302_007_2	5	1	Preferred Generic	1	3	001000	1	2		110	01	100		1				30		90	1			90				30		31								10.00		30.00					0.00		0.00							0.00																10.00				0.00			0.33	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1302	007	2	1	04	01	H1302_007_2	5	3	Preferred Brand	1	3	000001	1	2		110	01	100		1				30		90	1			90				30		31								47.00		141.00					37.00		111.00							111.00																47.00				37.00			1.57	1.23				1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1302	007	2	1	04	01	H1302_007_2	5	5	Specialty Tier	1	3	101101	1	1		110	01	010		1				30		90	1	30						30		31											990.00	25		25				990.00	25		25				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1302	007	2	1	04	01	H1302_007_2	5	4	Non-Preferred Brand	1	3	100000	1	2		110	01	100		1				30		90	1			90				30		31								100.00		300.00					90.00		270.00							270.00																100.00				90.00			3.33	3.00				2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1304	002	0	1	04	01	H1304_002_0	7	1	Preferred Generic	1	3	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	10.00	20.00	20.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1304	002	0	1	04	01	H1304_002_0	7	2	Generic	1	3	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	17.00	34.00	34.00																			17.00	34.00	34.00																17.00				17.00		0.57			0.57			0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1304	002	0	1	04	01	H1304_002_0	7	3	Preferred Brand	1	3	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	94.00	117.50																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1304	002	0	1	04	01	H1304_002_0	7	5	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1304	002	0	1	04	01	H1304_002_0	7	4	Non-Preferred Brand	1	3	110000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	100.00	200.00	250.00																			100.00	200.00	250.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1304	002	0	1	04	01	H1304_002_0	7	6	Select Care Drugs	1	3	010000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1304	004	0	1	04	01	H1304_004_0	6	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	94.00	117.50																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1304	004	0	1	04	01	H1304_004_0	6	4	Non-Preferred Brand	1	4	110000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	100.00	200.00	250.00																			100.00	200.00	250.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1304	004	0	1	04	01	H1304_004_0	6	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1304	004	0	1	04	01	H1304_004_0	6	6	Select Care Drugs	1	4	010000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1304	004	0	1	04	01	H1304_004_0	6	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	5.00	10.00	10.00																			5.00	10.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1304	004	0	1	04	01	H1304_004_0	6	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	12.00	24.00	24.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1304	009	0	1	04	01	H1304_009_0	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	13.00	26.00	26.00																			13.00	26.00	26.00																13.00				13.00		0.43			0.43			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1304	009	0	1	04	01	H1304_009_0	7	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	20.00	40.00	40.00																			20.00	40.00	40.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1304	009	0	1	04	01	H1304_009_0	7	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	94.00	117.50																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1304	009	0	1	04	01	H1304_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	100.00	200.00	250.00																			100.00	200.00	250.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1304	009	0	1	04	01	H1304_009_0	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1304	009	0	1	04	01	H1304_009_0	7	6	Select Care Drugs	1	4	010000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1304	010	0	1	04	01	H1304_010_0	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	5.00	10.00	10.00																			5.00	10.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1304	010	0	1	04	01	H1304_010_0	7	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	12.00	24.00	24.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1304	010	0	1	04	01	H1304_010_0	7	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	94.00	117.50																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1304	010	0	1	04	01	H1304_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	100.00	200.00	250.00																			100.00	200.00	250.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1304	010	0	1	04	01	H1304_010_0	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1304	010	0	1	04	01	H1304_010_0	7	6	Select Care Drugs	1	4	010000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1350	012	0	1	01	01	H1350_012_0	3	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31								45.00		135.00					35.00		105.00							105.00																45.00				35.00			1.50	1.17				1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	012	0	1	01	01	H1350_012_0	3	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					85.00		255.00							255.00																95.00				85.00			3.17	2.83				2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	012	0	1	01	01	H1350_012_0	3	2	Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								12.00		36.00					6.00		18.00							18.00																12.00				6.00			0.40	0.20				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	012	0	1	01	01	H1350_012_0	3	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				0.00			0.17	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	012	0	1	01	01	H1350_012_0	3	5	Specialty Tier	1	4	101101	1	1		110	01	010		1				30		90	1	30						30		31											990.00	33		33				990.00	33		33				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	014	0	1	01	01	H1350_014_0	5	2	Generic	1	3	000100	1	2	110		01	100		1	30		90				1			90				30		31	12.00		36.00																					36.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	014	0	1	01	01	H1350_014_0	5	1	Preferred Generic	1	3	001000	1	2	110		01	100		1	30		90				1			90				30		31	4.00		12.00																					12.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	014	0	1	01	01	H1350_014_0	5	3	Preferred Brand	1	3	000001	1	2	110		01	100		1	30		90				1			90				30		31	45.00		135.00																					135.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	014	0	1	01	01	H1350_014_0	5	5	Specialty Tier	1	3	101101	1	1	010		01	010		1	30							30						30		31				990.00	29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	014	0	1	01	01	H1350_014_0	5	4	Non-Preferred Brand	1	3	100000	1	2	110		01	100		1	30		90				1			90				30		31	95.00		285.00																					285.00																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	015	1	1	02	01	H1350_015_1	5	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				0.00			0.17	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	015	1	1	02	01	H1350_015_1	5	2	Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								12.00		36.00					6.00		18.00							18.00																12.00				6.00			0.40	0.20				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	015	1	1	02	01	H1350_015_1	5	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					85.00		255.00							255.00																95.00				85.00			3.17	2.83				2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	015	1	1	02	01	H1350_015_1	5	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31								45.00		135.00					35.00		105.00							105.00																45.00				35.00			1.50	1.17				1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	015	1	1	02	01	H1350_015_1	5	5	Specialty Tier	1	4	101101	1	1		110	01	010		1				30		90	1	30						30		31											990.00	33		33				990.00	33		33				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	015	2	1	02	01	H1350_015_2	5	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					85.00		255.00							255.00																95.00				85.00			3.17	2.83				2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	015	2	1	02	01	H1350_015_2	5	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31								45.00		135.00					35.00		105.00							105.00																45.00				35.00			1.50	1.17				1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	015	2	1	02	01	H1350_015_2	5	2	Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								12.00		36.00					6.00		18.00							18.00																12.00				6.00			0.40	0.20				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	015	2	1	02	01	H1350_015_2	5	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				0.00			0.17	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	015	2	1	02	01	H1350_015_2	5	5	Specialty Tier	1	4	101101	1	1		110	01	010		1				30		90	1	30						30		31											990.00	33		33				990.00	33		33				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	016	1	1	01	01	H1350_016_1	6	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31								100.00		300.00					90.00		270.00							270.00																100.00				90.00			3.33	3.00				2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	016	1	1	01	01	H1350_016_1	6	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31								47.00		141.00					37.00		111.00							111.00																47.00				37.00			1.57	1.23				1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	016	1	1	01	01	H1350_016_1	6	2	Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								20.00		60.00					12.00		36.00							36.00																20.00				12.00			0.67	0.40				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	016	1	1	01	01	H1350_016_1	6	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								10.00		30.00					0.00		0.00							0.00																10.00				0.00			0.33	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	016	1	1	01	01	H1350_016_1	6	5	Specialty Tier	1	4	101101	1	1		110	01	010		1				30		90	1	30						30		31											990.00	28		28				990.00	28		28				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	016	2	1	01	01	H1350_016_2	6	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31								100.00		300.00					90.00		270.00							270.00																100.00				90.00			3.33	3.00				2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	016	2	1	01	01	H1350_016_2	6	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31								47.00		141.00					37.00		111.00							111.00																47.00				37.00			1.57	1.23				1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	016	2	1	01	01	H1350_016_2	6	2	Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								20.00		60.00					12.00		36.00							36.00																20.00				12.00			0.67	0.40				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	016	2	1	01	01	H1350_016_2	6	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								10.00		30.00					0.00		0.00							0.00																10.00				0.00			0.33	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	016	2	1	01	01	H1350_016_2	6	5	Specialty Tier	1	4	101101	1	1		110	01	010		1				30		90	1	30						30		31											990.00	28		28				990.00	28		28				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1352	001	0	1	01	01	H1352_001_0	4	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								10.00	20.00	30.00					3.00	6.00	9.00					0.00	0.00	0.00																10.00				10.00			0.33	0.10	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1352	001	0	1	01	01	H1352_001_0	4	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	37.50																20.00				20.00			0.67	0.50	0.50			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1352	001	0	1	01	01	H1352_001_0	4	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1352	001	0	1	01	01	H1352_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								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	237.50																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1352	001	0	1	01	01	H1352_001_0	4	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31											1.00	33						1.00	33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1352	002	0	1	01	01	H1352_002_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								8.00	16.00	24.00					3.00	6.00	9.00					0.00	0.00	0.00																8.00				8.00			0.27	0.10	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1352	002	0	1	01	01	H1352_002_0	5	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								13.00	26.00	39.00					8.00	16.00	24.00					8.00	16.00	20.00																13.00				13.00			0.43	0.27	0.27			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1352	002	0	1	01	01	H1352_002_0	5	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1352	002	0	1	01	01	H1352_002_0	5	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	237.50																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1352	002	0	1	01	01	H1352_002_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1365	001	0	1	04	01	H1365_001_0	10	2	Generic	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								15.00	30.00	45.00					8.00	16.00	24.00					15.00	30.00	37.50																15.00				15.00			0.33	0.20	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1365	001	0	1	04	01	H1365_001_0	10	1	Preferred Generic	1	4	001001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					4.00	8.00	10.00																4.00				4.00			0.13	0.00	0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1365	001	0	1	04	01	H1365_001_0	10	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					47.00	94.00	117.50																47.00				47.00			1.50	1.33	1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1365	001	0	1	04	01	H1365_001_0	10	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	250.00																100.00				100.00			3.17	3.00	3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1365	001	0	1	04	01	H1365_001_0	10	5	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											600.00	33	33	33				600.00	33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1365	002	0	1	04	01	H1365_002_0	10	2	Generic	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								15.00	30.00	45.00					8.00	16.00	24.00					15.00	30.00	37.50																15.00				15.00			0.33	0.20	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1365	002	0	1	04	01	H1365_002_0	10	1	Preferred Generic	1	4	001001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					4.00	8.00	10.00																4.00				4.00			0.13	0.00	0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1365	002	0	1	04	01	H1365_002_0	10	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					47.00	94.00	117.50																47.00				47.00			1.50	1.33	1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1365	002	0	1	04	01	H1365_002_0	10	5	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											600.00	33	33	33				600.00	33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1365	002	0	1	04	01	H1365_002_0	10	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	250.00																100.00				100.00			3.17	3.00	3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1365	003	0	1	04	01	H1365_003_0	12	1	Preferred Generic	1	4	001001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					4.00	8.00	10.00																4.00				4.00			0.13	0.00	0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1365	003	0	1	04	01	H1365_003_0	12	2	Generic	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								15.00	30.00	45.00					8.00	16.00	24.00					15.00	30.00	37.50																15.00				15.00			0.33	0.20	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1365	003	0	1	04	01	H1365_003_0	12	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	250.00																100.00				100.00			3.17	3.00	3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1365	003	0	1	04	01	H1365_003_0	12	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					47.00	94.00	117.50																47.00				47.00			1.50	1.33	1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1365	003	0	1	04	01	H1365_003_0	12	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1394	003	0	1	01	01	H1394_003_0	9	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1394	003	0	1	01	01	H1394_003_0	9	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								13.00	26.00	39.00					8.00	16.00	24.00					8.00	24.00	24.00																13.00				13.00			0.43	0.27	0.27			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1394	003	0	1	01	01	H1394_003_0	9	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1394	003	0	1	01	01	H1394_003_0	9	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1394	003	0	1	01	01	H1394_003_0	9	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34											1992.80	33						1992.80	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1394	003	0	1	01	01	H1394_003_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1394	003	0	1	01	01	H1394_003_0	9	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H1394	006	0	1	01	01	H1394_006_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1394	006	0	1	01	01	H1394_006_0	8	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								7.00	14.00	21.00					7.00	14.00	21.00					7.00	21.00	21.00																7.00				7.00			0.23	0.23	0.23			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1394	006	0	1	01	01	H1394_006_0	8	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1394	006	0	1	01	01	H1394_006_0	8	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								91.00	182.00	273.00					86.00	172.00	258.00					86.00	258.00	258.00																91.00				91.00			3.03	2.87	2.87			2.68	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1394	006	0	1	01	01	H1394_006_0	8	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34											777.44	25						777.44	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1394	006	0	1	01	01	H1394_006_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1394	006	0	1	01	01	H1394_006_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H1406	013	0	1	01	01	H1406_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	013	0	1	01	01	H1406_013_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	013	0	1	01	01	H1406_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1406	013	0	1	01	01	H1406_013_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1406	013	0	1	01	01	H1406_013_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1406	013	0	1	01	01	H1406_013_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1406	013	0	1	01	01	H1406_013_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1406	013	0	1	01	01	H1406_013_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	013	0	1	01	01	H1406_013_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	013	0	1	01	01	H1406_013_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	022	0	1	01	01	H1406_022_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	022	0	1	01	01	H1406_022_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1406	022	0	1	01	01	H1406_022_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1406	022	0	1	01	01	H1406_022_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1406	022	0	1	01	01	H1406_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1406	022	0	1	01	01	H1406_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	022	0	1	01	01	H1406_022_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	022	0	1	01	01	H1406_022_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	022	0	1	01	01	H1406_022_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	022	0	1	01	01	H1406_022_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1406	026	0	1	01	01	H1406_026_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	026	0	1	01	01	H1406_026_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	026	0	1	01	01	H1406_026_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	026	0	1	01	01	H1406_026_0	5	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	026	0	1	01	01	H1406_026_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	026	0	1	01	01	H1406_026_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1406	026	0	1	01	01	H1406_026_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1406	026	0	1	01	01	H1406_026_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1406	026	0	1	01	01	H1406_026_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1406	026	0	1	01	01	H1406_026_0	5	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1406	028	0	1	01	01	H1406_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1406	028	0	1	01	01	H1406_028_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1406	028	0	1	01	01	H1406_028_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1406	028	0	1	01	01	H1406_028_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1406	028	0	1	01	01	H1406_028_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	028	0	1	01	01	H1406_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	028	0	1	01	01	H1406_028_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	028	0	1	01	01	H1406_028_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	028	0	1	01	01	H1406_028_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	028	0	1	01	01	H1406_028_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H1406	029	0	1	01	01	H1406_029_0	4	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, 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, 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, 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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1406	029	0	1	01	01	H1406_029_0	4	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, 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, 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	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1406	030	0	1	01	01	H1406_030_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	030	0	1	01	01	H1406_030_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	030	0	1	01	01	H1406_030_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	030	0	1	01	01	H1406_030_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	030	0	1	01	01	H1406_030_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1406	030	0	1	01	01	H1406_030_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1406	030	0	1	01	01	H1406_030_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1406	030	0	1	01	01	H1406_030_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1406	030	0	1	01	01	H1406_030_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1406	030	0	1	01	01	H1406_030_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1406	032	0	1	01	01	H1406_032_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1406	032	0	1	01	01	H1406_032_0	4	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1406	032	0	1	01	01	H1406_032_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1406	032	0	1	01	01	H1406_032_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1406	032	0	1	01	01	H1406_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1406	032	0	1	01	01	H1406_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H1406	032	0	1	01	01	H1406_032_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H1406	032	0	1	01	01	H1406_032_0	4	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H1406	032	0	1	01	01	H1406_032_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H1406	032	0	1	01	01	H1406_032_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H1406	032	0	1	01	01	H1406_032_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1415	021	0	1	02	01	H1415_021_0	4	1	Preferred Generic	1	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	7.00	14.00	21.00																			7.00		21.00																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1415	021	0	1	02	01	H1415_021_0	4	2	Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	15.00	30.00	45.00																			15.00		45.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1415	021	0	1	02	01	H1415_021_0	4	3	Preferred Brand	1	4	000101	1	2	111		01	110		1	30	60	90				2	30		90				30		31	45.00	90.00	135.00																			45.00		135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1415	021	0	1	02	01	H1415_021_0	4	4	Non-Preferred Brand	1	4	100100	1	1	111		01	110		1	30	60	90				2	30		90				30		31				96.77	37	37	37																		37		37															37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1415	021	0	1	02	01	H1415_021_0	4	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31				462.20	33	33	33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1416	007	0	1	01	01	H1416_007_0	4	2	Generic	1	3	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		42.50				17.00				17.00		0.57				0.57	0.57	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1416	007	0	1	01	01	H1416_007_0	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1416	007	0	1	01	01	H1416_007_0	4	3	Preferred Brand	1	3	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1416	007	0	1	01	01	H1416_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1416	007	0	1	01	01	H1416_007_0	4	4	Non-Preferred Brand	1	3	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				78.70	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1416	009	0	1	02	01	H1416_009_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		110	1	30		90				1				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1416	009	0	1	02	01	H1416_009_0	4	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		37.50				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1416	009	0	1	02	01	H1416_009_0	4	4	Non-Preferred Brand	1	4	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				68.90	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1416	009	0	1	02	01	H1416_009_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1416	009	0	1	02	01	H1416_009_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1416	023	0	1	01	01	H1416_023_0	4	2	Generic	1	2	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	3.00		9.00																									3.00		9.00				3.00		7.50				3.00				3.00		0.10				0.10	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1416	023	0	1	01	01	H1416_023_0	4	1	Preferred Generic	1	2	001000	1	2	110		01		110	1	30		90				1				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1416	023	0	1	01	01	H1416_023_0	4	3	Preferred Brand	1	2	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1416	023	0	1	01	01	H1416_023_0	4	5	Specialty Tier	1	2	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1416	023	0	1	01	01	H1416_023_0	4	4	Non-Preferred Brand	1	2	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				54.10	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1416	024	0	1	02	01	H1416_024_0	4	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		37.50				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1416	024	0	1	02	01	H1416_024_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1416	024	0	1	02	01	H1416_024_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1416	024	0	1	02	01	H1416_024_0	4	4	Non-Preferred Brand	1	4	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				60.90	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1416	024	0	1	02	01	H1416_024_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1417	002	0	1	04	01	H1417_002_0	4	2	Generic	1	3	000100	1	2		110	01	110		1				30		90	1	30		90				30		31								20.00		60.00					20.00		40.00					20.00		60.00																20.00				20.00			.67	.67	.67			.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1417	002	0	1	04	01	H1417_002_0	4	1	Preferred Generic	1	3	001000	1	2		110	01	110		1				30		90	1	30		90				30		31								14.00		42.00					0.00		0.00					14.00		42.00																14.00				14.00			.47	0.00	.47			.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1417	002	0	1	04	01	H1417_002_0	4	3	Preferred Brand	1	3	000001	1	2		110	01	110		1				30		90	1	30		90				30		31								47.00		141.00					47.00		94.00					47.00		141.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1417	002	0	1	04	01	H1417_002_0	4	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1417	002	0	1	04	01	H1417_002_0	4	4	Non-Preferred Brand	1	3	100000	1	2		110	01	110		1				30		90	1	30		90				30		31								100.00		300.00					100.00		200.00					100.00		300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1417	004	0	1	04	01	H1417_004_0	4	1	Preferred Generic	1	3	001000	1	2		110	01	110		1				30		90	1	30		90				30		31								15.50		46.50					0.00		0.00					15.50		46.50																15.50				15.50			.52	0.00	.52			.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1417	004	0	1	04	01	H1417_004_0	4	2	Generic	1	3	000100	1	2		110	01	110		1				30		90	1	30		90				30		31								20.00		60.00					20.00		40.00					20.00		60.00																20.00				20.00			.67	.67	.67			.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1417	004	0	1	04	01	H1417_004_0	4	3	Preferred Brand	1	3	000001	1	2		110	01	110		1				30		90	1	30		90				30		31								47.00		141.00					47.00		94.00					47.00		141.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1417	004	0	1	04	01	H1417_004_0	4	4	Non-Preferred Brand	1	3	100000	1	2		110	01	110		1				30		90	1	30		90				30		31								100.00		300.00					100.00		200.00					100.00		300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1417	004	0	1	04	01	H1417_004_0	4	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1417	010	0	1	04	01	H1417_010_0	4	3	Preferred Brand	1	3	000001	1	2		110	01	110		1				30		90	1	30		90				30		31								47.00		141.00					47.00		94.00					47.00		141.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1417	010	0	1	04	01	H1417_010_0	4	4	Non-Preferred Brand	1	3	100000	1	2		110	01	110		1				30		90	1	30		90				30		31								100.00		300.00					100.00		200.00					100.00		300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1417	010	0	1	04	01	H1417_010_0	4	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1417	010	0	1	04	01	H1417_010_0	4	1	Preferred Generic	1	3	001000	1	2		110	01	110		1				30		90	1	30		90				30		31								16.00		48.00					0.00		0.00					16.00		48.00																16.00				16.00			.53	0.00	.53			.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1417	010	0	1	04	01	H1417_010_0	4	2	Generic	1	3	000100	1	2		110	01	110		1				30		90	1	30		90				30		31								20.00		60.00					20.00		40.00					20.00		60.00																20.00				20.00			.67	.67	.67			.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1418	002	0	1	04	01	H1418_002_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1418	002	0	1	04	01	H1418_002_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1418	002	0	1	04	01	H1418_002_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1418	002	0	1	04	01	H1418_002_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1418	002	0	1	04	01	H1418_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1418	002	0	1	04	01	H1418_002_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1418	002	0	1	04	01	H1418_002_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1418	002	0	1	04	01	H1418_002_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1418	002	0	1	04	01	H1418_002_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1418	002	0	1	04	01	H1418_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1418	007	0	1	04	01	H1418_007_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1418	007	0	1	04	01	H1418_007_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1418	007	0	1	04	01	H1418_007_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1418	007	0	1	04	01	H1418_007_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1418	007	0	1	04	01	H1418_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1418	007	0	1	04	01	H1418_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1418	007	0	1	04	01	H1418_007_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1418	007	0	1	04	01	H1418_007_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1418	007	0	1	04	01	H1418_007_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1418	007	0	1	04	01	H1418_007_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1418	008	0	1	04	01	H1418_008_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	18.00		54.00																									18.00		54.00				18.00		0.00				18.00				18.00		0.60				0.60	0.60	0.58	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1418	008	0	1	04	01	H1418_008_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	18.00		54.00																									18.00		54.00				18.00		0.00				18.00				18.00		0.60				0.60	0.60	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1463	003	0	1	01	01	H1463_003_0	4	2	Generic	1	3	000100	1	2		110	01	110		1				30		90	1	30		90				30		31								20.00		60.00					20.00		40.00					20.00		60.00																20.00				20.00			.67	.67	.67			.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1463	003	0	1	01	01	H1463_003_0	4	1	Preferred Generic	1	3	001000	1	2		110	01	110		1				30		90	1	30		90				30		31								14.50		43.50					0.00		0.00					14.50		43.50																14.50				14.50			.48	0.00	.48			.47	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1463	003	0	1	01	01	H1463_003_0	4	3	Preferred Brand	1	3	000001	1	2		110	01	110		1				30		90	1	30		90				30		31								47.00		141.00					47.00		94.00					47.00		141.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1463	003	0	1	01	01	H1463_003_0	4	4	Non-Preferred Brand	1	3	100000	1	2		110	01	110		1				30		90	1	30		90				30		31								100.00		300.00					100.00		200.00					100.00		300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1463	003	0	1	01	01	H1463_003_0	4	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1463	009	0	1	01	01	H1463_009_0	4	1	Preferred Generic	1	3	001000	1	2		110	01	110		1				30		90	1	30		90				30		31								15.50		46.50					0.00		0.00					15.50		46.50																15.50				15.50			.52	0.00	.52			.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1463	009	0	1	01	01	H1463_009_0	4	2	Generic	1	3	000100	1	2		110	01	110		1				30		90	1	30		90				30		31								20.00		60.00					20.00		40.00					20.00		60.00																20.00				20.00			.67	.67	.67			.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1463	009	0	1	01	01	H1463_009_0	4	3	Preferred Brand	1	3	000001	1	2		110	01	110		1				30		90	1	30		90				30		31								47.00		141.00					47.00		94.00					47.00		141.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1463	009	0	1	01	01	H1463_009_0	4	4	Non-Preferred Brand	1	3	100000	1	2		110	01	110		1				30		90	1	30		90				30		31								100.00		300.00					100.00		200.00					100.00		300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1463	009	0	1	01	01	H1463_009_0	4	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1463	010	0	1	01	01	H1463_010_0	4	2	Generic	1	3	000100	1	2		110	01	110		1				30		90	1	30		90				30		31								20.00		60.00					20.00		40.00					20.00		60.00																20.00				20.00			.67	.67	.67			.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1463	010	0	1	01	01	H1463_010_0	4	1	Preferred Generic	1	3	001000	1	2		110	01	110		1				30		90	1	30		90				30		31								16.00		48.00					0.00		0.00					16.00		48.00																16.00				16.00			.53	0.00	.53			.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1463	010	0	1	01	01	H1463_010_0	4	3	Preferred Brand	1	3	000001	1	2		110	01	110		1				30		90	1	30		90				30		31								47.00		141.00					47.00		94.00					47.00		141.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1463	010	0	1	01	01	H1463_010_0	4	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1463	010	0	1	01	01	H1463_010_0	4	4	Non-Preferred Brand	1	3	100000	1	2		110	01	110		1				30		90	1	30		90				30		31								100.00		300.00					100.00		200.00					100.00		300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1468	007	0	1	01	01	H1468_007_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1468	007	0	1	01	01	H1468_007_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1468	007	0	1	01	01	H1468_007_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1468	007	0	1	01	01	H1468_007_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1468	007	0	1	01	01	H1468_007_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1468	007	0	1	01	01	H1468_007_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1468	007	0	1	01	01	H1468_007_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1468	007	0	1	01	01	H1468_007_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1468	007	0	1	01	01	H1468_007_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1468	007	0	1	01	01	H1468_007_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1493	001	0	1	01	01	H1493_001_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	4.00		12.00																					10.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1493	001	0	1	01	01	H1493_001_0	6	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	10.00		30.00																					25.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1493	001	0	1	01	01	H1493_001_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	47.00		141.00																					118.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1493	001	0	1	01	01	H1493_001_0	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	100.00		300.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1493	001	0	1	01	01	H1493_001_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1493	002	0	1	01	01	H1493_002_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1493	002	0	1	01	01	H1493_002_0	6	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	10.00		30.00																					25.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1493	002	0	1	01	01	H1493_002_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	47.00		141.00																					118.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1493	002	0	1	01	01	H1493_002_0	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	100.00		300.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1493	002	0	1	01	01	H1493_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1510	001	0	1	04	01	H1510_001_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, 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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1510	001	0	1	04	01	H1510_001_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, 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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1510	004	0	1	04	01	H1510_004_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1510	004	0	1	04	01	H1510_004_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1510	005	0	1	04	01	H1510_005_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1510	005	0	1	04	01	H1510_005_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1517	007	0	1	04	01	H1517_007_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1517	007	0	1	04	01	H1517_007_0	10	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1517	007	0	1	04	01	H1517_007_0	10	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								97.00	194.00	291.00					92.00	184.00	276.00					92.00	276.00	276.00																97.00				97.00			3.23	3.07	3.07			2.85	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1517	007	0	1	04	01	H1517_007_0	10	5	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34											1453.54	33						1453.54	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1517	007	0	1	04	01	H1517_007_0	10	2	Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								18.00	36.00	54.00					13.00	26.00	39.00					13.00	39.00	39.00																18.00				18.00			0.60	0.43	0.43			0.53	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1517	007	0	1	04	01	H1517_007_0	10	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00	9.00	9.00																8.00				8.00			0.27	0.10	0.10			0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1537	001	0	1	04	01	H1537_001_0	3	2	Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1537	001	0	1	04	01	H1537_001_0	3	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1537	001	0	1	04	01	H1537_001_0	3	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1537	001	0	1	04	01	H1537_001_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1537	001	0	1	04	01	H1537_001_0	3	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31				525.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1607	012	0	1	04	01	H1607_012_0	9	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1607	012	0	1	04	01	H1607_012_0	9	2	Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00	36.00	36.00																17.00				17.00			0.57	0.40	0.40			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1607	012	0	1	04	01	H1607_012_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1607	012	0	1	04	01	H1607_012_0	9	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1607	012	0	1	04	01	H1607_012_0	9	5	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34											1751.72	32						1751.72	32						32																	32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1607	012	0	1	04	01	H1607_012_0	9	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1608	001	0	1	04	01	H1608_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											48.85	50	50	50				44.86	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	001	0	1	04	01	H1608_001_0	5	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	001	0	1	04	01	H1608_001_0	5	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								15.00	30.00	45.00					3.00	6.00	9.00					15.00	30.00	45.00																	15.00			15.00			0.50	0.10	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	001	0	1	04	01	H1608_001_0	5	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					8.00	16.00	24.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.27	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	001	0	1	04	01	H1608_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	004	0	1	04	01	H1608_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											52.71	50	50	50				45.53	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	004	0	1	04	01	H1608_004_0	5	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	004	0	1	04	01	H1608_004_0	5	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								15.00	30.00	45.00					5.00	10.00	15.00					15.00	30.00	45.00																	15.00			15.00			0.50	0.17	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	004	0	1	04	01	H1608_004_0	5	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					0.00	0.00	0.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.00	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	004	0	1	04	01	H1608_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	007	0	1	04	01	H1608_007_0	5	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					0.00	0.00	0.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.00	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	007	0	1	04	01	H1608_007_0	5	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								15.00	30.00	45.00					5.00	10.00	15.00					15.00	30.00	45.00																	15.00			15.00			0.50	0.17	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	007	0	1	04	01	H1608_007_0	5	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	007	0	1	04	01	H1608_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											58.25	50	50	50				51.51	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	007	0	1	04	01	H1608_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	008	0	1	04	01	H1608_008_0	6	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					0.00	0.00	0.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.00	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	008	0	1	04	01	H1608_008_0	6	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								15.00	30.00	45.00					5.00	10.00	15.00					15.00	30.00	45.00																	15.00			15.00			0.50	0.17	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	008	0	1	04	01	H1608_008_0	6	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	008	0	1	04	01	H1608_008_0	6	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											46.24	50	50	50				41.58	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	008	0	1	04	01	H1608_008_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	012	0	1	04	01	H1608_012_0	5	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					8.00	16.00	24.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.27	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	012	0	1	04	01	H1608_012_0	5	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								15.00	30.00	45.00					3.00	6.00	9.00					15.00	30.00	45.00																	15.00			15.00			0.50	0.10	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	012	0	1	04	01	H1608_012_0	5	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	012	0	1	04	01	H1608_012_0	5	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	012	0	1	04	01	H1608_012_0	5	4	Non-Preferred Brand	1	4	110000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	013	0	1	04	01	H1608_013_0	6	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											41.94	50	50	50				40.56	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	013	0	1	04	01	H1608_013_0	6	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	013	0	1	04	01	H1608_013_0	6	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								13.00	26.00	39.00					8.00	16.00	24.00					13.00	26.00	39.00																	13.00			13.00			0.43	0.27	0.43			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	013	0	1	04	01	H1608_013_0	6	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	013	0	1	04	01	H1608_013_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	016	0	1	04	01	H1608_016_0	3	4	Non-Preferred Brand	1	4	110000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	016	0	1	04	01	H1608_016_0	3	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	016	0	1	04	01	H1608_016_0	3	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								15.00	30.00	45.00					9.00	18.00	0.00					15.00	30.00	45.00																	15.00			15.00			0.50	0.30	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	016	0	1	04	01	H1608_016_0	3	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					4.00	8.00	0.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.13	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	016	0	1	04	01	H1608_016_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	017	0	1	04	01	H1608_017_0	4	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					4.00	8.00	8.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.13	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	017	0	1	04	01	H1608_017_0	4	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								15.00	30.00	45.00					9.00	18.00	18.00					15.00	30.00	45.00																	15.00			15.00			0.50	0.30	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	017	0	1	04	01	H1608_017_0	4	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	94.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	017	0	1	04	01	H1608_017_0	4	4	Non-Preferred Brand	1	4	110000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								100.00	200.00	300.00					100.00	200.00	200.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	017	0	1	04	01	H1608_017_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	018	0	1	04	01	H1608_018_0	3	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					4.00	8.00	8.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.13	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	018	0	1	04	01	H1608_018_0	3	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								15.00	30.00	45.00					9.00	18.00	18.00					15.00	30.00	45.00																	15.00			15.00			0.50	0.30	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	018	0	1	04	01	H1608_018_0	3	4	Non-Preferred Brand	1	4	110000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								100.00	200.00	300.00					100.00	200.00	200.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	018	0	1	04	01	H1608_018_0	3	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	94.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	018	0	1	04	01	H1608_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	021	0	1	04	01	H1608_021_0	3	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					4.00	8.00	0.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.13	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	021	0	1	04	01	H1608_021_0	3	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								15.00	30.00	45.00					9.00	18.00	0.00					15.00	30.00	45.00																	15.00			15.00			0.50	0.30	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	021	0	1	04	01	H1608_021_0	3	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	021	0	1	04	01	H1608_021_0	3	4	Non-Preferred Brand	1	4	110000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	021	0	1	04	01	H1608_021_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	023	0	1	04	01	H1608_023_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	023	0	1	04	01	H1608_023_0	3	4	Non-Preferred Brand	1	4	110000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	023	0	1	04	01	H1608_023_0	3	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					2.00	4.00	2.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.07	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	023	0	1	04	01	H1608_023_0	3	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	023	0	1	04	01	H1608_023_0	3	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								15.00	30.00	45.00					7.00	14.00	7.00					15.00	30.00	45.00																	15.00			15.00			0.50	0.23	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	024	0	1	04	01	H1608_024_0	4	1	Generic	1	4	010010	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	024	0	1	04	01	H1608_024_0	4	2	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	024	0	1	04	01	H1608_024_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												
H1608	024	0	1	04	01	H1608_024_0	4	1	Generic	3	4	010010	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					10.00	20.00	30.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.33	0.67			0.65	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1608	024	0	1	04	01	H1608_024_0	4	3	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											34.31	50	50	50				31.30	50	50	50				50	50	50																50		50								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	025	0	1	04	01	H1608_025_0	6	2	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					45.00	90.00	135.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.50	1.57			1.52	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	025	0	1	04	01	H1608_025_0	6	3	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											43.05	50	50	50				38.67	50	50	50				50	50	50																50		50								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	025	0	1	04	01	H1608_025_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												
H1608	025	0	1	04	01	H1608_025_0	6	1	Generic	1	4	010010	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								8.00	16.00	24.00					3.00	6.00	9.00					8.00	16.00	24.00																	8.00			8.00			0.27	0.10	0.27			0.26	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	026	0	1	04	01	H1608_026_0	6	4	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31											1.00	30						1.00	30						30																		30		30								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	026	0	1	04	01	H1608_026_0	6	3	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											39.72	50	50	50				36.41	50	50	50				50	50	50																50		50								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	026	0	1	04	01	H1608_026_0	6	2	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								45.00	90.00	135.00					45.00	90.00	135.00					45.00	90.00	135.00																	45.00			45.00			1.50	1.50	1.50			1.45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	026	0	1	04	01	H1608_026_0	6	1	Generic	1	4	010010	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					2.00	4.00	6.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.07	0.67			0.65	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	027	0	1	04	01	H1608_027_0	6	3	Non-Preferred Brand	1	4	110000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	027	0	1	04	01	H1608_027_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												
H1608	027	0	1	04	01	H1608_027_0	6	1	Generic	1	4	010010	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								14.00	28.00	35.00					9.00	18.00	22.50					14.00	28.00	35.00																	14.00			14.00			0.47	0.30	0.47			0.45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	027	0	1	04	01	H1608_027_0	6	2	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	028	0	1	04	01	H1608_028_0	9	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					45.00	90.00	135.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.50	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	028	0	1	04	01	H1608_028_0	9	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											46.57	50	50	50				42.60	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	028	0	1	04	01	H1608_028_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	028	0	1	04	01	H1608_028_0	9	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					15.00	30.00	45.00					20.00	40.00	60.00																	20.00			20.00			.67	.50	.67			.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	028	0	1	04	01	H1608_028_0	9	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					5.00	10.00	15.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.17	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	029	0	1	04	01	H1608_029_0	9	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					0.00	0.00	0.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.00	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	029	0	1	04	01	H1608_029_0	9	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					10.00	20.00	30.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.33	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	029	0	1	04	01	H1608_029_0	9	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	029	0	1	04	01	H1608_029_0	9	4	Non-Preferred Brand	1	4	110000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	029	0	1	04	01	H1608_029_0	9	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	030	0	1	04	01	H1608_030_0	6	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					0.00	0.00	0.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.00	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	030	0	1	04	01	H1608_030_0	6	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	030	0	1	04	01	H1608_030_0	6	4	Non-Preferred Brand	1	4	110000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	030	0	1	04	01	H1608_030_0	6	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1608	030	0	1	04	01	H1608_030_0	6	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					10.00	20.00	30.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.33	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1609	001	0	1	01	01	H1609_001_0	5	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								15.00	30.00	45.00					3.00	6.00	9.00					15.00	30.00	45.00																	15.00			15.00			0.50	0.10	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1609	001	0	1	01	01	H1609_001_0	5	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					8.00	16.00	24.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.27	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1609	001	0	1	01	01	H1609_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1609	001	0	1	01	01	H1609_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											42.81	50	50	50				40.87	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1609	001	0	1	01	01	H1609_001_0	5	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, 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, 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								10.00	20.00	30.00					0.00	0.00	0.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.00	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1609	009	0	1	01	01	H1609_009_0	5	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								15.00	30.00	45.00					5.00	10.00	15.00					15.00	30.00	45.00																	15.00			15.00			0.50	0.17	0.50			0.48	Preferred Generic, 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								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, 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											43.93	50	50	50				38.23	50	50	50				50	50	50																50		50								Preferred Generic, 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								10.00	20.00	30.00					0.00	0.00	0.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.00	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1609	010	0	1	01	01	H1609_010_0	5	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								15.00	30.00	45.00					5.00	10.00	15.00					15.00	30.00	45.00																	15.00			15.00			0.50	0.17	0.50			0.48	Preferred Generic, 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, 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											42.05	50	50	50				36.89	50	50	50				50	50	50																50		50								Preferred Generic, 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								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1659	001	0	1	04	01	H1659_001_0	5	2	Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	18.00		54.00																			18.00		36.00																18.00				18.00		.60			.60			.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1659	001	0	1	04	01	H1659_001_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	6.00		18.00																			6.00		12.00																6.00				6.00		.20			.20			.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1659	001	0	1	04	01	H1659_001_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				1	30		90				30		31	40.00		120.00																			40.00		80.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1659	001	0	1	04	01	H1659_001_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	80.00		240.00																			80.00		160.00																80.00				80.00		2.67			2.67			2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1659	001	0	1	04	01	H1659_001_0	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1659	002	0	1	04	01	H1659_002_0	6	2	Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	18.00		54.00																			18.00		36.00																18.00				18.00		.60			.60			.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1659	002	0	1	04	01	H1659_002_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	8.00		24.00																			8.00		16.00																8.00				8.00		.27			.27			.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1659	002	0	1	04	01	H1659_002_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				1	30		90				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1659	002	0	1	04	01	H1659_002_0	6	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1659	002	0	1	04	01	H1659_002_0	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	95.00		285.00																			95.00		190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1659	003	0	1	04	01	H1659_003_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		.33			.33			.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1659	003	0	1	04	01	H1659_003_0	5	2	Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	20.00		60.00																			20.00		40.00																20.00				20.00		.67			.67			.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1659	003	0	1	04	01	H1659_003_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1659	003	0	1	04	01	H1659_003_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				1	30		90				30		31	47.00		141.00																			47.00		94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1659	003	0	1	04	01	H1659_003_0	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	001	0	1	01	01	H1660_001_0	6	1	Preferred Generic	1	4	001000	3	2	110		01	111		1	30		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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	001	0	1	01	01	H1660_001_0	6	2	Generic	1	4	000100	3	2	110		01	111		1	30		90				1	30	60	90				30		31	10.00		30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	001	0	1	01	01	H1660_001_0	6	3	Preferred Brand	1	4	000001	3	2	110		01	111		1	30		90				1	30	60	90				30		31	47.00		141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	001	0	1	01	01	H1660_001_0	6	4	Non-Preferred Brand	1	4	100100	3	2	110		01	111		1	30		90				1	30	60	90				30		31	100.00		300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	001	0	1	01	01	H1660_001_0	6	5	Specialty Tier	1	4	010010	1	1	110		01	111		1	30		90				1	30	60	90				30		31				300.00	33		33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	001	0	1	01	01	H1660_001_0	6	1	Preferred Generic	3	4	001000	3	2	110		01	111		1	30		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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H1660	001	0	1	01	01	H1660_001_0	6	2	Generic	3	4	000100	3	2	110		01	111		1	30		90				1	30	60	90				30		31	10.00		30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H1660	004	0	1	01	01	H1660_004_0	6	1	Preferred Generic	1	4	001000	3	2	110		01	111		1	30		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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	004	0	1	01	01	H1660_004_0	6	2	Generic	1	4	000100	3	2	110		01	111		1	30		90				1	30	60	90				30		31	10.00		30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	004	0	1	01	01	H1660_004_0	6	3	Preferred Brand	1	4	000001	3	2	110		01	111		1	30		90				1	30	60	90				30		31	47.00		141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	004	0	1	01	01	H1660_004_0	6	4	Non-Preferred Brand	1	4	100100	3	2	110		01	111		1	30		90				1	30	60	90				30		31	100.00		300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	004	0	1	01	01	H1660_004_0	6	5	Specialty Tier	1	4	010010	1	1	110		01	111		1	30		90				1	30	60	90				30		31				300.00	33		33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	004	0	1	01	01	H1660_004_0	6	1	Preferred Generic	3	4	001000	3	2	110		01	111		1	30		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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H1660	004	0	1	01	01	H1660_004_0	6	2	Generic	3	4	000100	3	2	110		01	111		1	30		90				1	30	60	90				30		31	10.00		30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H1660	005	0	1	01	01	H1660_005_0	6	3	Preferred Brand	1	4	000001	3	2	110		01	111		1	30		90				1	30	60	90				30		31	47.00		141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	005	0	1	01	01	H1660_005_0	6	4	Non-Preferred Brand	1	4	100100	3	2	110		01	111		1	30		90				1	30	60	90				30		31	100.00		300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	005	0	1	01	01	H1660_005_0	6	5	Specialty Tier	1	4	010010	1	1	110		01	111		1	30		90				1	30	60	90				30		31				300.00	33		33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	005	0	1	01	01	H1660_005_0	6	1	Preferred Generic	3	4	001000	3	2	110		01	111		1	30		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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H1660	005	0	1	01	01	H1660_005_0	6	2	Generic	3	4	000100	3	2	110		01	111		1	30		90				1	30	60	90				30		31	10.00		30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H1660	005	0	1	01	01	H1660_005_0	6	1	Preferred Generic	1	4	001000	3	2	110		01	111		1	30		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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	005	0	1	01	01	H1660_005_0	6	2	Generic	1	4	000100	3	2	110		01	111		1	30		90				1	30	60	90				30		31	10.00		30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	009	0	1	01	01	H1660_009_0	6	2	Generic	1	4	000100	3	2	110		01	111		1	30		90				1	30	60	90				30		31	10.00		30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	009	0	1	01	01	H1660_009_0	6	1	Preferred Generic	1	4	001000	3	2	110		01	111		1	30		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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	009	0	1	01	01	H1660_009_0	6	3	Preferred Brand	1	4	000001	3	2	110		01	111		1	30		90				1	30	60	90				30		31	47.00		141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	009	0	1	01	01	H1660_009_0	6	4	Non-Preferred Brand	1	4	100100	3	2	110		01	111		1	30		90				1	30	60	90				30		31	100.00		300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	009	0	1	01	01	H1660_009_0	6	5	Specialty Tier	1	4	010010	1	1	110		01	111		1	30		90				1	30	60	90				30		31				300.00	25		25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	012	0	1	01	01	H1660_012_0	7	5	Specialty Tier	1	4	010010	1	1	110		01	111		1	30		90				1	30	60	90				30		31				300.00	25		25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	012	0	1	01	01	H1660_012_0	7	3	Preferred Brand	1	4	000001	3	2	110		01	111		1	30		90				1	30	60	90				30		31	47.00		141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	012	0	1	01	01	H1660_012_0	7	2	Generic	1	4	000100	3	2	110		01	111		1	30		90				1	30	60	90				30		31	10.00		30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	012	0	1	01	01	H1660_012_0	7	4	Non-Preferred Brand	1	4	100100	3	2	110		01	111		1	30		90				1	30	60	90				30		31	100.00		300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	012	0	1	01	01	H1660_012_0	7	1	Preferred Generic	1	4	001000	3	2	110		01	111		1	30		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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	013	0	1	01	01	H1660_013_0	8	1	Preferred Generic	1	4	001000	3	2	110		01	111		1	30		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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	013	0	1	01	01	H1660_013_0	8	5	Specialty Tier	1	4	010010	1	1	110		01	111		1	30		90				1	30	60	90				30		31				300.00	33		33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	013	0	1	01	01	H1660_013_0	8	4	Non-Preferred Brand	1	4	100100	3	2	110		01	111		1	30		90				1	30	60	90				30		31	100.00		300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	013	0	1	01	01	H1660_013_0	8	3	Preferred Brand	1	4	000001	3	2	110		01	111		1	30		90				1	30	60	90				30		31	47.00		141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	013	0	1	01	01	H1660_013_0	8	2	Generic	1	4	000100	3	2	110		01	111		1	30		90				1	30	60	90				30		31	10.00		30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	001	0	1	04	01	H1666_001_0	7	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	001	0	1	04	01	H1666_001_0	7	2	Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								11.00		33.00					6.00		18.00							33.00																11.00				11.00			0.37	0.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	001	0	1	04	01	H1666_001_0	7	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			.16	.00				.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1666	001	0	1	04	01	H1666_001_0	7	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31											1330.00	33		33				1330.00	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	001	0	1	04	01	H1666_001_0	7	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					85.00		255.00							285.00																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	001	0	1	04	01	H1666_001_0	7	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31								44.00		132.00					39.00		117.00							132.00																44.00				44.00			1.47	1.30				1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	001	0	1	04	01	H1666_001_0	7	2	Generic	3	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								11.00		33.00					6.00		18.00							33.00																11.00				11.00			.36	.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1666	002	0	1	04	01	H1666_002_0	7	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			.16	.00				.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1666	002	0	1	04	01	H1666_002_0	7	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31											1330.00	33		33				1330.00	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	002	0	1	04	01	H1666_002_0	7	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					85.00		255.00							285.00																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	002	0	1	04	01	H1666_002_0	7	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31								44.00		132.00					39.00		117.00							132.00																44.00				44.00			1.47	1.30				1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	002	0	1	04	01	H1666_002_0	7	2	Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								11.00		33.00					6.00		18.00							33.00																11.00				11.00			0.37	0.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	002	0	1	04	01	H1666_002_0	7	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	002	0	1	04	01	H1666_002_0	7	2	Generic	3	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								11.00		33.00					6.00		18.00							33.00																11.00				11.00			.36	.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1666	003	0	1	04	01	H1666_003_0	6	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			.16	.00				.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1666	003	0	1	04	01	H1666_003_0	6	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31											1330.00	33		33				1330.00	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	003	0	1	04	01	H1666_003_0	6	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					85.00		255.00							285.00																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	003	0	1	04	01	H1666_003_0	6	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31								44.00		132.00					39.00		117.00							132.00																44.00				44.00			1.47	1.30				1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	003	0	1	04	01	H1666_003_0	6	2	Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								11.00		33.00					6.00		18.00							33.00																11.00				11.00			0.37	0.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	003	0	1	04	01	H1666_003_0	6	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	003	0	1	04	01	H1666_003_0	6	2	Generic	3	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								11.00		33.00					6.00		18.00							33.00																11.00				11.00			.36	.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1666	004	0	1	04	01	H1666_004_0	6	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			.16	.00				.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1666	004	0	1	04	01	H1666_004_0	6	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31											1330.00	33		33				1330.00	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	004	0	1	04	01	H1666_004_0	6	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					85.00		255.00							285.00																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	004	0	1	04	01	H1666_004_0	6	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31								44.00		132.00					39.00		117.00							132.00																44.00				44.00			1.47	1.30				1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	004	0	1	04	01	H1666_004_0	6	2	Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								11.00		33.00					6.00		18.00							33.00																11.00				11.00			0.37	0.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	004	0	1	04	01	H1666_004_0	6	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	004	0	1	04	01	H1666_004_0	6	2	Generic	3	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								11.00		33.00					6.00		18.00							33.00																11.00				11.00			.36	.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1666	005	0	1	04	01	H1666_005_0	6	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	005	0	1	04	01	H1666_005_0	6	2	Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								11.00		33.00					6.00		18.00							33.00																11.00				11.00			0.37	0.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	005	0	1	04	01	H1666_005_0	6	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31								44.00		132.00					39.00		117.00							132.00																44.00				44.00			1.47	1.30				1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	005	0	1	04	01	H1666_005_0	6	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					85.00		255.00							285.00																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	005	0	1	04	01	H1666_005_0	6	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31											1330.00	33		33				1330.00	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	005	0	1	04	01	H1666_005_0	6	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			.16	.00				.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1666	005	0	1	04	01	H1666_005_0	6	2	Generic	3	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								11.00		33.00					6.00		18.00							33.00																11.00				11.00			.36	.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1666	006	0	1	04	01	H1666_006_0	6	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	006	0	1	04	01	H1666_006_0	6	2	Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								11.00		33.00					6.00		18.00							33.00																11.00				11.00			0.37	0.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	006	0	1	04	01	H1666_006_0	6	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31								44.00		132.00					39.00		117.00							132.00																44.00				44.00			1.47	1.30				1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	006	0	1	04	01	H1666_006_0	6	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					85.00		255.00							285.00																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	006	0	1	04	01	H1666_006_0	6	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31											1330.00	33		33				1330.00	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	006	0	1	04	01	H1666_006_0	6	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			.16	.00				.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1666	006	0	1	04	01	H1666_006_0	6	2	Generic	3	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								11.00		33.00					6.00		18.00							33.00																11.00				11.00			.36	.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1666	008	0	1	04	01	H1666_008_0	10	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	008	0	1	04	01	H1666_008_0	10	2	Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								11.00		33.00					6.00		18.00							33.00																11.00				11.00			0.37	0.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	008	0	1	04	01	H1666_008_0	10	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31								44.00		132.00					39.00		117.00							132.00																44.00				44.00			1.47	1.30				1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	008	0	1	04	01	H1666_008_0	10	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					85.00		255.00							285.00																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	008	0	1	04	01	H1666_008_0	10	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31											1330.00	33		33				1330.00	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	008	0	1	04	01	H1666_008_0	10	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1666	008	0	1	04	01	H1666_008_0	10	2	Generic	3	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								11.00		33.00					6.00		18.00							33.00																11.00				11.00			0.37	0.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1666	009	0	1	04	01	H1666_009_0	11	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	009	0	1	04	01	H1666_009_0	11	2	Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								11.00		33.00					6.00		18.00							33.00																11.00				11.00			0.37	0.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	009	0	1	04	01	H1666_009_0	11	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31								44.00		132.00					39.00		117.00							132.00																44.00				44.00			1.47	1.30				1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	009	0	1	04	01	H1666_009_0	11	2	Generic	3	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								11.00		33.00					6.00		18.00							33.00																11.00				11.00			0.37	0.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1666	009	0	1	04	01	H1666_009_0	11	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31											1330.00	33		33				1330.00	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	009	0	1	04	01	H1666_009_0	11	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1666	009	0	1	04	01	H1666_009_0	11	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					85.00		255.00							285.00																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1692	002	0	1	01	01	H1692_002_0	5	2	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1692	002	0	1	01	01	H1692_002_0	5	1	Generic	1	4	010010	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					2.00	4.00	6.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.07	0.67			0.65	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1692	002	0	1	01	01	H1692_002_0	5	3	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											35.77	50	50	50				28.47	50	50	50				50	50	50																50		50								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1692	002	0	1	01	01	H1692_002_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												
H1692	003	0	1	01	01	H1692_003_0	3	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					15.00	30.00	45.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.50	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1692	003	0	1	01	01	H1692_003_0	3	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								16.00	32.00	48.00					6.00	12.00	18.00					16.00	32.00	48.00																	16.00			16.00			0.53	0.20	0.53			0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1692	003	0	1	01	01	H1692_003_0	3	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1692	003	0	1	01	01	H1692_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1692	003	0	1	01	01	H1692_003_0	3	4	Non-Preferred Brand	1	4	110000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1692	004	0	1	01	01	H1692_004_0	3	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								18.00	36.00	54.00					6.00	12.00	18.00					18.00	36.00	54.00																	18.00			18.00			0.60	0.20	0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1692	004	0	1	01	01	H1692_004_0	3	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					17.00	34.00	51.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.57	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1692	004	0	1	01	01	H1692_004_0	3	4	Non-Preferred Brand	1	4	110000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1692	004	0	1	01	01	H1692_004_0	3	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1692	004	0	1	01	01	H1692_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, 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					27																										27						27					27			27								Preferred Generic, 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	8.00		24.00																									8.00		24.00				8.00		0.00				8.00				8.00		0.26				0.26	0.26	0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1716	001	0	1	04	01	H1716_001_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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					27																										27						27					27			27								Preferred Generic, 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	8.00		24.00																									8.00		24.00				8.00		0.00				8.00				8.00		0.26				0.26	0.26	0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1716	001	0	1	04	01	H1716_001_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1723	001	0	1	48	05	H1723_001_0	9	2	Brand Drugs	1	4	000010			110		01	100		1	30		90				2			90				30		31																																														0.00						0.00	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	9	3	Non-Medicare Rx/OTC Drugs	1	4	010010			110		01	100		1	30		90				2			90				30		31																																														0.00						0.00	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	9	1	Generic Drugs	1	4	010000			110		01	100		1	30		90				2			90				30		31																																														0.00						0.00	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	4	1	Preferred Generic	1	3	001000	1	2		110	01	110		1				30		90	1	30		90				30		31								9.00		27.00					0.00		0.00					9.00		27.00																9.00				9.00			.30	0.00	.30			.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1737	001	0	1	01	01	H1737_001_0	4	2	Generic	1	3	000100	1	2		110	01	110		1				30		90	1	30		90				30		31								20.00		60.00					20.00		40.00					20.00		60.00																20.00				20.00			.67	.67	.67			.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1737	001	0	1	01	01	H1737_001_0	4	3	Preferred Brand	1	3	000001	1	2		110	01	110		1				30		90	1	30		90				30		31								47.00		141.00					47.00		94.00					47.00		141.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1737	001	0	1	01	01	H1737_001_0	4	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1737	001	0	1	01	01	H1737_001_0	4	4	Non-Preferred Brand	1	3	100000	1	2		110	01	110		1				30		90	1	30		90				30		31								100.00		300.00					100.00		200.00					100.00		300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1737	003	0	1	01	01	H1737_003_0	5	4	Non-Preferred Brand	1	3	100000	1	2		110	01	110		1				30		90	1	30		90				30		31								100.00		300.00					100.00		200.00					100.00		300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1737	003	0	1	01	01	H1737_003_0	5	3	Preferred Brand	1	3	000001	1	2		110	01	110		1				30		90	1	30		90				30		31								47.00		141.00					47.00		94.00					47.00		141.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1737	003	0	1	01	01	H1737_003_0	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1737	003	0	1	01	01	H1737_003_0	5	1	Preferred Generic	1	3	001000	1	2		110	01	110		1				30		90	1	30		90				30		31								9.00		27.00					0.00		0.00					9.00		27.00																9.00				9.00			.30	0.00	.30			.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1737	003	0	1	01	01	H1737_003_0	5	2	Generic	1	3	000100	1	2		110	01	110		1				30		90	1	30		90				30		31								20.00		60.00					20.00		40.00					20.00		60.00																20.00				20.00			.67	.67	.67			.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1846	001	0	1	04	01	H1846_001_0	8	2	Generic	1	4	000101	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, 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, 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	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, 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	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, 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, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1846	003	0	1	04	01	H1846_003_0	10	2	Generic	1	4	000101	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	18.00	36.00	54.00																			18.00	36.00	36.00																18.00				18.00		0.60			0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1846	003	0	1	04	01	H1846_003_0	10	1	Preferred Generic	1	4	001001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1846	003	0	1	04	01	H1846_003_0	10	3	Preferred Brand	1	4	000101	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1846	003	0	1	04	01	H1846_003_0	10	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1846	003	0	1	04	01	H1846_003_0	10	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				792.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1846	003	0	1	04	01	H1846_003_0	10	4	Non-Preferred Brand	1	4	100100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1849	017	0	1	01	01	H1849_017_0	8	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1849	017	0	1	01	01	H1849_017_0	8	2	Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								4.00	8.00	12.00					4.00	8.00	12.00					4.00	12.00	12.00																4.00				4.00			0.13	0.13	0.13			0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1849	017	0	1	01	01	H1849_017_0	8	5	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34											783.27	25						783.27	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1849	017	0	1	01	01	H1849_017_0	8	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								93.00	186.00	279.00					88.00	176.00	264.00					88.00	264.00	264.00																93.00				93.00			3.10	2.93	2.93			2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1849	017	0	1	01	01	H1849_017_0	8	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								46.00	92.00	138.00					46.00	92.00	138.00					46.00	138.00	138.00																46.00				46.00			1.53	1.53	1.53			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1849	017	0	1	01	01	H1849_017_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1849	018	0	1	01	01	H1849_018_0	8	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1849	018	0	1	01	01	H1849_018_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1849	018	0	1	01	01	H1849_018_0	8	5	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34											1578.13	33						1578.13	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1849	018	0	1	01	01	H1849_018_0	8	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								93.00	186.00	279.00					88.00	176.00	264.00					88.00	264.00	264.00																93.00				93.00			3.10	2.93	2.93			2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1849	018	0	1	01	01	H1849_018_0	8	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1849	018	0	1	01	01	H1849_018_0	8	2	Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								14.00	28.00	42.00					9.00	18.00	27.00					9.00	27.00	27.00																14.00				14.00			0.47	0.30	0.30			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1894	001	0	1	01	01	H1894_001_0	10	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	15.00	15.00																10.00				10.00			0.33	.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1894	001	0	1	01	01	H1894_001_0	10	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1894	001	0	1	01	01	H1894_001_0	10	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1894	001	0	1	01	01	H1894_001_0	10	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1894	001	0	1	01	01	H1894_001_0	10	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34											1156.91	33						1156.91	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1894	001	0	1	01	01	H1894_001_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1894	001	0	1	01	01	H1894_001_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H1894	002	0	1	01	01	H1894_002_0	10	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1894	002	0	1	01	01	H1894_002_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1894	002	0	1	01	01	H1894_002_0	10	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34											861.62	25						861.62	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1894	002	0	1	01	01	H1894_002_0	10	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								87.00	174.00	261.00					82.00	164.00	246.00					82.00	246.00	246.00																87.00				87.00			2.90	2.73	2.73			2.56	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1894	002	0	1	01	01	H1894_002_0	10	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1894	002	0	1	01	01	H1894_002_0	10	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								6.00	12.00	18.00					6.00	12.00	18.00					6.00	18.00	18.00																6.00				6.00			0.20	0.20	0.20			0.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1894	002	0	1	01	01	H1894_002_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H1903	011	0	1	01	01	H1903_011_0	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1903	011	0	1	01	01	H1903_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1903	011	0	1	01	01	H1903_011_0	5	4	Non-Preferred Brand	1	3	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				67.40	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1903	011	0	1	01	01	H1903_011_0	5	3	Preferred Brand	1	3	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1903	011	0	1	01	01	H1903_011_0	5	2	Generic	1	3	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1903	022	0	1	01	01	H1903_022_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1903	022	0	1	01	01	H1903_022_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1903	022	0	1	01	01	H1903_022_0	5	4	Non-Preferred Brand	1	4	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				55.10	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1903	022	0	1	01	01	H1903_022_0	5	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1903	022	0	1	01	01	H1903_022_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		110	1	30		90				1				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1903	025	0	1	01	01	H1903_025_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		110	1	30		90				1				30		90	30		31	3.00		9.00																									3.00		9.00				3.00		0.00				3.00				3.00		0.10				0.10	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1903	025	0	1	01	01	H1903_025_0	5	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1903	025	0	1	01	01	H1903_025_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1903	025	0	1	01	01	H1903_025_0	5	4	Non-Preferred Brand	1	4	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				48.90	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1903	025	0	1	01	01	H1903_025_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1916	001	0	1	48	05	H1916_001_0	4	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	4	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	4	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	11.00		33.00																											33.00						0.00				11.00				11.00		0.36						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	001	0	1	01	01	H1944_001_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	001	0	1	01	01	H1944_001_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	001	0	1	01	01	H1944_001_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				508.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	001	0	1	01	01	H1944_001_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	004	0	1	01	01	H1944_004_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	004	0	1	01	01	H1944_004_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	11.00		33.00																											33.00						0.00				11.00				11.00		0.36						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	004	0	1	01	01	H1944_004_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	004	0	1	01	01	H1944_004_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	004	0	1	01	01	H1944_004_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				592.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	005	0	1	01	01	H1944_005_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				446.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	005	0	1	01	01	H1944_005_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	005	0	1	01	01	H1944_005_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	005	0	1	01	01	H1944_005_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	005	0	1	01	01	H1944_005_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	9.00		27.00																											27.00						0.00				9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	006	0	1	01	01	H1944_006_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	006	0	1	01	01	H1944_006_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	006	0	1	01	01	H1944_006_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	006	0	1	01	01	H1944_006_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	006	0	1	01	01	H1944_006_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				508.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	007	0	1	01	01	H1944_007_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	007	0	1	01	01	H1944_007_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	007	0	1	01	01	H1944_007_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	9.00		27.00																											27.00						0.00				9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	007	0	1	01	01	H1944_007_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	007	0	1	01	01	H1944_007_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				442.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	008	0	1	01	01	H1944_008_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	008	0	1	01	01	H1944_008_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	008	0	1	01	01	H1944_008_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	008	0	1	01	01	H1944_008_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	008	0	1	01	01	H1944_008_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				508.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	009	0	1	01	01	H1944_009_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	009	0	1	01	01	H1944_009_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	009	0	1	01	01	H1944_009_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	009	0	1	01	01	H1944_009_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	009	0	1	01	01	H1944_009_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				510.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	010	0	1	01	01	H1944_010_0	3	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	010	0	1	01	01	H1944_010_0	3	2	Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	010	0	1	01	01	H1944_010_0	3	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	010	0	1	01	01	H1944_010_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		100	1	30		90				1						90	30		31	93.00		279.00																											279.00						269.00				93.00				93.00		3.10						3.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	010	0	1	01	01	H1944_010_0	3	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31				468.00	25		25																										25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	011	0	1	01	01	H1944_011_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	011	0	1	01	01	H1944_011_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	011	0	1	01	01	H1944_011_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	011	0	1	01	01	H1944_011_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				552.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	011	0	1	01	01	H1944_011_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	012	0	1	01	01	H1944_012_0	3	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	012	0	1	01	01	H1944_012_0	3	2	Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	012	0	1	01	01	H1944_012_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		100	1	30		90				1						90	30		31	93.00		279.00																											279.00						269.00				93.00				93.00		3.10						3.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	012	0	1	01	01	H1944_012_0	3	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	012	0	1	01	01	H1944_012_0	3	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31				468.00	25		25																										25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	013	0	1	01	01	H1944_013_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	013	0	1	01	01	H1944_013_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	013	0	1	01	01	H1944_013_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	013	0	1	01	01	H1944_013_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				552.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	013	0	1	01	01	H1944_013_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	014	0	1	01	01	H1944_014_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	9.00		27.00																											27.00						0.00				9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	014	0	1	01	01	H1944_014_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	014	0	1	01	01	H1944_014_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	014	0	1	01	01	H1944_014_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	014	0	1	01	01	H1944_014_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				420.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	016	0	1	01	01	H1944_016_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	9.00		27.00																											27.00						0.00				9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	016	0	1	01	01	H1944_016_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	016	0	1	01	01	H1944_016_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	016	0	1	01	01	H1944_016_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				425.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	016	0	1	01	01	H1944_016_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	017	0	1	01	01	H1944_017_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	017	0	1	01	01	H1944_017_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	017	0	1	01	01	H1944_017_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	017	0	1	01	01	H1944_017_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	017	0	1	01	01	H1944_017_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				419.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	018	0	1	01	01	H1944_018_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	018	0	1	01	01	H1944_018_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				435.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	018	0	1	01	01	H1944_018_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	018	0	1	01	01	H1944_018_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	018	0	1	01	01	H1944_018_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	019	0	1	02	01	H1944_019_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	019	0	1	02	01	H1944_019_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	019	0	1	02	01	H1944_019_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				484.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	019	0	1	02	01	H1944_019_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1944	019	0	1	02	01	H1944_019_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, 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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	001	0	1	01	01	H1951_001_0	4	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, 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					25																										25						25					25			25								Preferred Generic, 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	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1951	001	0	1	01	01	H1951_001_0	4	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, 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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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					25																										25						25					25			25								Preferred Generic, 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	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, 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	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1951	005	0	1	01	01	H1951_005_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	11.00		33.00																									11.00		33.00				11.00		0.00				11.00				11.00		0.36				0.36	0.36	0.35	Preferred Generic, 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					25																										25						25					25			25								Preferred Generic, 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					25																										25						25					25			25								Preferred Generic, 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	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	005	0	1	01	01	H1951_005_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	11.00		33.00																									11.00		33.00				11.00		0.00				11.00				11.00		0.36				0.36	0.36	0.35	Preferred Generic, 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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1951	013	0	1	01	01	H1951_013_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	013	0	1	01	01	H1951_013_0	4	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	013	0	1	01	01	H1951_013_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	013	0	1	01	01	H1951_013_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	013	0	1	01	01	H1951_013_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1951	013	0	1	01	01	H1951_013_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1951	013	0	1	01	01	H1951_013_0	4	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1951	013	0	1	01	01	H1951_013_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1951	013	0	1	01	01	H1951_013_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1951	013	0	1	01	01	H1951_013_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	024	0	1	01	01	H1951_024_0	4	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		0.00				12.00				12.00		0.40				0.40	0.40	0.38	Preferred Generic, 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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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					25																										25						25					25			25								Preferred Generic, 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	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	024	0	1	01	01	H1951_024_0	4	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		0.00				12.00				12.00		0.40				0.40	0.40	0.38	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, 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					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	025	0	1	01	01	H1951_025_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1951	025	0	1	01	01	H1951_025_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	025	0	1	01	01	H1951_025_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1951	025	0	1	01	01	H1951_025_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1951	025	0	1	01	01	H1951_025_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1951	025	0	1	01	01	H1951_025_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	025	0	1	01	01	H1951_025_0	4	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		0.00				12.00				12.00		0.40				0.40	0.40	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	025	0	1	01	01	H1951_025_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	025	0	1	01	01	H1951_025_0	4	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		0.00				12.00				12.00		0.40				0.40	0.40	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1951	025	0	1	01	01	H1951_025_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	028	0	1	01	01	H1951_028_0	4	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	14.00		42.00																									14.00		42.00				14.00		0.00				14.00				14.00		0.46				0.46	0.46	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1951	028	0	1	01	01	H1951_028_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1951	028	0	1	01	01	H1951_028_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	028	0	1	01	01	H1951_028_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	028	0	1	01	01	H1951_028_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	028	0	1	01	01	H1951_028_0	4	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	14.00		42.00																									14.00		42.00				14.00		0.00				14.00				14.00		0.46				0.46	0.46	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	028	0	1	01	01	H1951_028_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	028	0	1	01	01	H1951_028_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1951	028	0	1	01	01	H1951_028_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1951	028	0	1	01	01	H1951_028_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1951	032	0	1	01	01	H1951_032_0	5	2	Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, 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, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, 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					27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	033	0	1	01	01	H1951_033_0	5	2	Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, 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, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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					28																										28						28					28			28								Preferred Generic, 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	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	034	0	1	01	01	H1951_034_0	5	2	Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, 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	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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					28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	036	0	1	01	01	H1951_036_0	4	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1951	036	0	1	01	01	H1951_036_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1951	036	0	1	01	01	H1951_036_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1951	036	0	1	01	01	H1951_036_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1951	036	0	1	01	01	H1951_036_0	4	6	Select Care Drugs	1	4	010010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1951	036	0	1	01	01	H1951_036_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H1951	036	0	1	01	01	H1951_036_0	4	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H1951	036	0	1	01	01	H1951_036_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H1951	036	0	1	01	01	H1951_036_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H1951	036	0	1	01	01	H1951_036_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H1951	036	0	1	01	01	H1951_036_0	4	6	Select Care Drugs	3	4	010010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H1951	036	0	1	01	01	H1951_036_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1951	037	0	1	01	01	H1951_037_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1951	037	0	1	01	01	H1951_037_0	4	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1951	037	0	1	01	01	H1951_037_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1951	037	0	1	01	01	H1951_037_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1951	037	0	1	01	01	H1951_037_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1951	037	0	1	01	01	H1951_037_0	4	6	Select Care Drugs	1	4	010010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1951	037	0	1	01	01	H1951_037_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H1951	037	0	1	01	01	H1951_037_0	4	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H1951	037	0	1	01	01	H1951_037_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H1951	037	0	1	01	01	H1951_037_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H1951	037	0	1	01	01	H1951_037_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H1951	037	0	1	01	01	H1951_037_0	4	6	Select Care Drugs	3	4	010010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H1951	038	0	1	01	01	H1951_038_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	038	0	1	01	01	H1951_038_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, 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	35.00		105.00																									35.00		105.00				35.00		95.00				35.00				35.00		1.16				1.16	1.16	1.12	Preferred Generic, 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	80.00		240.00																									80.00		240.00				80.00		230.00				80.00				80.00		2.66				2.66	2.66	2.58	Preferred Generic, 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					27																										27						27					27			27								Preferred Generic, 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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1951	038	0	1	01	01	H1951_038_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	35.00		105.00																									35.00		105.00				35.00		95.00				35.00				35.00		1.16				1.16	1.16	1.12	Preferred Generic, 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	80.00		240.00																									80.00		240.00				80.00		230.00				80.00				80.00		2.66				2.66	2.66	2.58	Preferred Generic, 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					27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	039	0	1	01	01	H1951_039_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, 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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, 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	35.00		105.00																									35.00		105.00				35.00		95.00				35.00				35.00		1.16				1.16	1.16	1.12	Preferred Generic, 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					27																										27						27					27			27								Preferred Generic, 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	80.00		240.00																									80.00		240.00				80.00		230.00				80.00				80.00		2.66				2.66	2.66	2.58	Preferred Generic, 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	35.00		105.00																									35.00		105.00				35.00		95.00				35.00				35.00		1.16				1.16	1.16	1.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1951	039	0	1	01	01	H1951_039_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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	80.00		240.00																									80.00		240.00				80.00		230.00				80.00				80.00		2.66				2.66	2.66	2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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					27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1951	041	0	1	01	01	H1951_041_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	041	0	1	01	01	H1951_041_0	5	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	041	0	1	01	01	H1951_041_0	5	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	041	0	1	01	01	H1951_041_0	5	2	Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	8.00		24.00																									8.00		24.00				8.00		0.00				8.00				8.00		0.26				0.26	0.26	0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	041	0	1	01	01	H1951_041_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	042	0	1	01	01	H1951_042_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1951	042	0	1	01	01	H1951_042_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1951	042	0	1	01	01	H1951_042_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1951	042	0	1	01	01	H1951_042_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1951	042	0	1	01	01	H1951_042_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H1951	042	0	1	01	01	H1951_042_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	042	0	1	01	01	H1951_042_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	042	0	1	01	01	H1951_042_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	042	0	1	01	01	H1951_042_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	042	0	1	01	01	H1951_042_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1951	043	0	1	01	01	H1951_043_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H1951	043	0	1	01	01	H1951_043_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1951	043	0	1	01	01	H1951_043_0	4	6	Select Care Drugs	3	4	010010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H1951	043	0	1	01	01	H1951_043_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H1951	043	0	1	01	01	H1951_043_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1951	043	0	1	01	01	H1951_043_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1951	043	0	1	01	01	H1951_043_0	4	6	Select Care Drugs	1	4	010010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1951	043	0	1	01	01	H1951_043_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H1951	043	0	1	01	01	H1951_043_0	4	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		0.00				12.00				12.00		0.40				0.40	0.40	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H1951	043	0	1	01	01	H1951_043_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H1951	043	0	1	01	01	H1951_043_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1951	043	0	1	01	01	H1951_043_0	4	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		0.00				12.00				12.00		0.40				0.40	0.40	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1951	044	0	1	01	01	H1951_044_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H1951	044	0	1	01	01	H1951_044_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H1951	044	0	1	01	01	H1951_044_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H1951	044	0	1	01	01	H1951_044_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H1951	044	0	1	01	01	H1951_044_0	4	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H1951	044	0	1	01	01	H1951_044_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1951	044	0	1	01	01	H1951_044_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1951	044	0	1	01	01	H1951_044_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1951	044	0	1	01	01	H1951_044_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1951	044	0	1	01	01	H1951_044_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1951	044	0	1	01	01	H1951_044_0	4	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1951	044	0	1	01	01	H1951_044_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H1961	002	0	1	01	01	H1961_002_0	8	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	2						90	30		31								45.00		135.00					35.00		105.00													135.00						105.00				45.00				35.00			1.50	1.17				1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1961	002	0	1	01	01	H1961_002_0	8	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	2						90	30		31								3.00		9.00					0.00		0.00													9.00						0.00				3.00				0.00			0.10	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1961	002	0	1	01	01	H1961_002_0	8	2	Generic	1	4	000100	1	2		110	01		100	1				30		90	2						90	30		31								15.00		45.00					10.00		30.00													45.00						30.00				15.00				10.00			0.50	0.33				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1961	002	0	1	01	01	H1961_002_0	8	4	Non-Preferred Brand	1	4	110000	1	2		110	01		100	1				30		90	2						90	30		31								90.00		270.00					80.00		240.00													270.00						240.00				90.00				80.00			3.00	2.67				2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1961	002	0	1	01	01	H1961_002_0	8	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	2						90	30		31											1204.94	33		33				1204.94	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1961	002	0	1	01	01	H1961_002_0	8	1	Preferred Generic	3	4	001000	1	2		110	01		100	1				30		90	2						90	30		31								3.00		9.00					0.00		0.00													9.00						0.00				3.00				0.00			0.10	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1961	002	0	1	01	01	H1961_002_0	8	2	Generic	3	4	000100	1	2		110	01		100	1				30		90	2						90	30		31								15.00		45.00					10.00		30.00													45.00						30.00				15.00				10.00			0.50	0.33				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1961	007	0	1	01	01	H1961_007_0	7	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	2						90	30		31								47.00		141.00					37.00		111.00													141.00						111.00				47.00				37.00			1.57	1.23				1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1961	007	0	1	01	01	H1961_007_0	7	2	Generic	1	4	000100	1	2		110	01		100	1				30		90	2						90	30		31								15.00		45.00					10.00		30.00													45.00						30.00				15.00				10.00			0.50	0.33				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1961	007	0	1	01	01	H1961_007_0	7	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	2						90	30		31								3.00		9.00					0.00		0.00													9.00						0.00				3.00				0.00			0.10	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1961	007	0	1	01	01	H1961_007_0	7	4	Non-Preferred Brand	1	4	110000	1	2		110	01		100	1				30		90	2						90	30		31								95.00		285.00					85.00		255.00													285.00						255.00				95.00				85.00			3.17	2.83				2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1961	007	0	1	01	01	H1961_007_0	7	2	Generic	3	4	000100	1	2		110	01		100	1				30		90	2						90	30		31								15.00		45.00					10.00		30.00													45.00						30.00				15.00				10.00			0.50	0.33				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1961	007	0	1	01	01	H1961_007_0	7	1	Preferred Generic	3	4	001000	1	2		110	01		100	1				30		90	2						90	30		31								3.00		9.00					0.00		0.00													9.00						0.00				3.00				0.00			0.10	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1961	007	0	1	01	01	H1961_007_0	7	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	2						90	30		31											515.27	33		33				515.27	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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								3.00		9.00					0.00		0.00													9.00						0.00				3.00				0.00			0.10	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1961	009	0	1	01	01	H1961_009_0	7	2	Generic	1	4	000100	1	2		110	01		100	1				30		90	2						90	30		31								15.00		45.00					10.00		30.00													45.00						30.00				15.00				10.00			0.50	0.33				0.32	Preferred Generic, 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								47.00		141.00					37.00		111.00													141.00						111.00				47.00				37.00			1.57	1.23				1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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								3.00		9.00					0.00		0.00													9.00						0.00				3.00				0.00			0.10	0.00				0.00	Preferred Generic, 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				498.94	33		33												33						33			33			33								Preferred Generic, 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								90.00		270.00					80.00		240.00													270.00						240.00				90.00				80.00			3.00	2.67				2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1961	009	0	1	01	01	H1961_009_0	7	2	Generic	3	4	000100	1	2		110	01		100	1				30		90	2						90	30		31								15.00		45.00					10.00		30.00													45.00						30.00				15.00				10.00			0.50	0.33				.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1961	014	1	1	01	01	H1961_014_1	7	2	Generic	1	4	000100	1	2		110	01		100	1				30		90	2						90	30		31								15.00		45.00					10.00		30.00													45.00						30.00				15.00				10.00			0.50	0.33				.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1961	014	1	1	01	01	H1961_014_1	7	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	2						90	30		31								4.00		12.00					0.00		0.00													12.00						0.00				4.00				0.00			0.13	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1961	014	1	1	01	01	H1961_014_1	7	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	2						90	30		31								47.00		141.00					37.00		111.00													141.00						111.00				47.00				37.00			1.57	1.23				1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1961	014	1	1	01	01	H1961_014_1	7	2	Generic	3	4	000100	1	2		110	01		100	1				30		90	2						90	30		31								15.00		45.00					10.00		30.00													45.00						30.00				15.00				10.00			0.50	0.33				.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1961	014	1	1	01	01	H1961_014_1	7	1	Preferred Generic	3	4	001000	1	2		110	01		100	1				30		90	2						90	30		31								4.00		12.00					0.00		0.00													12.00						0.00				4.00				0.00			0.13	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1961	014	1	1	01	01	H1961_014_1	7	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	2						90	30		31											498.94	33		33				498.94	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1961	014	1	1	01	01	H1961_014_1	7	4	Non-Preferred Brand	1	4	110000	1	2		110	01		100	1				30		90	2						90	30		31								90.00		270.00					80.00		240.00													270.00						240.00				90.00				80.00			3.00	2.67				2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1961	014	2	1	01	01	H1961_014_2	6	2	Generic	1	4	000100	1	2		110	01		100	1				30		90	2						90	30		31								15.00		45.00					10.00		30.00													45.00						30.00				15.00				10.00			0.50	0.33				.32	Preferred Generic, 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								4.00		12.00					0.00		0.00													12.00						0.00				4.00				0.00			0.13	0.00				0.00	Preferred Generic, 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								47.00		141.00					37.00		111.00													141.00						111.00				47.00				37.00			1.57	1.23				1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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								90.00		270.00					80.00		240.00													270.00						240.00				90.00				80.00			3.00	2.67				2.58	Preferred Generic, 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				498.94	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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								4.00		12.00					0.00		0.00													12.00						0.00				4.00				0.00			0.13	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1961	014	2	1	01	01	H1961_014_2	6	2	Generic	3	4	000100	1	2		110	01		100	1				30		90	2						90	30		31								15.00		45.00					10.00		30.00													45.00						30.00				15.00				10.00			0.50	0.33				.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1969	002	0	1	01	01	H1969_002_0	7	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	12.00	24.00	24.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1969	002	0	1	01	01	H1969_002_0	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	5.00	10.00	10.00																			5.00	10.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1969	002	0	1	01	01	H1969_002_0	7	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	94.00	117.50																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1969	002	0	1	01	01	H1969_002_0	7	6	Select Care Drugs	1	4	010000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1969	002	0	1	01	01	H1969_002_0	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1969	002	0	1	01	01	H1969_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	100.00	200.00	250.00																			100.00	200.00	250.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1969	003	0	1	01	01	H1969_003_0	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.00	6.00	6.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1969	003	0	1	01	01	H1969_003_0	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1969	003	0	1	01	01	H1969_003_0	7	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	10.00	20.00	20.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1969	003	0	1	01	01	H1969_003_0	7	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	94.00	117.50																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1969	003	0	1	01	01	H1969_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	100.00	200.00	250.00																			100.00	200.00	250.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1969	003	0	1	01	01	H1969_003_0	7	6	Select Care Drugs	1	4	010000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1977	001	0	1	48	05	H1977_001_0	4	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	4	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	01	01	H1994_001_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	001	0	1	01	01	H1994_001_0	5	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	001	0	1	01	01	H1994_001_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	001	0	1	01	01	H1994_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	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	001	0	1	01	01	H1994_001_0	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				1035.56	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	002	0	1	01	01	H1994_002_0	5	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	002	0	1	01	01	H1994_002_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	002	0	1	01	01	H1994_002_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	002	0	1	01	01	H1994_002_0	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				1035.56	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	002	0	1	01	01	H1994_002_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	003	0	1	01	01	H1994_003_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	003	0	1	01	01	H1994_003_0	5	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	003	0	1	01	01	H1994_003_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	003	0	1	01	01	H1994_003_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	003	0	1	01	01	H1994_003_0	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				1035.56	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	004	0	1	01	01	H1994_004_0	5	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	004	0	1	01	01	H1994_004_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	004	0	1	01	01	H1994_004_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	004	0	1	01	01	H1994_004_0	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				1035.56	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	004	0	1	01	01	H1994_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	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	005	0	1	01	01	H1994_005_0	5	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	005	0	1	01	01	H1994_005_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	005	0	1	01	01	H1994_005_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	005	0	1	01	01	H1994_005_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	005	0	1	01	01	H1994_005_0	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				1035.56	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	006	0	1	01	01	H1994_006_0	5	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	006	0	1	01	01	H1994_006_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	006	0	1	01	01	H1994_006_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	006	0	1	01	01	H1994_006_0	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				1035.56	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	006	0	1	01	01	H1994_006_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1997	002	0	1	01	01	H1997_002_0	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	4.00	8.00	8.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1997	002	0	1	01	01	H1997_002_0	7	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	12.00	24.00	24.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1997	002	0	1	01	01	H1997_002_0	7	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	94.00	117.50																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1997	002	0	1	01	01	H1997_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	100.00	200.00	250.00																			100.00	200.00	250.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1997	002	0	1	01	01	H1997_002_0	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H1997	002	0	1	01	01	H1997_002_0	7	6	Select Care Drugs	1	4	010000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2001	001	0	1	04	01	H2001_001_0	2	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	9.00		27.00																											27.00						0.00				9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2001	001	0	1	04	01	H2001_001_0	2	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2001	001	0	1	04	01	H2001_001_0	2	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				416.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2001	001	0	1	04	01	H2001_001_0	2	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2001	001	0	1	04	01	H2001_001_0	2	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2001	010	0	1	04	01	H2001_010_0	2	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				484.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2001	010	0	1	04	01	H2001_010_0	2	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2001	010	0	1	04	01	H2001_010_0	2	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2001	010	0	1	04	01	H2001_010_0	2	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2001	010	0	1	04	01	H2001_010_0	2	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, 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	95.00		285.00																									95.00		285.00				95.00		275.00				95.00				95.00		3.16				3.16	3.16	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, 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, 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	95.00		285.00																									95.00		285.00				95.00		275.00				95.00				95.00		3.16				3.16	3.16	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	002	0	1	01	01	H2012_002_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	002	0	1	01	01	H2012_002_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	003	0	1	01	01	H2012_003_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	003	0	1	01	01	H2012_003_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	003	0	1	01	01	H2012_003_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	003	0	1	01	01	H2012_003_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	003	0	1	01	01	H2012_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	003	0	1	01	01	H2012_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	003	0	1	01	01	H2012_003_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	003	0	1	01	01	H2012_003_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	003	0	1	01	01	H2012_003_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	003	0	1	01	01	H2012_003_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	006	0	1	01	01	H2012_006_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	006	0	1	01	01	H2012_006_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	006	0	1	01	01	H2012_006_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	006	0	1	01	01	H2012_006_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	006	0	1	01	01	H2012_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	006	0	1	01	01	H2012_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	006	0	1	01	01	H2012_006_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	006	0	1	01	01	H2012_006_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	006	0	1	01	01	H2012_006_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	006	0	1	01	01	H2012_006_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	008	0	1	01	01	H2012_008_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	008	0	1	01	01	H2012_008_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	008	0	1	01	01	H2012_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	008	0	1	01	01	H2012_008_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	008	0	1	01	01	H2012_008_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	008	0	1	01	01	H2012_008_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	008	0	1	01	01	H2012_008_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	008	0	1	01	01	H2012_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	008	0	1	01	01	H2012_008_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	008	0	1	01	01	H2012_008_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, 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					27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	009	0	1	01	01	H2012_009_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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					27																										27						27					27			27								Preferred Generic, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	009	0	1	01	01	H2012_009_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	011	0	1	01	01	H2012_011_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	011	0	1	01	01	H2012_011_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	011	0	1	01	01	H2012_011_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	011	0	1	01	01	H2012_011_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	011	0	1	01	01	H2012_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	011	0	1	01	01	H2012_011_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	011	0	1	01	01	H2012_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	011	0	1	01	01	H2012_011_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	011	0	1	01	01	H2012_011_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	011	0	1	01	01	H2012_011_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	012	0	1	01	01	H2012_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	012	0	1	01	01	H2012_012_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	012	0	1	01	01	H2012_012_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	012	0	1	01	01	H2012_012_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	012	0	1	01	01	H2012_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	012	0	1	01	01	H2012_012_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	012	0	1	01	01	H2012_012_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	012	0	1	01	01	H2012_012_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	012	0	1	01	01	H2012_012_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	012	0	1	01	01	H2012_012_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	015	0	1	01	01	H2012_015_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, 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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	015	0	1	01	01	H2012_015_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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					28																										28						28					28			28								Preferred Generic, 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					28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	016	0	1	01	01	H2012_016_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	016	0	1	01	01	H2012_016_0	4	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.66				0.66	0.66	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	016	0	1	01	01	H2012_016_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	016	0	1	01	01	H2012_016_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	016	0	1	01	01	H2012_016_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	016	0	1	01	01	H2012_016_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	016	0	1	01	01	H2012_016_0	4	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.66				0.66	0.66	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	016	0	1	01	01	H2012_016_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	016	0	1	01	01	H2012_016_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	016	0	1	01	01	H2012_016_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	021	0	1	01	01	H2012_021_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	021	0	1	01	01	H2012_021_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	021	0	1	01	01	H2012_021_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	021	0	1	01	01	H2012_021_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.66				0.66	0.66	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	021	0	1	01	01	H2012_021_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	021	0	1	01	01	H2012_021_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	021	0	1	01	01	H2012_021_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	021	0	1	01	01	H2012_021_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	021	0	1	01	01	H2012_021_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.66				0.66	0.66	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	021	0	1	01	01	H2012_021_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, 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, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	022	0	1	01	01	H2012_022_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	3.00		9.00																									3.00		9.00				3.00		0.00				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	022	0	1	01	01	H2012_022_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, 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	3.00		9.00																									3.00		9.00				3.00		0.00				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, 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					27																										27						27					27			27								Preferred Generic, 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	95.00		285.00																									95.00		285.00				95.00		275.00				95.00				95.00		3.16				3.16	3.16	3.06	Preferred Generic, 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	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	027	0	1	01	01	H2012_027_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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					27																										27						27					27			27								Preferred Generic, 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	95.00		285.00																									95.00		285.00				95.00		275.00				95.00				95.00		3.16				3.16	3.16	3.06	Preferred Generic, 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	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	027	0	1	01	01	H2012_027_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, 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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, 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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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					25																										25						25					25			25								Preferred Generic, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	028	0	1	01	01	H2012_028_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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					25																										25						25					25			25								Preferred Generic, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	028	0	1	01	01	H2012_028_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, 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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	029	0	1	01	01	H2012_029_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	029	0	1	01	01	H2012_029_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	030	0	1	01	01	H2012_030_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	030	0	1	01	01	H2012_030_0	4	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	030	0	1	01	01	H2012_030_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	030	0	1	01	01	H2012_030_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	030	0	1	01	01	H2012_030_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	95.00		285.00																									95.00		285.00				95.00		275.00				95.00				95.00		3.16				3.16	3.16	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	030	0	1	01	01	H2012_030_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	030	0	1	01	01	H2012_030_0	4	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	030	0	1	01	01	H2012_030_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	030	0	1	01	01	H2012_030_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	030	0	1	01	01	H2012_030_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	95.00		285.00																									95.00		285.00				95.00		275.00				95.00				95.00		3.16				3.16	3.16	3.06	Preferred Generic, 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	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	031	0	1	01	01	H2012_031_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, 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	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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, 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	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	031	0	1	01	01	H2012_031_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, 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	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	95.00		285.00																									95.00		285.00				95.00		275.00				95.00				95.00		3.16				3.16	3.16	3.06	Preferred Generic, 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	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	95.00		285.00																									95.00		285.00				95.00		275.00				95.00				95.00		3.16				3.16	3.16	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	033	0	1	01	01	H2012_033_0	4	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, 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	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	033	0	1	01	01	H2012_033_0	4	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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, 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	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	035	0	1	01	01	H2012_035_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	035	0	1	01	01	H2012_035_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, 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	95.00		285.00																									95.00		285.00				95.00		275.00				95.00				95.00		3.16				3.16	3.16	3.06	Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, 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	95.00		285.00																									95.00		285.00				95.00		275.00				95.00				95.00		3.16				3.16	3.16	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	037	0	1	01	01	H2012_037_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, 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	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	037	0	1	01	01	H2012_037_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, 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	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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, 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	95.00		285.00																									95.00		285.00				95.00		275.00				95.00				95.00		3.16				3.16	3.16	3.06	Preferred Generic, 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	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	039	0	1	01	01	H2012_039_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, 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	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, 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, 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	95.00		285.00																									95.00		285.00				95.00		275.00				95.00				95.00		3.16				3.16	3.16	3.06	Preferred Generic, 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	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	039	0	1	01	01	H2012_039_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, 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	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	042	0	1	01	01	H2012_042_0	4	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	042	0	1	01	01	H2012_042_0	4	2	Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	14.00		42.00																									14.00		42.00				14.00		0.00				14.00				14.00		0.46				0.46	0.46	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	042	0	1	01	01	H2012_042_0	4	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	042	0	1	01	01	H2012_042_0	4	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	042	0	1	01	01	H2012_042_0	4	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	053	0	1	01	01	H2012_053_0	4	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	053	0	1	01	01	H2012_053_0	4	2	Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	053	0	1	01	01	H2012_053_0	4	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	053	0	1	01	01	H2012_053_0	4	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	053	0	1	01	01	H2012_053_0	4	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	054	0	1	01	01	H2012_054_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	054	0	1	01	01	H2012_054_0	4	2	Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	054	0	1	01	01	H2012_054_0	4	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	054	0	1	01	01	H2012_054_0	4	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	054	0	1	01	01	H2012_054_0	4	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					27																										27						27					27			27								Preferred Generic, 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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	055	0	1	01	01	H2012_055_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, 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					25																										25						25					25			25								Preferred Generic, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	055	0	1	01	01	H2012_055_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, 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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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					25																										25						25					25			25								Preferred Generic, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	056	0	1	01	01	H2012_056_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, 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					25																										25						25					25			25								Preferred Generic, 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					25																										25						25					25			25								Preferred Generic, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	056	0	1	01	01	H2012_056_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, 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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	060	0	1	01	01	H2012_060_0	4	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2012	060	0	1	01	01	H2012_060_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2012	060	0	1	01	01	H2012_060_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H2012	060	0	1	01	01	H2012_060_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H2012	060	0	1	01	01	H2012_060_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2012	060	0	1	01	01	H2012_060_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H2012	060	0	1	01	01	H2012_060_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2012	060	0	1	01	01	H2012_060_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2012	060	0	1	01	01	H2012_060_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H2012	060	0	1	01	01	H2012_060_0	4	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H2012	060	0	1	01	01	H2012_060_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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, 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					31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	064	0	1	01	01	H2012_064_0	4	2	Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	070	0	1	01	01	H2012_070_0	3	2	Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, 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					27																										27						27					27			27								Preferred Generic, 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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	080	0	1	01	01	H2012_080_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	11.00		33.00																									11.00		33.00				11.00		0.00				11.00				11.00		0.36				0.36	0.36	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	080	0	1	01	01	H2012_080_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	11.00		33.00																									11.00		33.00				11.00		0.00				11.00				11.00		0.36				0.36	0.36	0.35	Preferred Generic, 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	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, 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	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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					29																										29						29					29			29								Preferred Generic, 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	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	082	0	1	01	01	H2012_082_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	11.00		33.00																									11.00		33.00				11.00		0.00				11.00				11.00		0.36				0.36	0.36	0.35	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	082	0	1	01	01	H2012_082_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	11.00		33.00																									11.00		33.00				11.00		0.00				11.00				11.00		0.36				0.36	0.36	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	084	0	1	01	01	H2012_084_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H2012	084	0	1	01	01	H2012_084_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H2012	084	0	1	01	01	H2012_084_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H2012	084	0	1	01	01	H2012_084_0	4	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H2012	084	0	1	01	01	H2012_084_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2012	084	0	1	01	01	H2012_084_0	4	6	Select Care Drugs	1	4	010010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2012	084	0	1	01	01	H2012_084_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H2012	084	0	1	01	01	H2012_084_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2012	084	0	1	01	01	H2012_084_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2012	084	0	1	01	01	H2012_084_0	4	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2012	084	0	1	01	01	H2012_084_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
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, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	087	0	1	01	01	H2012_087_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, 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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	087	0	1	01	01	H2012_087_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, 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	3.00		9.00																									3.00		9.00				3.00		0.00				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	088	0	1	01	01	H2012_088_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, 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	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, 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	95.00		285.00																									95.00		285.00				95.00		275.00				95.00				95.00		3.16				3.16	3.16	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	3.00		9.00																									3.00		9.00				3.00		0.00				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	088	0	1	01	01	H2012_088_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, 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	95.00		285.00																									95.00		285.00				95.00		275.00				95.00				95.00		3.16				3.16	3.16	3.06	Preferred Generic, 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, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	3.00		9.00																									3.00		9.00				3.00		0.00				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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, 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	95.00		285.00																									95.00		285.00				95.00		275.00				95.00				95.00		3.16				3.16	3.16	3.06	Preferred Generic, 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	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	090	0	1	01	01	H2012_090_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	95.00		285.00																									95.00		285.00				95.00		275.00				95.00				95.00		3.16				3.16	3.16	3.06	Preferred Generic, 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	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	090	0	1	01	01	H2012_090_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, 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	3.00		9.00																									3.00		9.00				3.00		0.00				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	3.00		9.00																									3.00		9.00				3.00		0.00				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	093	0	1	01	01	H2012_093_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, 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	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, 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	95.00		285.00																									95.00		285.00				95.00		275.00				95.00				95.00		3.16				3.16	3.16	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	95.00		285.00																									95.00		285.00				95.00		275.00				95.00				95.00		3.16				3.16	3.16	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	3.00		9.00																									3.00		9.00				3.00		0.00				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	093	0	1	01	01	H2012_093_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	096	0	1	01	01	H2012_096_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	096	0	1	01	01	H2012_096_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	096	0	1	01	01	H2012_096_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	096	0	1	01	01	H2012_096_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	096	0	1	01	01	H2012_096_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	096	0	1	01	01	H2012_096_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	096	0	1	01	01	H2012_096_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	096	0	1	01	01	H2012_096_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	096	0	1	01	01	H2012_096_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	096	0	1	01	01	H2012_096_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	097	0	1	01	01	H2012_097_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	097	0	1	01	01	H2012_097_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	097	0	1	01	01	H2012_097_0	4	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	097	0	1	01	01	H2012_097_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	097	0	1	01	01	H2012_097_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	097	0	1	01	01	H2012_097_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	097	0	1	01	01	H2012_097_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	097	0	1	01	01	H2012_097_0	4	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	097	0	1	01	01	H2012_097_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	097	0	1	01	01	H2012_097_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, 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	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	099	1	1	01	01	H2012_099_1	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	11.00		33.00																									11.00		33.00				11.00		0.00				11.00				11.00		0.36				0.36	0.36	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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					29																										29						29					29			29								Preferred Generic, 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	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	099	1	1	01	01	H2012_099_1	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	11.00		33.00																									11.00		33.00				11.00		0.00				11.00				11.00		0.36				0.36	0.36	0.35	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	099	2	1	01	01	H2012_099_2	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	11.00		33.00																									11.00		33.00				11.00		0.00				11.00				11.00		0.36				0.36	0.36	0.35	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	099	2	1	01	01	H2012_099_2	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	11.00		33.00																									11.00		33.00				11.00		0.00				11.00				11.00		0.36				0.36	0.36	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	100	4	1	01	01	H2012_100_4	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	100	4	1	01	01	H2012_100_4	4	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	100	4	1	01	01	H2012_100_4	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	100	4	1	01	01	H2012_100_4	4	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	100	4	1	01	01	H2012_100_4	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	100	4	1	01	01	H2012_100_4	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	100	4	1	01	01	H2012_100_4	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	100	4	1	01	01	H2012_100_4	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	100	4	1	01	01	H2012_100_4	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	100	4	1	01	01	H2012_100_4	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	100	5	1	01	01	H2012_100_5	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	100	5	1	01	01	H2012_100_5	4	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	100	5	1	01	01	H2012_100_5	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	100	5	1	01	01	H2012_100_5	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	100	5	1	01	01	H2012_100_5	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	100	5	1	01	01	H2012_100_5	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	100	5	1	01	01	H2012_100_5	4	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	100	5	1	01	01	H2012_100_5	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	100	5	1	01	01	H2012_100_5	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	100	5	1	01	01	H2012_100_5	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	101	1	1	01	01	H2012_101_1	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	101	1	1	01	01	H2012_101_1	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	101	1	1	01	01	H2012_101_1	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	101	1	1	01	01	H2012_101_1	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	101	1	1	01	01	H2012_101_1	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	101	1	1	01	01	H2012_101_1	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	101	1	1	01	01	H2012_101_1	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	101	1	1	01	01	H2012_101_1	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	101	1	1	01	01	H2012_101_1	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	101	1	1	01	01	H2012_101_1	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	101	2	1	01	01	H2012_101_2	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	101	2	1	01	01	H2012_101_2	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	101	2	1	01	01	H2012_101_2	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	101	2	1	01	01	H2012_101_2	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	101	2	1	01	01	H2012_101_2	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	101	2	1	01	01	H2012_101_2	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	101	2	1	01	01	H2012_101_2	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	101	2	1	01	01	H2012_101_2	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	101	2	1	01	01	H2012_101_2	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	101	2	1	01	01	H2012_101_2	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	102	0	1	01	01	H2012_102_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	102	0	1	01	01	H2012_102_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	102	0	1	01	01	H2012_102_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2012	102	0	1	01	01	H2012_102_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	102	0	1	01	01	H2012_102_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2012	102	0	1	01	01	H2012_102_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	102	0	1	01	01	H2012_102_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	102	0	1	01	01	H2012_102_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	102	0	1	01	01	H2012_102_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	102	0	1	01	01	H2012_102_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	103	0	1	01	01	H2012_103_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	103	0	1	01	01	H2012_103_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	103	0	1	01	01	H2012_103_0	3	2	Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	14.00		42.00																									14.00		42.00				14.00		0.00				14.00				14.00		0.46				0.46	0.46	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	103	0	1	01	01	H2012_103_0	3	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	103	0	1	01	01	H2012_103_0	3	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	104	0	1	01	01	H2012_104_0	3	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	104	0	1	01	01	H2012_104_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	104	0	1	01	01	H2012_104_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	104	0	1	01	01	H2012_104_0	3	2	Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	14.00		42.00																									14.00		42.00				14.00		0.00				14.00				14.00		0.46				0.46	0.46	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2012	104	0	1	01	01	H2012_104_0	3	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2029	001	0	1	04	01	H2029_001_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00		9.00																									3.00		9.00				3.00		0.00				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2029	001	0	1	04	01	H2029_001_0	4	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2029	001	0	1	04	01	H2029_001_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2029	001	0	1	04	01	H2029_001_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2029	001	0	1	04	01	H2029_001_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2029	001	0	1	04	01	H2029_001_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00		9.00																									3.00		9.00				3.00		0.00				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2029	001	0	1	04	01	H2029_001_0	4	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2029	001	0	1	04	01	H2029_001_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2029	001	0	1	04	01	H2029_001_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2029	001	0	1	04	01	H2029_001_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2108	022	0	1	01	01	H2108_022_0	4	3	Preferred Brand	1	4	000101	1	2	111		01	110		1	30	60	90				2	30		90				30		31	47.00	94.00	141.00																			47.00		141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2108	022	0	1	01	01	H2108_022_0	4	2	Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	15.00	30.00	37.50																			15.00		37.50																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2108	022	0	1	01	01	H2108_022_0	4	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31				502.55	26	26	26																		26		26															26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2108	022	0	1	01	01	H2108_022_0	4	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	95.00	190.00	285.00																			95.00		285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2108	022	0	1	01	01	H2108_022_0	4	1	Preferred Generic	1	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	7.00	14.00	17.50																			7.00		17.50																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2108	028	0	1	01	01	H2108_028_0	4	3	Preferred Brand	1	4	000101	1	2	111		01	110		1	30	60	90				2	30		90				30		31	47.00	94.00	141.00																			47.00		141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2108	028	0	1	01	01	H2108_028_0	4	1	Preferred Generic	1	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	7.00	14.00	17.50																			7.00		17.50																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2108	028	0	1	01	01	H2108_028_0	4	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31				531.16	26	26	26																		26		26															26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2108	028	0	1	01	01	H2108_028_0	4	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	95.00	190.00	285.00																			95.00		285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2108	028	0	1	01	01	H2108_028_0	4	2	Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	12.00	24.00	30.00																			12.00		30.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2108	029	0	1	01	01	H2108_029_0	4	3	Preferred Brand	1	4	000101	1	2	111		01	110		1	30	60	90				2	30		90				30		31	47.00	94.00	141.00																			47.00		141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2108	029	0	1	01	01	H2108_029_0	4	1	Preferred Generic	1	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	7.00	14.00	17.50																			7.00		17.50																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2108	029	0	1	01	01	H2108_029_0	4	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31				524.55	26	26	26																		26		26															26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2108	029	0	1	01	01	H2108_029_0	4	6	Select Diabetic Drugs	1	4	010010	1	2	111		01	110		1	30	60	90				2	30		90				30		31	5.00	10.00	12.50																			5.00		12.50																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2108	029	0	1	01	01	H2108_029_0	4	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	95.00	190.00	285.00																			95.00		285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2108	029	0	1	01	01	H2108_029_0	4	2	Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	12.00	24.00	30.00																			12.00		30.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, 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	000101	1	2	111		01	110		1	30	60	90				2	30		90				30		31	47.00	94.00	141.00																			47.00		141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, 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	8.00	16.00	20.00																			8.00		20.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, 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				383.69	26	26	26																		26		26															26			26								Preferred Generic, 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	10.00	20.00	25.00																			10.00		25.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, 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	95.00	190.00	285.00																			95.00		285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2108	030	0	1	01	01	H2108_030_0	5	2	Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	15.00	30.00	37.50																			15.00		37.50																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2108	032	0	1	01	01	H2108_032_0	4	2	Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	15.00	30.00	37.50																			15.00		37.50																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2108	032	0	1	01	01	H2108_032_0	4	3	Preferred Brand	1	4	000101	1	2	111		01	110		1	30	60	90				2	30		90				30		31	47.00	94.00	141.00																			47.00		141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2108	032	0	1	01	01	H2108_032_0	4	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31				531.16	26	26	26																		26		26															26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2108	032	0	1	01	01	H2108_032_0	4	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	95.00	190.00	285.00																			95.00		285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2108	032	0	1	01	01	H2108_032_0	4	1	Preferred Generic	1	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	7.00	14.00	17.50																			7.00		17.50																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2108	033	0	1	01	01	H2108_033_0	4	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31				502.55	26	26	26																		26		26															26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2108	033	0	1	01	01	H2108_033_0	4	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	95.00	190.00	285.00																			95.00		285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2108	033	0	1	01	01	H2108_033_0	4	3	Preferred Brand	1	4	000101	1	2	111		01	110		1	30	60	90				2	30		90				30		31	47.00	94.00	141.00																			47.00		141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2108	033	0	1	01	01	H2108_033_0	4	1	Preferred Generic	1	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	7.00	14.00	17.50																			7.00		17.50																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2108	033	0	1	01	01	H2108_033_0	4	2	Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	15.00	30.00	37.50																			15.00		37.50																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2150	002	0	1	18	06	H2150_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	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	002	0	1	18	06	H2150_002_0	5	1	Preferred Generic	3	4	001000	1	2		110	01		110	1				30		90	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.16		0.33	0.16	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H2150	002	0	1	18	06	H2150_002_0	5	2	Generic	3	4	000100	1	2		110	01		110	1				30		90	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		30.00				20.00				20.00			0.66	0.50		0.66	0.50	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H2150	002	0	1	18	06	H2150_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	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H2150	002	0	1	18	06	H2150_002_0	5	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.16		0.33	0.16	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	002	0	1	18	06	H2150_002_0	5	2	Generic	1	4	000100	1	2		110	01		110	1				30		90	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		30.00				20.00				20.00			0.66	0.50		0.66	0.50	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	002	0	1	18	06	H2150_002_0	5	3	Preferred Brand	1	4	000001	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		84.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	002	0	1	18	06	H2150_002_0	5	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	2				30		90	30		31								100.00		300.00					80.00		240.00											100.00		300.00				80.00		160.00				100.00				100.00			3.33	2.66		3.33	2.66	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	002	0	1	18	06	H2150_002_0	5	5	Specialty Tier	1	4	100001	1	1		110	01		110	1				30		90	2				30		90	30		31											1462.00	33		33				1462.00	33		33										33		33				33		33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	009	0	1	18	06	H2150_009_0	5	2	Generic	1	4	000100	1	2		110	01		110	1				30		90	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		30.00				20.00				20.00			0.66	0.50		0.66	0.50	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	009	0	1	18	06	H2150_009_0	5	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	009	0	1	18	06	H2150_009_0	5	3	Preferred Brand	1	4	000001	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		84.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	009	0	1	18	06	H2150_009_0	5	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		190.00				100.00				100.00			3.33	3.16		3.33	3.16	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	009	0	1	18	06	H2150_009_0	5	5	Specialty Tier	1	4	100001	1	1		110	01		110	1				30		90	2				30		90	30		31											1347.00	33		33				1347.00	33		33										33		33				33		33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	009	0	1	18	06	H2150_009_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	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	009	0	1	18	06	H2150_009_0	5	6	Vaccines	3	4	000001	1	1		010	01			1				30										30		31											1347.00	0						1347.00	0																							0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H2150	029	0	2	18	06	H2150_029_0	5	2	Generic	1	4	000100	1	2		110	01		110	1				30		90	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		30.00				20.00				20.00			0.66	0.50		0.66	0.50	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	029	0	2	18	06	H2150_029_0	5	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	029	0	2	18	06	H2150_029_0	5	3	Preferred Brand	1	4	000001	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		84.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	029	0	2	18	06	H2150_029_0	5	6	Vaccines	3	4	000001	1	1		010	01			1				30										30		31											1469.00	0						1469.00	0																							0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H2150	029	0	2	18	06	H2150_029_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	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	029	0	2	18	06	H2150_029_0	5	5	Specialty Tier	1	4	100001	1	1		110	01		110	1				30		90	2				30		90	30		31											1469.00	33		33				1469.00	33		33										33		33				33		33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	029	0	2	18	06	H2150_029_0	5	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		190.00				100.00				100.00			3.33	3.16		3.33	3.16	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2161	002	0	1	01	01	H2161_002_0	3	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	95.00	190.00	190.00																			95.00	142.50	142.50																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2161	002	0	1	01	01	H2161_002_0	3	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	42.00	84.00	84.00																			42.00	63.00	63.00																42.00				42.00		1.40			1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2161	002	0	1	01	01	H2161_002_0	3	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	10.00	20.00	20.00																			10.00	15.00	15.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2161	002	0	1	01	01	H2161_002_0	3	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	5.00	10.00	10.00																			5.00	7.50	7.50																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2161	002	0	1	01	01	H2161_002_0	3	5	Specialty Tier	1	4	100000	1	1	010		01	010		1	30							30						30		31					33																				33																	33			33								Preferred Generic, 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	3.00	6.00	9.00																			3.00		9.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2165	005	0	1	01	01	H2165_005_0	4	2	Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	20.00	40.00	60.00																			20.00		60.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, 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	3.00	6.00	9.00																			3.00		9.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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				402.16	28	28	28																		28		28															28			28								Preferred Generic, 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	100.00	200.00	300.00																			100.00		300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2165	005	0	1	01	01	H2165_005_0	4	3	Preferred Brand	1	4	000101	1	2	111		01	110		1	30	60	90				2	30		90				30		31	47.00	94.00	141.00																			47.00		141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2165	018	0	1	01	01	H2165_018_0	4	2	Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	8.00	16.00	20.00																			8.00		20.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2165	018	0	1	01	01	H2165_018_0	4	1	Preferred Generic	1	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	3.00	6.00	7.50																			3.00		7.50																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2165	018	0	1	01	01	H2165_018_0	4	3	Preferred Brand	1	4	000101	1	2	111		01	110		1	30	60	90				2	30		90				30		31	35.00	70.00	105.00																			35.00		105.00																35.00				35.00		1.17			1.17			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2165	018	0	1	01	01	H2165_018_0	4	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	70.00	140.00	210.00																			70.00		210.00																70.00				70.00		2.33			2.33			2.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2165	018	0	1	01	01	H2165_018_0	4	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31				495.16	33	33	33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2171	001	0	1	01	01	H2171_001_0	6	2	Generic	1	4	000100	1	2	111		10	111		1	30	60	90				1	30	60	90					29	31	8.00	16.00	16.00																			8.00	16.00	16.00																	8.00			8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2171	001	0	1	01	01	H2171_001_0	6	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2171	001	0	1	01	01	H2171_001_0	6	3	Preferred Brand	1	4	000001	1	2	111		10	111		1	30	60	90				1	30	60	90					29	31	40.00	80.00	80.00																			40.00	80.00	80.00																	40.00			40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2171	001	0	1	01	01	H2171_001_0	6	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2171	001	0	1	01	01	H2171_001_0	6	5	Specialty Tier	1	4	010010	1	1	111		10	111		1	30	60	90				2	30	60	90					29	31				1000.70	33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2171	001	0	1	01	01	H2171_001_0	6	4	Non-Preferred Brand	1	4	100000	1	2	111		10	111		1	30	60	90				1	30	60	90					29	31	85.00	170.00	170.00																			85.00	170.00	170.00																	85.00			85.00		2.83			2.83			2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2174	009	0	1	01	01	H2174_009_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.06			3.06			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2174	009	0	1	01	01	H2174_009_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	3.00	6.00	9.00																			2.00	4.00	6.00																3.00				3.00		0.10			0.06			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2174	009	0	1	01	01	H2174_009_0	5	2	Generic	1	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	12.00	24.00	36.00																			12.00	24.00	36.00																12.00				12.00		0.39			0.39			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2174	009	0	1	01	01	H2174_009_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.45			1.45			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2174	009	0	1	01	01	H2174_009_0	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31				710.00	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	011	0	1	04	01	H2228_011_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	011	0	1	04	01	H2228_011_0	3	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	011	0	1	04	01	H2228_011_0	3	2	Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	011	0	1	04	01	H2228_011_0	3	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	011	0	1	04	01	H2228_011_0	3	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31				454.00	31		31																										31						31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	012	0	1	04	01	H2228_012_0	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	012	0	1	04	01	H2228_012_0	2	2	Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	012	0	1	04	01	H2228_012_0	2	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	012	0	1	04	01	H2228_012_0	2	4	Non-Preferred Brand	1	3	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	012	0	1	04	01	H2228_012_0	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31				452.00	31		31																										31						31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	017	0	1	04	01	H2228_017_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	017	0	1	04	01	H2228_017_0	3	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	017	0	1	04	01	H2228_017_0	3	2	Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	017	0	1	04	01	H2228_017_0	3	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	017	0	1	04	01	H2228_017_0	3	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31				444.00	30		30																										30						30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	018	0	1	04	01	H2228_018_0	2	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	018	0	1	04	01	H2228_018_0	2	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	018	0	1	04	01	H2228_018_0	2	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	018	0	1	04	01	H2228_018_0	2	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	018	0	1	04	01	H2228_018_0	2	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				610.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	019	0	1	04	01	H2228_019_0	5	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	019	0	1	04	01	H2228_019_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	019	0	1	04	01	H2228_019_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	019	0	1	04	01	H2228_019_0	5	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				436.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	019	0	1	04	01	H2228_019_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	020	0	1	04	01	H2228_020_0	2	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	020	0	1	04	01	H2228_020_0	2	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	020	0	1	04	01	H2228_020_0	2	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	020	0	1	04	01	H2228_020_0	2	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	020	0	1	04	01	H2228_020_0	2	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				451.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	021	0	1	04	01	H2228_021_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				510.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	021	0	1	04	01	H2228_021_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	021	0	1	04	01	H2228_021_0	4	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	021	0	1	04	01	H2228_021_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	021	0	1	04	01	H2228_021_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	022	0	1	04	01	H2228_022_0	2	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	022	0	1	04	01	H2228_022_0	2	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	022	0	1	04	01	H2228_022_0	2	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	022	0	1	04	01	H2228_022_0	2	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	022	0	1	04	01	H2228_022_0	2	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				503.00	30		30																										30						30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	023	0	1	04	01	H2228_023_0	2	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	023	0	1	04	01	H2228_023_0	2	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	023	0	1	04	01	H2228_023_0	2	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	023	0	1	04	01	H2228_023_0	2	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	023	0	1	04	01	H2228_023_0	2	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				648.00	25		25																										25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	024	0	1	04	01	H2228_024_0	2	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	024	0	1	04	01	H2228_024_0	2	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	024	0	1	04	01	H2228_024_0	2	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	024	0	1	04	01	H2228_024_0	2	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	024	0	1	04	01	H2228_024_0	2	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				564.00	26		26																										26						26			26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	029	0	1	04	01	H2228_029_0	2	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	029	0	1	04	01	H2228_029_0	2	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	029	0	1	04	01	H2228_029_0	2	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	029	0	1	04	01	H2228_029_0	2	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	029	0	1	04	01	H2228_029_0	2	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				415.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	030	0	1	04	01	H2228_030_0	2	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	030	0	1	04	01	H2228_030_0	2	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	030	0	1	04	01	H2228_030_0	2	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	030	0	1	04	01	H2228_030_0	2	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	030	0	1	04	01	H2228_030_0	2	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				582.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	031	0	1	04	01	H2228_031_0	2	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	031	0	1	04	01	H2228_031_0	2	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	031	0	1	04	01	H2228_031_0	2	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	031	0	1	04	01	H2228_031_0	2	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	031	0	1	04	01	H2228_031_0	2	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				512.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	032	0	1	04	01	H2228_032_0	2	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				490.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	032	0	1	04	01	H2228_032_0	2	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	032	0	1	04	01	H2228_032_0	2	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	032	0	1	04	01	H2228_032_0	2	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	032	0	1	04	01	H2228_032_0	2	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	033	0	1	04	01	H2228_033_0	2	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				532.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	033	0	1	04	01	H2228_033_0	2	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	033	0	1	04	01	H2228_033_0	2	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	033	0	1	04	01	H2228_033_0	2	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	033	0	1	04	01	H2228_033_0	2	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	034	0	1	04	01	H2228_034_0	2	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	034	0	1	04	01	H2228_034_0	2	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				518.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	034	0	1	04	01	H2228_034_0	2	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	034	0	1	04	01	H2228_034_0	2	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	034	0	1	04	01	H2228_034_0	2	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	035	0	1	04	01	H2228_035_0	2	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	035	0	1	04	01	H2228_035_0	2	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	035	0	1	04	01	H2228_035_0	2	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	035	0	1	04	01	H2228_035_0	2	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	035	0	1	04	01	H2228_035_0	2	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				499.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	036	0	1	04	01	H2228_036_0	2	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	036	0	1	04	01	H2228_036_0	2	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	036	0	1	04	01	H2228_036_0	2	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	036	0	1	04	01	H2228_036_0	2	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				440.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	036	0	1	04	01	H2228_036_0	2	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	037	0	1	04	01	H2228_037_0	2	2	Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	13.00		39.00																											39.00						0.00				13.00				13.00		0.43						0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	037	0	1	04	01	H2228_037_0	2	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	44.00		132.00																											132.00						122.00				44.00				44.00		1.46						1.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	037	0	1	04	01	H2228_037_0	2	4	Non-Preferred Brand	1	3	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	037	0	1	04	01	H2228_037_0	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31				468.00	25		25																										25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	037	0	1	04	01	H2228_037_0	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	039	0	1	04	01	H2228_039_0	3	2	Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	039	0	1	04	01	H2228_039_0	3	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	039	0	1	04	01	H2228_039_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	039	0	1	04	01	H2228_039_0	3	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31				444.00	30		30																										30						30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	039	0	1	04	01	H2228_039_0	3	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2230	002	0	1	04	01	H2230_002_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	2.00	4.00	6.00																			2.00	2.00	2.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2230	002	0	1	04	01	H2230_002_0	5	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	6.00	12.00	18.00																			6.00	12.00	12.00																6.00				6.00		0.20			0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2230	002	0	1	04	01	H2230_002_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2230	002	0	1	04	01	H2230_002_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2230	002	0	1	04	01	H2230_002_0	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2230	016	0	1	04	01	H2230_016_0	7	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2230	016	0	1	04	01	H2230_016_0	7	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2230	016	0	1	04	01	H2230_016_0	7	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2230	016	0	1	04	01	H2230_016_0	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	4.00	8.00	12.00																			4.00	4.00	4.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2230	016	0	1	04	01	H2230_016_0	7	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	16.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, 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	6.00	12.00	18.00																			6.00	6.00	6.00																6.00				6.00		0.20			0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2230	017	0	1	04	01	H2230_017_0	6	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, 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, 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	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, 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	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2237	001	0	1	01	01	H2237_001_0	12	3	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		31				1.00	25																				25																	25			25								Generic, Brand, Specialty Tier												
H2237	001	0	1	01	01	H2237_001_0	12	1	Generic	1	3	010000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	13.00	26.00	39.00																			13.00	26.00	39.00																13.00				13.00		0.43			0.43			0.42	Generic, Brand, Specialty Tier												
H2237	001	0	1	01	01	H2237_001_0	12	2	Brand	1	3	000010	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	44.00	88.00	132.00																			44.00	88.00	132.00																44.00				44.00		1.47			1.47			1.42	Generic, Brand, Specialty Tier												
H2237	007	0	1	01	01	H2237_007_0	9	2	Brand	1	3	000010	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	44.00	88.00	132.00																			44.00	88.00	132.00																44.00				44.00		1.47			1.47			1.42	Generic, Brand, Specialty Tier												
H2237	007	0	1	01	01	H2237_007_0	9	1	Generic	1	3	010000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	30.00																10.00				10.00		0.33			0.33			0.32	Generic, Brand, Specialty Tier												
H2237	007	0	1	01	01	H2237_007_0	9	3	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		31				1.00	25																				25																	25			25								Generic, Brand, Specialty Tier												
H2241	006	0	1	01	01	H2241_006_0	9	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	31		90				1			90				31		31	5.00		15.00																					10.00																5.00				5.00		0.16						.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2241	006	0	1	01	01	H2241_006_0	9	2	Generic	1	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	10.00		30.00																					20.00																10.00				10.00		.32						.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2241	006	0	1	01	01	H2241_006_0	9	3	Preferred Brand	1	4	010001	3	2	110		01	100		1	31		90				1			90				31		31	45.00		135.00																					90.00																45.00				45.00		1.45						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2241	006	0	1	01	01	H2241_006_0	9	2	Generic	3	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	10.00		30.00																					20.00																10.00				10.00		.32						.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2241	006	0	1	01	01	H2241_006_0	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2241	006	0	1	01	01	H2241_006_0	9	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	31		90				1			90				31		31	5.00		15.00																					10.00																5.00				5.00		0.16						.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2241	006	0	1	01	01	H2241_006_0	9	4	Non-Preferred Brand	1	4	100100	3	2	110		01	100		1	31		90				1			90				31		31	95.00		285.00																					190.00																95.00				95.00		3.06						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	001	1	1	01	01	H2256_001_1	14	3	Preferred Brand	1	4	000101	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	30.00	60.00	90.00																			30.00	60.00	90.00																30.00				30.00		1.00			1.00			0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	001	1	1	01	01	H2256_001_1	14	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	4.00	8.00	12.00																			3.00	7.00	10.00																4.00				4.00		0.13			0.10			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	001	1	1	01	01	H2256_001_1	14	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	2.00	4.00	6.00																			2.00	3.00	5.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	001	1	1	01	01	H2256_001_1	14	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	80.00	160.00	240.00																			80.00	160.00	240.00																80.00				80.00		2.67			2.67			2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	001	1	1	01	01	H2256_001_1	14	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	001	1	1	01	01	H2256_001_1	14	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	2.00	4.00	6.00																			2.00	3.00	5.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2256	001	1	1	01	01	H2256_001_1	14	2	Generic	3	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	4.00	8.00	12.00																			3.00	7.00	10.00																4.00				4.00		0.13			0.10			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2256	001	2	1	01	01	H2256_001_2	14	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	2.00	4.00	6.00																			2.00	3.00	5.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	001	2	1	01	01	H2256_001_2	14	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	4.00	8.00	12.00																			3.00	7.00	10.00																4.00				4.00		0.13			0.10			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	001	2	1	01	01	H2256_001_2	14	3	Preferred Brand	1	4	000101	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	30.00	60.00	90.00																			30.00	60.00	90.00																30.00				30.00		1.00			1.00			0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	001	2	1	01	01	H2256_001_2	14	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	80.00	160.00	240.00																			80.00	160.00	240.00																80.00				80.00		2.67			2.67			2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	001	2	1	01	01	H2256_001_2	14	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	001	2	1	01	01	H2256_001_2	14	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	2.00	4.00	6.00																			2.00	3.00	5.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2256	001	2	1	01	01	H2256_001_2	14	2	Generic	3	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	4.00	8.00	12.00																			3.00	7.00	10.00																4.00				4.00		0.13			0.10			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2256	001	6	1	01	01	H2256_001_6	14	3	Preferred Brand	1	4	000101	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	30.00	60.00	90.00																			30.00	60.00	90.00																30.00				30.00		1.00			1.00			0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	001	6	1	01	01	H2256_001_6	14	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	4.00	8.00	12.00																			3.00	7.00	10.00																4.00				4.00		0.13			0.10			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	001	6	1	01	01	H2256_001_6	14	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	2.00	4.00	6.00																			2.00	3.00	5.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	001	6	1	01	01	H2256_001_6	14	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	80.00	160.00	240.00																			80.00	160.00	240.00																80.00				80.00		2.67			2.67			2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	001	6	1	01	01	H2256_001_6	14	2	Generic	3	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	4.00	8.00	12.00																			3.00	7.00	10.00																4.00				4.00		0.13			0.10			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2256	001	6	1	01	01	H2256_001_6	14	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	2.00	4.00	6.00																			2.00	3.00	5.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2256	001	6	1	01	01	H2256_001_6	14	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	015	1	1	01	01	H2256_015_1	14	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	8.00	16.00	24.00																			7.00	14.00	21.00																8.00				8.00		0.27			0.23			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	015	1	1	01	01	H2256_015_1	14	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	4.00	8.00	12.00																			3.00	7.00	10.00																4.00				4.00		0.13			0.10			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	015	1	1	01	01	H2256_015_1	14	3	Preferred Brand	1	4	000101	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	015	1	1	01	01	H2256_015_1	14	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	015	1	1	01	01	H2256_015_1	14	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	015	2	1	01	01	H2256_015_2	14	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	8.00	16.00	24.00																			7.00	14.00	21.00																8.00				8.00		0.27			0.23			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	015	2	1	01	01	H2256_015_2	14	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	4.00	8.00	12.00																			3.00	7.00	10.00																4.00				4.00		0.13			0.10			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	015	2	1	01	01	H2256_015_2	14	3	Preferred Brand	1	4	000101	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	015	2	1	01	01	H2256_015_2	14	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	015	2	1	01	01	H2256_015_2	14	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	015	6	1	01	01	H2256_015_6	14	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	4.00	8.00	12.00																			3.00	7.00	10.00																4.00				4.00		0.13			0.10			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	015	6	1	01	01	H2256_015_6	14	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	015	6	1	01	01	H2256_015_6	14	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	8.00	16.00	24.00																			7.00	14.00	21.00																8.00				8.00		0.27			0.23			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	015	6	1	01	01	H2256_015_6	14	3	Preferred Brand	1	4	000101	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	015	6	1	01	01	H2256_015_6	14	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								Preferred Generic, 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	4.00	8.00	12.00																			3.00	7.00	10.00																4.00				4.00		0.13			0.10			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	018	1	1	01	01	H2256_018_1	14	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	8.00	16.00	24.00																			7.00	14.00	21.00																8.00				8.00		0.27			0.23			0.26	Preferred Generic, 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	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, 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	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, 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					28	28	28																		28	28	28															28			28								Preferred Generic, 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	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, 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	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	018	7	1	01	01	H2256_018_7	14	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	8.00	16.00	24.00																			7.00	14.00	21.00																8.00				8.00		0.27			0.23			0.26	Preferred Generic, 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	4.00	8.00	12.00																			3.00	7.00	10.00																4.00				4.00		0.13			0.10			0.13	Preferred Generic, 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					28	28	28																		28	28	28															28			28								Preferred Generic, 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	4.00	8.00	12.00																			3.00	7.00	10.00																4.00				4.00		0.13			0.10			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	018	8	1	01	01	H2256_018_8	14	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	8.00	16.00	24.00																			7.00	14.00	21.00																8.00				8.00		0.27			0.23			0.26	Preferred Generic, 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	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, 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	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, 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					28	28	28																		28	28	28															28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	026	1	1	01	01	H2256_026_1	14	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	8.00	16.00	24.00																			7.00	14.00	21.00																8.00				8.00		0.27			0.23			0.26	Preferred Generic, 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	4.00	8.00	12.00																			3.00	7.00	10.00																4.00				4.00		0.13			0.10			0.13	Preferred Generic, 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	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, 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					27	27	27																		27	27	27															27			27								Preferred Generic, 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	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, 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	4.00	8.00	12.00																			3.00	7.00	10.00																4.00				4.00		0.13			0.10			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	026	2	1	01	01	H2256_026_2	14	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	8.00	16.00	24.00																			7.00	14.00	21.00																8.00				8.00		0.27			0.23			0.26	Preferred Generic, 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	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, 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	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, 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					27	27	27																		27	27	27															27			27								Preferred Generic, 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	4.00	8.00	12.00																			3.00	7.00	10.00																4.00				4.00		0.13			0.10			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	026	3	1	01	01	H2256_026_3	14	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	8.00	16.00	24.00																			7.00	14.00	21.00																8.00				8.00		0.27			0.23			0.26	Preferred Generic, 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	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, 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	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, 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					27	27	27																		27	27	27															27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	028	0	1	01	01	H2256_028_0	14	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	028	0	1	01	01	H2256_028_0	14	3	Preferred Brand	1	4	000101	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	028	0	1	01	01	H2256_028_0	14	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	12.00	24.00	36.00																			10.00	20.00	30.00																12.00				12.00		0.40			0.33			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	028	0	1	01	01	H2256_028_0	14	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	6.00	12.00	18.00																			5.00	10.00	15.00																6.00				6.00		0.20			0.17			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	028	0	1	01	01	H2256_028_0	14	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					26	26	26																		26	26	26															26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	033	0	1	01	01	H2256_033_0	14	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	75.00	150.00	225.00																			75.00	150.00	225.00																75.00				75.00		2.50			2.50			2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	033	0	1	01	01	H2256_033_0	14	3	Preferred Brand	1	4	000101	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	033	0	1	01	01	H2256_033_0	14	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	6.00	12.00	18.00																			5.00	10.00	15.00																6.00				6.00		0.20			0.17			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	033	0	1	01	01	H2256_033_0	14	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	4.00	8.00	12.00																			3.00	7.00	10.00																4.00				4.00		0.13			0.10			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	033	0	1	01	01	H2256_033_0	14	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	034	0	1	01	01	H2256_034_0	14	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	4.00	8.00	12.00																			3.00	7.00	10.00																4.00				4.00		0.13			0.10			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	034	0	1	01	01	H2256_034_0	14	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	6.00	12.00	18.00																			5.00	10.00	15.00																6.00				6.00		0.20			0.17			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	034	0	1	01	01	H2256_034_0	14	3	Preferred Brand	1	4	000101	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	034	0	1	01	01	H2256_034_0	14	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	75.00	150.00	225.00																			75.00	150.00	225.00																75.00				75.00		2.50			2.50			2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	034	0	1	01	01	H2256_034_0	14	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					28	28	28																		28	28	28															28			28								Preferred Generic, 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	75.00	150.00	225.00																			75.00	150.00	225.00																75.00				75.00		2.50			2.50			2.42	Preferred Generic, 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	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	036	0	1	01	01	H2256_036_0	14	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	6.00	12.00	18.00																			5.00	10.00	15.00																6.00				6.00		0.20			0.17			0.19	Preferred Generic, 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	4.00	8.00	12.00																			3.00	7.00	10.00																4.00				4.00		0.13			0.10			0.13	Preferred Generic, 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					27	27	27																		27	27	27															27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	005	0	1	01	01	H2261_005_0	10	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	6.00	12.00	18.00																			6.00	12.00	12.00																6.00				6.00		0.20			0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	005	0	1	01	01	H2261_005_0	10	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	2.00	4.00	6.00																			2.00	2.00	2.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	005	0	1	01	01	H2261_005_0	10	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	005	0	1	01	01	H2261_005_0	10	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	005	0	1	01	01	H2261_005_0	10	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	019	0	1	01	01	H2261_019_0	9	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	16.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, 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	4.00	8.00	12.00																			4.00	4.00	4.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, 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	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, 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, 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	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	021	0	1	02	01	H2261_021_0	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	2.00	4.00	6.00																			2.00	2.00	2.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	021	0	1	02	01	H2261_021_0	7	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	6.00	12.00	18.00																			6.00	12.00	12.00																6.00				6.00		0.20			0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	021	0	1	02	01	H2261_021_0	7	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	021	0	1	02	01	H2261_021_0	7	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	021	0	1	02	01	H2261_021_0	7	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2312	004	0	1	01	01	H2312_004_0	9	5	Specialty Tier	1	4	000010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31				2211.70	28	28	28																		28	28	28															28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2312	004	0	1	01	01	H2312_004_0	9	1	Preferred Generic	1	4	001000	3	2	111		01	111		1	30	60	90				1	30	60	90				30		31	2.00	4.00	5.00																			2.00	4.00	5.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2312	004	0	1	01	01	H2312_004_0	9	2	Generic	1	4	000100	3	2	111		01	111		1	30	60	90				1	30	60	90				30		31	15.00	30.00	37.50																			15.00	30.00	37.50																15.00				15.00		.50			.50			.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2312	004	0	1	01	01	H2312_004_0	9	3	Preferred Brand	1	4	000001	3	2	111		01	111		1	30	60	90				1	30	60	90				30		31	45.00	90.00	112.50																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2312	004	0	1	01	01	H2312_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				98.02	28	28	28																		28	28	28															28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2312	007	0	1	02	01	H2312_007_0	9	3	Preferred Brand	1	4	000001	3	2	111		01	111		1	30	60	90				1	30	60	90				30		31	45.00	90.00	112.50																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2312	007	0	1	02	01	H2312_007_0	9	2	Generic	1	4	000100	3	2	111		01	111		1	30	60	90				1	30	60	90				30		31	15.00	30.00	37.50																			15.00	30.00	37.50																15.00				15.00		.50			.50			.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2312	007	0	1	02	01	H2312_007_0	9	1	Preferred Generic	1	4	001000	3	2	111		01	111		1	30	60	90				1	30	60	90				30		31	2.00	4.00	5.00																			2.00	4.00	5.00																2.00				2.00		.07			.07			.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2312	007	0	1	02	01	H2312_007_0	9	4	Non-Preferred Brand	1	4	100000	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31				97.43	28	28	28																		28	28	28															28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2312	007	0	1	02	01	H2312_007_0	9	5	Specialty Tier	1	4	000010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31				1887.77	30	30	30																		30	30	30															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2312	010	0	1	02	01	H2312_010_0	8	3	Preferred Brand	1	4	000001	3	2	111		01	111		1	30	60	90				1	30	60	90				30		31	45.00	90.00	112.50																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2312	010	0	1	02	01	H2312_010_0	8	2	Generic	1	4	000100	3	2	111		01	111		1	30	60	90				1	30	60	90				30		31	10.00	20.00	25.00																			10.00	20.00	25.00																10.00				10.00		.33			.33			.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2312	010	0	1	02	01	H2312_010_0	8	1	Preferred Generic	1	4	001000	3	2	111		01	111		1	30	60	90				1	30	60	90				30		31	4.00	8.00	10.00																			4.00	8.00	10.00																4.00				4.00		.13			.13			.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2312	010	0	1	02	01	H2312_010_0	8	4	Non-Preferred Brand	1	4	100000	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31				97.96	31	31	31																		31	31	31															31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2312	010	0	1	02	01	H2312_010_0	8	2	Generic	3	4	000100	3	2	111		01	111		1	30	60	90				1	30	60	90				30		31	10.00	20.00	25.00																			10.00	20.00	25.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H2312	010	0	1	02	01	H2312_010_0	8	1	Preferred Generic	3	4	001000	3	2	111		01	111		1	30	60	90				1	30	60	90				30		31	4.00	8.00	10.00																			4.00	8.00	10.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H2312	010	0	1	02	01	H2312_010_0	8	5	Specialty Tier	1	4	000010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31				2498.29	31	31	31																		31	31	31															31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2312	012	0	1	02	01	H2312_012_0	8	1	Preferred Generic	1	4	001000	3	2	111		01	111		1	30	60	90				1	30	60	90				30		31	6.00	12.00	15.00																			6.00	12.00	15.00																6.00				6.00		.20			.20			.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2312	012	0	1	02	01	H2312_012_0	8	4	Non-Preferred Brand	1	4	100000	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31				97.73	23	23	23																		23	23	23															23			23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2312	012	0	1	02	01	H2312_012_0	8	3	Preferred Brand	1	4	000001	3	2	111		01	111		1	30	60	90				1	30	60	90				30		31	45.00	90.00	112.50																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2312	012	0	1	02	01	H2312_012_0	8	2	Generic	1	4	000100	3	2	111		01	111		1	30	60	90				1	30	60	90				30		31	11.00	22.00	27.50																			11.00	22.00	27.50																11.00				11.00		.37			.37			.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2312	012	0	1	02	01	H2312_012_0	8	5	Specialty Tier	1	4	000010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31				2151.83	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	007	0	1	02	01	H2320_007_0	6	4	Non-Preferred Brand	1	4	110000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	85.00	170.00	255.00																			85.00	170.00	212.50																85.00				85.00		2.83			2.83			2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	007	0	1	02	01	H2320_007_0	6	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	40.00	80.00	120.00																			40.00	80.00	100.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	007	0	1	02	01	H2320_007_0	6	2	Generic	1	4	000110	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	0.00																10.00				10.00		.33			.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	007	0	1	02	01	H2320_007_0	6	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	0.00																4.00				4.00		.13			.13			0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	007	0	1	02	01	H2320_007_0	6	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	008	0	1	02	01	H2320_008_0	6	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	0.00																4.00				4.00		.13			.13			0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	008	0	1	02	01	H2320_008_0	6	2	Generic	1	4	000110	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	0.00																10.00				10.00		.33			.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	008	0	1	02	01	H2320_008_0	6	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	40.00	80.00	120.00																			40.00	80.00	100.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	008	0	1	02	01	H2320_008_0	6	4	Non-Preferred Brand	1	4	110000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	85.00	170.00	255.00																			85.00	170.00	212.50																85.00				85.00		2.83			2.83			2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	008	0	1	02	01	H2320_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	011	0	1	02	01	H2320_011_0	5	4	Non-Preferred Brand	1	4	110000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	237.50																95.00				95.00		3.16			3.16			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	011	0	1	02	01	H2320_011_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	011	0	1	02	01	H2320_011_0	5	2	Generic	1	4	000110	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	12.00	24.00	36.00																			12.00	24.00	0.00																12.00				12.00		.40			.40			.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	011	0	1	02	01	H2320_011_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	0.00																5.00				5.00		.16			.16			.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	011	0	1	02	01	H2320_011_0	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					31																				31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	012	0	1	02	01	H2320_012_0	5	2	Generic	1	4	000110	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	12.00	24.00	36.00																			12.00	24.00	0.00																12.00				12.00		.40			.40			.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	012	0	1	02	01	H2320_012_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	0.00																5.00				5.00		.16			.16			.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	012	0	1	02	01	H2320_012_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	012	0	1	02	01	H2320_012_0	5	4	Non-Preferred Brand	1	4	110000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	237.50																95.00				95.00		3.16			3.16			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	012	0	1	02	01	H2320_012_0	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					31																				31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	013	0	1	02	01	H2320_013_0	5	2	Generic	1	4	000110	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	0.00																10.00				10.00		.33			.33			0.32	Preferred Generic, 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	4.00	8.00	12.00																			4.00	8.00	0.00																4.00				4.00		.13			.13			0.12	Preferred Generic, 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	40.00	80.00	120.00																			40.00	80.00	100.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, 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					33																				33																	33			33								Preferred Generic, 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	85.00	170.00	255.00																			85.00	170.00	212.50																85.00				85.00		2.83			2.83			2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	015	0	1	02	01	H2320_015_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	0.00																5.00				5.00		.16			.16			.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	015	0	1	02	01	H2320_015_0	5	2	Generic	1	4	000110	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	12.00	24.00	36.00																			12.00	24.00	0.00																12.00				12.00		.40			.40			.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	015	0	1	02	01	H2320_015_0	5	4	Non-Preferred Brand	1	4	110000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	237.50																95.00				95.00		3.16			3.16			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	015	0	1	02	01	H2320_015_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	015	0	1	02	01	H2320_015_0	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					31																				31																	31			31								Preferred Generic, 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	4.00	8.00	12.00																			4.00	8.00	0.00																4.00				4.00		.13			.13			0.12	Preferred Generic, 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					33																				33																	33			33								Preferred Generic, 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	85.00	170.00	255.00																			85.00	170.00	212.50																85.00				85.00		2.83			2.83			2.74	Preferred Generic, 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	40.00	80.00	120.00																			40.00	80.00	100.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	016	0	1	02	01	H2320_016_0	6	2	Generic	1	4	000110	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	0.00																10.00				10.00		.33			.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	018	0	1	02	01	H2320_018_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	018	0	1	02	01	H2320_018_0	5	2	Generic	1	4	000110	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	12.00	24.00	36.00																			12.00	24.00	0.00																12.00				12.00		.40			.40			.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	018	0	1	02	01	H2320_018_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	0.00																5.00				5.00		.16			.16			.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	018	0	1	02	01	H2320_018_0	5	4	Non-Preferred Brand	1	4	110000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	237.50																95.00				95.00		3.16			3.16			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	018	0	1	02	01	H2320_018_0	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					31																				31																	31			31								Preferred Generic, 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	4.00	8.00	12.00																			4.00	8.00	0.00																4.00				4.00		.13			.13			0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	019	0	1	02	01	H2320_019_0	5	2	Generic	1	4	000110	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	0.00																10.00				10.00		.33			.33			0.32	Preferred Generic, 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	40.00	80.00	120.00																			40.00	80.00	100.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, 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	85.00	170.00	255.00																			85.00	170.00	212.50																85.00				85.00		2.83			2.83			2.74	Preferred Generic, 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					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	021	0	1	02	01	H2320_021_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	021	0	1	02	01	H2320_021_0	5	2	Generic	1	4	000110	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	12.00	24.00	36.00																			12.00	24.00	0.00																12.00				12.00		.40			.40			.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	021	0	1	02	01	H2320_021_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	0.00																5.00				5.00		.16			.16			.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	021	0	1	02	01	H2320_021_0	5	4	Non-Preferred Brand	1	4	110000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	237.50																95.00				95.00		3.16			3.16			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2320	021	0	1	02	01	H2320_021_0	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					31																				31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2322	004	0	1	04	01	H2322_004_0	7	1	Preferred Generic	1	4	001000	3	2	111		01	111		1	30	60	90				1	30	60	90				30		31	4.00	8.00	10.00																			4.00	8.00	10.00																4.00				4.00		.13			.13			.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2322	004	0	1	04	01	H2322_004_0	7	2	Generic	1	4	000100	3	2	111		01	111		1	30	60	90				1	30	60	90				30		31	10.00	20.00	25.00																			10.00	20.00	25.00																10.00				10.00		.33			.33			.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2322	004	0	1	04	01	H2322_004_0	7	3	Preferred Brand	1	4	000001	3	2	111		01	111		1	30	60	90				1	30	60	90				30		31	40.00	80.00	100.00																			40.00	80.00	100.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2322	004	0	1	04	01	H2322_004_0	7	4	Non-Preferred Brand	1	4	100000	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31				85.63	29	29	29																		29	29	29															29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2322	004	0	1	04	01	H2322_004_0	7	5	Specialty Tier	1	4	000010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31				1542.69	29	29	29																		29	29	29															29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2322	004	0	1	04	01	H2322_004_0	7	1	Preferred Generic	3	4	001000	3	2	111		01	111		1	30	60	90				1	30	60	90				30		31	4.00	8.00	10.00																			4.00	8.00	10.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H2322	004	0	1	04	01	H2322_004_0	7	2	Generic	3	4	000100	3	2	111		01	111		1	30	60	90				1	30	60	90				30		31	10.00	20.00	25.00																			10.00	20.00	25.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H2322	008	0	1	04	01	H2322_008_0	7	4	Non-Preferred Brand	1	4	100000	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31				75.97	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2322	008	0	1	04	01	H2322_008_0	7	3	Preferred Brand	1	4	000001	3	2	111		01	111		1	30	60	90				1	30	60	90				30		31	45.00	90.00	112.50																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2322	008	0	1	04	01	H2322_008_0	7	2	Generic	1	4	000100	3	2	111		01	111		1	30	60	90				1	30	60	90				30		31	15.00	30.00	37.50																			15.00	30.00	37.50																15.00				15.00		.50			.50			.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2322	008	0	1	04	01	H2322_008_0	7	1	Preferred Generic	1	4	001000	3	2	111		01	111		1	30	60	90				1	30	60	90				30		31	2.00	4.00	5.00																			2.00	4.00	5.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2322	008	0	1	04	01	H2322_008_0	7	5	Specialty Tier	1	4	000010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31				2305.20	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2354	001	0	1	01	01	H2354_001_0	6	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.00	6.00	7.50																			3.00	6.00	7.50																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2354	001	0	1	01	01	H2354_001_0	6	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	15.00	30.00	37.50																			15.00	30.00	37.50																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2354	001	0	1	01	01	H2354_001_0	6	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	94.00	117.50																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2354	001	0	1	01	01	H2354_001_0	6	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	100.00	200.00	250.00																			100.00	200.00	250.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2354	001	0	1	01	01	H2354_001_0	6	5	Specialty Tier	1	4	101101	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31				768.83	30	30	30																		30	30	30															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2354	015	0	1	01	01	H2354_015_0	5	1	Preferred Generic	1	3	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	2.00	4.00	5.00																			2.00	4.00	5.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2354	015	0	1	01	01	H2354_015_0	5	2	Generic	1	3	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	11.00	22.00	27.50																			11.00	22.00	27.50																11.00				11.00		0.37			0.37			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2354	015	0	1	01	01	H2354_015_0	5	3	Preferred Brand	1	3	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	45.00	90.00	112.50																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2354	015	0	1	01	01	H2354_015_0	5	4	Non-Preferred Brand	1	3	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	95.00	190.00	237.50																			95.00	190.00	237.50																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2354	015	0	1	01	01	H2354_015_0	5	5	Specialty Tier	1	3	101101	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31				602.72	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2450	001	0	1	18	06	H2450_001_0	4	2	Generic	1	4	000100	1	2	110		01	100		1	31		93				1			93				31		31	15.00		45.00																					30.00																15.00				15.00		0.48						0.48	Preferred Generic, 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	43.00		129.00																					86.00																43.00				43.00		1.39						1.39	Preferred Generic, 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	8.00		24.00																					16.00																8.00				8.00		0.26						0.26	Preferred Generic, 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	85.00		255.00																					170.00																85.00				85.00		2.74						2.74	Preferred Generic, 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					33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2450	002	0	1	18	06	H2450_002_0	3	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	31		93				1			93				31		31	10.00		30.00																					20.00																10.00				10.00		0.32						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2450	002	0	1	18	06	H2450_002_0	3	2	Generic	1	4	000100	1	2	110		01	100		1	31		93				1			93				31		31	20.00		60.00																					40.00																20.00				20.00		0.65						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2450	002	0	1	18	06	H2450_002_0	3	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	31		93				1			93				31		31	35.00		105.00																					70.00																35.00				35.00		1.13						1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2450	002	0	1	18	06	H2450_002_0	3	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	31		93				1			93				31		31	85.00		255.00																					170.00																85.00				85.00		2.74						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2450	002	0	1	18	06	H2450_002_0	3	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	31		93				1			93				31		31					33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2450	007	0	1	18	06	H2450_007_0	3	2	Generic	1	3	000100	1	2	110		01	100		1	31		93				1			93				31		31	12.00		36.00																					24.00																12.00				12.00		0.39						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2450	007	0	1	18	06	H2450_007_0	3	1	Preferred Generic	1	3	001000	1	2	110		01	100		1	31		93				1			93				31		31	7.00		21.00																					14.00																7.00				7.00		0.23						0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2450	007	0	1	18	06	H2450_007_0	3	3	Preferred Brand	1	3	000001	1	2	110		01	100		1	31		93				1			93				31		31	47.00		141.00																					94.00																47.00				47.00		1.52						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2450	007	0	1	18	06	H2450_007_0	3	5	Specialty Tier	1	3	010010	1	1	110		01	100		1	31		93				1			93				31		31					25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2450	007	0	1	18	06	H2450_007_0	3	4	Non-Preferred Brand	1	3	100000	1	2	110		01	100		1	31		93				1			93				31		31	95.00		285.00																					190.00																95.00				95.00		3.06						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2450	016	0	1	18	06	H2450_016_0	4	1	Preferred Generic	1	3	001000	1	2	110		01	100		1	31		93				1			93				31		31	5.00		15.00																					10.00																5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2450	016	0	1	18	06	H2450_016_0	4	2	Generic	1	3	000100	1	2	110		01	100		1	31		93				1			93				31		31	11.00		33.00																					22.00																11.00				11.00		0.35						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2450	016	0	1	18	06	H2450_016_0	4	3	Preferred Brand	1	3	000001	1	2	110		01	100		1	31		93				1			93				31		31	47.00		141.00																					94.00																47.00				47.00		1.52						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2450	016	0	1	18	06	H2450_016_0	4	4	Non-Preferred Brand	1	3	100000	1	2	110		01	100		1	31		93				1			93				31		31	93.00		279.00																					186.00																93.00				93.00		3.00						3.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2450	016	0	1	18	06	H2450_016_0	4	5	Specialty Tier	1	3	010010	1	1	110		01	100		1	31		93				1			93				31		31					25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2450	017	0	1	18	06	H2450_017_0	3	1	Preferred Generic	1	3	001000	1	2	110		01	100		1	31		93				1			93				31		31	5.00		15.00																					10.00																5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2450	017	0	1	18	06	H2450_017_0	3	2	Generic	1	3	000100	1	2	110		01	100		1	31		93				1			93				31		31	11.00		33.00																					22.00																11.00				11.00		0.35						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2450	017	0	1	18	06	H2450_017_0	3	4	Non-Preferred Brand	1	3	100000	1	2	110		01	100		1	31		93				1			93				31		31	93.00		279.00																					186.00																93.00				93.00		3.00						3.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2450	017	0	1	18	06	H2450_017_0	3	3	Preferred Brand	1	3	000001	1	2	110		01	100		1	31		93				1			93				31		31	47.00		141.00																					94.00																47.00				47.00		1.52						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2450	017	0	1	18	06	H2450_017_0	3	5	Specialty Tier	1	3	010010	1	1	110		01	100		1	31		93				1			93				31		31					26		26																				26															26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2450	022	0	1	18	06	H2450_022_0	3	3	Preferred Brand	1	3	000001	1	2	110		01	100		1	31		93				1			93				31		31	47.00		141.00																					94.00																47.00				47.00		1.52						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2450	022	0	1	18	06	H2450_022_0	3	2	Generic	1	3	000100	1	2	110		01	100		1	31		93				1			93				31		31	13.00		39.00																					26.00																13.00				13.00		0.42						0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2450	022	0	1	18	06	H2450_022_0	3	1	Preferred Generic	1	3	001000	1	2	110		01	100		1	31		93				1			93				31		31	7.00		21.00																					14.00																7.00				7.00		0.23						0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2450	022	0	1	18	06	H2450_022_0	3	4	Non-Preferred Brand	1	3	100000	1	2	110		01	100		1	31		93				1			93				31		31	95.00		285.00																					190.00																95.00				95.00		3.06						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2450	022	0	1	18	06	H2450_022_0	3	5	Specialty Tier	1	3	010010	1	1	110		01	100		1	31		93				1			93				31		31					25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2450	023	0	1	18	06	H2450_023_0	3	2	Generic	1	4	000100	1	2	110		01	100		1	31		93				1			93				31		31	20.00		60.00																					40.00																20.00				20.00		0.65						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2450	023	0	1	18	06	H2450_023_0	3	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	31		93				1			93				31		31	45.00		135.00																					90.00																45.00				45.00		1.45						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2450	023	0	1	18	06	H2450_023_0	3	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	31		93				1			93				31		31	85.00		255.00																					170.00																85.00				85.00		2.74						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2450	023	0	1	18	06	H2450_023_0	3	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	31		93				1			93				31		31					33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2450	023	0	1	18	06	H2450_023_0	3	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	31		93				1			93				31		31	10.00		30.00																					20.00																10.00				10.00		0.32						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2450	029	0	1	18	06	H2450_029_0	3	2	Generic	1	3	000100	1	2	110		01	100		1	31		93				1			93				31		31	12.00		36.00																					24.00																12.00				12.00		0.39						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2450	029	0	1	18	06	H2450_029_0	3	3	Preferred Brand	1	3	000001	1	2	110		01	100		1	31		93				1			93				31		31	47.00		141.00																					94.00																47.00				47.00		1.52						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2450	029	0	1	18	06	H2450_029_0	3	5	Specialty Tier	1	3	010010	1	1	110		01	100		1	31		93				1			93				31		31					25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2450	029	0	1	18	06	H2450_029_0	3	4	Non-Preferred Brand	1	3	100000	1	2	110		01	100		1	31		93				1			93				31		31	93.00		279.00																					186.00																93.00				93.00		3.00						3.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2450	029	0	1	18	06	H2450_029_0	3	1	Preferred Generic	1	3	001000	1	2	110		01	100		1	31		93				1			93				31		31	4.00		12.00																					8.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2459	002	0	1	02	01	H2459_002_0	12	1	Preferred Generic	3	4	001000	1	2	110		10	100		1	30		90				1			90					29	31	5.00		12.50																					10.00																	5.00			5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2459	002	0	1	02	01	H2459_002_0	12	2	Generic	3	4	000100	1	2	110		10	100		1	30		90				1			90					29	31	12.00		30.00																					24.00																	12.00			12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2459	002	0	1	02	01	H2459_002_0	12	5	Specialty Tier	1	4	010010	1	1	110		10	100		1	30		90				1			90					29	31				1554.94	25		25																				25																25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2459	002	0	1	02	01	H2459_002_0	12	4	Non-Preferred Brand	1	4	100000	1	2	110		10	100		1	30		90				1			90					29	31	80.00		200.00																					160.00																	80.00			80.00		2.67						2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2459	002	0	1	02	01	H2459_002_0	12	3	Preferred Brand	1	4	000001	1	2	110		10	100		1	30		90				1			90					29	31	40.00		100.00																					80.00																	40.00			40.00		1.33						1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2459	002	0	1	02	01	H2459_002_0	12	2	Generic	1	4	000100	1	2	110		10	100		1	30		90				1			90					29	31	12.00		30.00																					24.00																	12.00			12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2459	002	0	1	02	01	H2459_002_0	12	1	Preferred Generic	1	4	001000	1	2	110		10	100		1	30		90				1			90					29	31	5.00		12.50																					10.00																	5.00			5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2459	013	0	1	02	01	H2459_013_0	9	4	Non-Preferred Brand	1	4	100000	1	2	110		10	100		1	30		90				1			90					29	31	80.00		200.00																					160.00																	80.00			80.00		2.67						2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2459	013	0	1	02	01	H2459_013_0	9	3	Preferred Brand	1	4	000001	1	2	110		10	100		1	30		90				1			90					29	31	40.00		100.00																					80.00																	40.00			40.00		1.33						1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2459	013	0	1	02	01	H2459_013_0	9	2	Generic	1	4	000100	1	2	110		10	100		1	30		90				1			90					29	31	12.00		30.00																					24.00																	12.00			12.00		.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2459	013	0	1	02	01	H2459_013_0	9	1	Preferred Generic	1	4	001000	1	2	110		10	100		1	30		90				1			90					29	31	6.00		15.00																					12.00																	6.00			6.00		0.20						0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2459	013	0	1	02	01	H2459_013_0	9	5	Specialty Tier	1	4	010010	1	1	110		10	100		1	30		90				1			90					29	31				1806.16	28		28																				28																28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2459	019	0	1	02	01	H2459_019_0	9	5	Specialty Tier	1	4	010010	1	1	110		10	100		1	30		90				1			90					29	31				1327.48	30		30																				30																30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2459	019	0	1	02	01	H2459_019_0	9	1	Preferred Generic	1	4	001000	1	2	110		10	100		1	30		90				1			90					29	31	6.00		18.00																					12.00																	6.00			6.00		0.20						0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2459	019	0	1	02	01	H2459_019_0	9	2	Generic	1	4	000100	1	2	110		10	100		1	30		90				1			90					29	31	15.00		45.00																					30.00																	15.00			15.00		.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2459	019	0	1	02	01	H2459_019_0	9	3	Preferred Brand	1	4	000001	1	2	110		10	100		1	30		90				1			90					29	31	45.00		135.00																					90.00																	45.00			45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2459	019	0	1	02	01	H2459_019_0	9	4	Non-Preferred Brand	1	4	100000	1	2	110		10	100		1	30		90				1			90					29	31	90.00		270.00																					180.00																	90.00			90.00		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2461	008	0	1	18	06	H2461_008_0	5	2	Generic	1	2	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	13.00	26.00	39.00																			13.00	26.00	26.00																13.00				13.00		0.42			.42			.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2461	008	0	1	18	06	H2461_008_0	5	1	Preferred Generic	1	2	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2461	008	0	1	18	06	H2461_008_0	5	3	Preferred Brand	1	2	010001	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	40.00	80.00	120.00																			40.00	80.00	80.00																40.00				40.00		1.29			1.29			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2461	008	0	1	18	06	H2461_008_0	5	4	Non-Preferred Brand	1	2	110000	1	1	111		01	111		1	31	60	90				1	31	60	90				31		31				52.99	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2461	008	0	1	18	06	H2461_008_0	5	5	Specialty Tier	1	2	010010	1	1	111		01	111		1	31	60	90				1	31	60	90				31		31				125.61	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2461	008	0	1	18	06	H2461_008_0	5	6	Select Care Drugs	1	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2461	009	0	1	18	06	H2461_009_0	6	2	Generic	1	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.48			0.48			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2461	009	0	1	18	06	H2461_009_0	6	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	5.00	10.00	15.00																			5.00	10.00	10.00																5.00				5.00		0.16			0.16			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2461	009	0	1	18	06	H2461_009_0	6	3	Preferred Brand	1	4	010001	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	40.00	80.00	120.00																			40.00	80.00	80.00																40.00				40.00		1.29			1.29			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2461	009	0	1	18	06	H2461_009_0	6	6	Select Care Drugs	1	4	010000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.06			0.06			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2461	009	0	1	18	06	H2461_009_0	6	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	31	60	90				1	31	60	90				31		31				229.21	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2461	009	0	1	18	06	H2461_009_0	6	4	Non-Preferred Brand	1	4	110000	1	1	111		01	111		1	31	60	90				1	31	60	90				31		31				56.06	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2461	010	0	1	18	06	H2461_010_0	6	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	3.00	6.00	9.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2461	010	0	1	18	06	H2461_010_0	6	2	Generic	1	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.32			0.32			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2461	010	0	1	18	06	H2461_010_0	6	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	31	60	90				1	31	60	90				31		31				290.01	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2461	010	0	1	18	06	H2461_010_0	6	4	Non-Preferred Brand	1	4	110000	1	1	111		01	111		1	31	60	90				1	31	60	90				31		31				53.12	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2461	010	0	1	18	06	H2461_010_0	6	3	Preferred Brand	1	4	010001	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	35.00	70.00	105.00																			35.00	70.00	70.00																35.00				35.00		1.13			1.13			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2461	010	0	1	18	06	H2461_010_0	6	6	Select Care Drugs	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2462	008	0	1	18	06	H2462_008_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01		110	1	30		90				1				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2462	008	0	1	18	06	H2462_008_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31				526.20	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2462	008	0	1	18	06	H2462_008_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		110	1	30		90				1				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		14.00				7.00				7.00		0.23				0.23	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2462	008	0	1	18	06	H2462_008_0	5	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	18.00		54.00																									18.00		54.00				18.00		36.00				18.00				18.00		0.60				0.60	0.60	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2462	008	0	1	18	06	H2462_008_0	5	3	Preferred Brand	1	4	000001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2462	011	0	1	18	06	H2462_011_0	5	2	Generic	1	3	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	16.00		48.00																									16.00		48.00				16.00		32.00				16.00				16.00		0.53				0.53	0.53	0.52	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, 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				566.31	29																										29						29					29			29								Preferred Generic, 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	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, 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	7.00		21.00																									7.00		21.00				7.00		14.00				7.00				7.00		0.23				0.23	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	7.00		21.00																									7.00		21.00				7.00		14.00				7.00				7.00		0.23				0.23	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2462	012	0	1	18	06	H2462_012_0	5	2	Generic	3	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		30.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, 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				568.86	29																										29						29					29			29								Preferred Generic, 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	85.00		255.00																									85.00		255.00				85.00		170.00				85.00				85.00		2.83				2.83	2.83	2.74	Preferred Generic, 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	40.00		120.00																									40.00		120.00				40.00		80.00				40.00				40.00		1.33				1.33	1.33	1.29	Preferred Generic, 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				207.76	50		50																								55		55				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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	7.00		21.00																									7.00		21.00				7.00		14.00				7.00				7.00		0.23				0.23	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2462	012	0	1	18	06	H2462_012_0	5	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		30.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2462	019	0	1	18	06	H2462_019_0	4	3	Preferred Brand	1	3	000001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2462	019	0	1	18	06	H2462_019_0	4	2	Generic	1	3	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		40.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2462	019	0	1	18	06	H2462_019_0	4	1	Preferred Generic	1	3	001000	1	2	110		01		110	1	30		90				1				30		90	30		31	8.00		24.00																									8.00		24.00				8.00		16.00				8.00				8.00		0.27				0.27	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2462	019	0	1	18	06	H2462_019_0	4	4	Non-Preferred Brand	1	3	100000	1	2	110		01		110	1	30		90				1				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2462	019	0	1	18	06	H2462_019_0	4	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31				666.79	28																										28						28					28			28								Preferred Generic, 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	3.00		9.00																									3.00		9.00				3.00		0.00				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2486	003	0	1	01	01	H2486_003_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, 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, 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	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2486	003	0	1	01	01	H2486_003_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	3.00		9.00																									3.00		9.00				3.00		0.00				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2491	002	0	1	02	01	H2491_002_0	5	4	Non-Preferred Brand	1	3	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				76.00	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2491	002	0	1	02	01	H2491_002_0	5	3	Preferred Brand	1	3	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2491	002	0	1	02	01	H2491_002_0	5	2	Generic	1	3	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2491	002	0	1	02	01	H2491_002_0	5	1	Preferred Generic	1	3	001000	1	2	110		01		110	1	30		90				1				30		90	30		31	2.00		6.00																									2.00		6.00				2.00		0.00				2.00				2.00		0.07				0.07	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2491	002	0	1	02	01	H2491_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2491	004	0	1	01	01	H2491_004_0	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2491	004	0	1	01	01	H2491_004_0	5	2	Generic	1	3	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2491	004	0	1	01	01	H2491_004_0	5	3	Preferred Brand	1	3	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2491	004	0	1	01	01	H2491_004_0	5	4	Non-Preferred Brand	1	3	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				94.30	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2491	004	0	1	01	01	H2491_004_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2506	001	0	1	48	05	H2506_001_0	7	2	Brand Drugs	1	4	000010			111		10	111		1	30	60	90				1	30	60	90					29	31																																														0.00			0.00			0.00	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	7	1	Generic Drugs	1	4	010000			111		10	111		1	30	60	90				1	30	60	90					29	31																																														0.00			0.00			0.00	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	7	3	Non-Medicare Rx/OTC Drugs	1	4	010010			111		10	111		1	30	60	90				1	30	60	90					29	31																																														0.00			0.00			0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H2531	001	0	1	48	05	H2531_001_0	4	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	2.95	0.00	2.95	0.00	2.95	0.00	2.95			
H2531	001	0	1	48	05	H2531_001_0	4	2	Brand Drugs	1	4	000010			111		01	111		1	30	60	90				1	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	7.40	0.00	7.40	0.00	7.40	0.00	7.40			
H2531	001	0	1	48	05	H2531_001_0	4	3	Non-Medicare Rx/OTC Drugs	1	4	010010			111		01	111		1	30	60	90				1	30	60	90				30		31																																														0.00			0.00			0.00	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	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			
H2533	001	0	1	48	05	H2533_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	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H2533	001	0	1	48	05	H2533_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			
H2563	001	0	1	01	01	H2563_001_0	10	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		34	8.00		24.00																					16.00																8.00				8.00		0.27						0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2563	001	0	1	01	01	H2563_001_0	10	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2563	001	0	1	01	01	H2563_001_0	10	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		34	40.00		120.00																					100.00																40.00				40.00		1.33						1.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2563	001	0	1	01	01	H2563_001_0	10	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2563	001	0	1	01	01	H2563_001_0	10	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		34	80.00		240.00																					200.00																80.00				80.00		2.67						2.35	Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2563	002	0	1	01	01	H2563_002_0	9	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		34	5.00		15.00																					10.00																5.00				5.00		0.17						0.15	Preferred Generic, 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	30.00		90.00																					75.00																30.00				30.00		1.00						0.88	Preferred Generic, 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	60.00		180.00																					150.00																60.00				60.00		2.00						1.76	Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2591	001	0	1	04	01	H2591_001_0	5	1	Preferred Generic	1	3	001000	1	2		110	01	110		1				30		90	1	30		90				30		31								10.00		30.00					0.00		0.00					10.00		30.00																10.00				10.00			.33	0.00	.33			.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2591	001	0	1	04	01	H2591_001_0	5	2	Generic	1	3	000100	1	2		110	01	110		1				30		90	1	30		90				30		31								20.00		60.00					20.00		40.00					20.00		60.00																20.00				20.00			.67	.67	.67			.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2591	001	0	1	04	01	H2591_001_0	5	4	Non-Preferred Brand	1	3	100000	1	2		110	01	110		1				30		90	1	30		90				30		31								100.00		300.00					100.00		200.00					100.00		300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2591	001	0	1	04	01	H2591_001_0	5	3	Preferred Brand	1	3	000001	1	2		110	01	110		1				30		90	1	30		90				30		31								47.00		141.00					47.00		94.00					47.00		141.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2591	001	0	1	04	01	H2591_001_0	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2593	001	0	1	01	01	H2593_001_0	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	001	0	1	01	01	H2593_001_0	5	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2593	001	0	1	01	01	H2593_001_0	5	2	Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			.40	.24				.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2593	001	0	1	01	01	H2593_001_0	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H2593	001	0	1	01	01	H2593_001_0	5	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	001	0	1	01	01	H2593_001_0	5	2	Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			.40	.24				.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	001	0	1	01	01	H2593_001_0	5	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31								45.00		135.00					40.00		120.00							100.00																45.00				45.00			1.45	1.29				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	001	0	1	01	01	H2593_001_0	5	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					85.00		255.00							212.50																95.00				95.00			3.06	2.74				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	001	0	1	01	01	H2593_001_0	5	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											584.00	33						584.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
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, 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, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H2593	003	0	1	01	01	H2593_003_0	6	2	Generic	3	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	7.50		22.50																					18.75																7.50				7.50		.24						.24	Preferred Generic, 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	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	003	0	1	01	01	H2593_003_0	6	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	7.50		22.50																					18.75																7.50				7.50		.24						.24	Preferred Generic, 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	40.00		120.00																					100.00																40.00				40.00		1.29						1.29	Preferred Generic, 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	85.00		255.00																					212.50																85.00				85.00		2.74						2.74	Preferred Generic, 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				584.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	005	0	1	01	01	H2593_005_0	5	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	005	0	1	01	01	H2593_005_0	5	2	Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			.40	.24				.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2593	005	0	1	01	01	H2593_005_0	5	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2593	005	0	1	01	01	H2593_005_0	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	005	0	1	01	01	H2593_005_0	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H2593	005	0	1	01	01	H2593_005_0	5	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					85.00		255.00							212.50																95.00				95.00			3.06	2.74				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	005	0	1	01	01	H2593_005_0	5	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31								45.00		135.00					40.00		120.00							100.00																45.00				45.00			1.45	1.29				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	005	0	1	01	01	H2593_005_0	5	2	Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			.40	.24				.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	005	0	1	01	01	H2593_005_0	5	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											584.00	33						584.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	006	0	1	01	01	H2593_006_0	5	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2593	006	0	1	01	01	H2593_006_0	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	006	0	1	01	01	H2593_006_0	5	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											584.00	33						584.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	006	0	1	01	01	H2593_006_0	5	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					85.00		255.00							212.50																95.00				95.00			3.06	2.74				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	006	0	1	01	01	H2593_006_0	5	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31								45.00		135.00					40.00		120.00							100.00																45.00				45.00			1.45	1.29				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	006	0	1	01	01	H2593_006_0	5	2	Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			.40	.24				.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	006	0	1	01	01	H2593_006_0	5	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	006	0	1	01	01	H2593_006_0	5	2	Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			.40	.24				.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2593	006	0	1	01	01	H2593_006_0	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H2593	013	0	1	01	01	H2593_013_0	5	2	Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			.40	.24				.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	013	0	1	01	01	H2593_013_0	5	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	013	0	1	01	01	H2593_013_0	5	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31								45.00		135.00					40.00		120.00							100.00																45.00				45.00			1.45	1.29				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	013	0	1	01	01	H2593_013_0	5	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					85.00		255.00							212.50																95.00				95.00			3.06	2.74				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	013	0	1	01	01	H2593_013_0	5	6	Select Care Drugs	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H2593	013	0	1	01	01	H2593_013_0	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	013	0	1	01	01	H2593_013_0	5	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2593	013	0	1	01	01	H2593_013_0	5	2	Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			.40	.24				.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2593	013	0	1	01	01	H2593_013_0	5	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											584.00	33						584.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	018	0	1	01	01	H2593_018_0	5	2	Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								15.50		46.50					10.50		31.50							26.25																15.50				15.50			.50	.33				.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	018	0	1	01	01	H2593_018_0	5	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								10.00		30.00					5.00		15.00							12.50																10.00				10.00			0.32	0.16				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	018	0	1	01	01	H2593_018_0	5	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31								45.00		135.00					40.00		120.00							100.00																45.00				45.00			1.45	1.29				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	018	0	1	01	01	H2593_018_0	5	6	Select Care Drugs	1	4	010010	1	2		110	01	100		1				30		90	1			90				30		31								10.00		30.00					10.00		30.00							25.00																10.00				10.00			0.32	0.32				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	018	0	1	01	01	H2593_018_0	5	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											584.00	33						584.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	018	0	1	01	01	H2593_018_0	5	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					90.00		270.00							225.00																95.00				95.00			3.06	2.90				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	019	0	1	01	01	H2593_019_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	019	0	1	01	01	H2593_019_0	5	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	7.50		22.50																					18.75																7.50				7.50		.24						.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	019	0	1	01	01	H2593_019_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	40.00		120.00																					100.00																40.00				40.00		1.29						1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	019	0	1	01	01	H2593_019_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	85.00		255.00																					212.50																85.00				85.00		2.74						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	019	0	1	01	01	H2593_019_0	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H2593	019	0	1	01	01	H2593_019_0	5	2	Generic	3	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	7.50		22.50																					18.75																7.50				7.50		.24						.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2593	019	0	1	01	01	H2593_019_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2593	019	0	1	01	01	H2593_019_0	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2593	019	0	1	01	01	H2593_019_0	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				584.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2610	005	0	1	01	01	H2610_005_0	7	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					5.00	10.00	15.00																5.00				5.00			0.17	0.00	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	005	0	1	01	01	H2610_005_0	7	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								2.00	4.00	6.00					0.00	0.00	0.00					2.00	4.00	6.00																2.00				2.00			0.07	0.00	0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	005	0	1	01	01	H2610_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								75.00	150.00	225.00					65.00	130.00	195.00					75.00	150.00	225.00																75.00				75.00			2.50	2.17	2.50			2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	005	0	1	01	01	H2610_005_0	7	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											1312.77	33						1312.77	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	005	0	1	01	01	H2610_005_0	7	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								39.00	78.00	117.00					34.00	68.00	102.00					39.00	78.00	117.00																39.00				39.00			1.30	1.13	1.30			1.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	006	0	1	01	01	H2610_006_0	7	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											1138.46	33						1138.46	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	006	0	1	01	01	H2610_006_0	7	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								65.00	130.00	195.00					55.00	110.00	165.00					65.00	130.00	195.00																65.00				65.00			2.17	1.83	2.17			2.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	006	0	1	01	01	H2610_006_0	7	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								2.00	4.00	6.00					0.00	0.00	0.00					2.00	4.00	6.00																2.00				2.00			0.07	0.00	0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	006	0	1	01	01	H2610_006_0	7	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					5.00	10.00	15.00																5.00				5.00			0.17	0.00	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	006	0	1	01	01	H2610_006_0	7	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								34.00	68.00	102.00					29.00	58.00	87.00					34.00	68.00	102.00																34.00				34.00			1.13	0.97	1.13			1.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	006	0	1	01	01	H2610_006_0	7	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								2.00	4.00	6.00					0.00	0.00	0.00					2.00	4.00	6.00																2.00				2.00			.06	0.00	.06			.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2610	006	0	1	01	01	H2610_006_0	7	2	Generic	3	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					5.00	10.00	15.00																5.00				5.00			.16	0.00	.16			.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2610	011	0	1	01	01	H2610_011_0	7	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								10.00	20.00	30.00					0.00	0.00	0.00					10.00	20.00	30.00																10.00				10.00			0.33	0.00	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	011	0	1	01	01	H2610_011_0	7	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								7.00	14.00	21.00					0.00	0.00	0.00					7.00	14.00	21.00																7.00				7.00			0.23	0.00	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	011	0	1	01	01	H2610_011_0	7	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								42.00	84.00	126.00					37.00	74.00	111.00					42.00	84.00	126.00																42.00				42.00			1.40	1.23	1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	011	0	1	01	01	H2610_011_0	7	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								85.00	170.00	255.00					75.00	150.00	225.00					85.00	170.00	255.00																85.00				85.00			2.83	2.50	2.83			2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	011	0	1	01	01	H2610_011_0	7	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											1061.51	33						1061.51	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	014	0	1	02	01	H2610_014_0	7	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					5.00	10.00	15.00																5.00				5.00			0.17	0.00	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	014	0	1	02	01	H2610_014_0	7	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								39.00	78.00	117.00					34.00	68.00	102.00					39.00	78.00	117.00																39.00				39.00			1.30	1.13	1.30			1.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	014	0	1	02	01	H2610_014_0	7	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											1468.32	33						1468.32	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	014	0	1	02	01	H2610_014_0	7	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								75.00	150.00	225.00					65.00	130.00	195.00					75.00	150.00	225.00																75.00				75.00			2.50	2.17	2.50			2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	014	0	1	02	01	H2610_014_0	7	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								2.00	4.00	6.00					0.00	0.00	0.00					2.00	4.00	6.00																2.00				2.00			0.07	0.00	0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	015	0	1	01	01	H2610_015_0	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	6.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	015	0	1	01	01	H2610_015_0	7	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	015	0	1	01	01	H2610_015_0	7	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	015	0	1	01	01	H2610_015_0	7	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	15.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	015	0	1	01	01	H2610_015_0	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				1298.95	33																				33																	33			33								Preferred Generic, 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	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	004	0	1	01	01	H2649_004_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	11.00		33.00																									11.00		33.00				11.00		0.00				11.00				11.00		0.36				0.36	0.36	0.35	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, 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					29																										29						29					29			29								Preferred Generic, 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	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	004	0	1	01	01	H2649_004_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	11.00		33.00																									11.00		33.00				11.00		0.00				11.00				11.00		0.36				0.36	0.36	0.35	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, 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					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	021	0	1	01	01	H2649_021_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	021	0	1	01	01	H2649_021_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	021	0	1	01	01	H2649_021_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	021	0	1	01	01	H2649_021_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	021	0	1	01	01	H2649_021_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	11.00		33.00																									11.00		33.00				11.00		0.00				11.00				11.00		0.36				0.36	0.36	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	021	0	1	01	01	H2649_021_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	021	0	1	01	01	H2649_021_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	021	0	1	01	01	H2649_021_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	021	0	1	01	01	H2649_021_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	021	0	1	01	01	H2649_021_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	11.00		33.00																									11.00		33.00				11.00		0.00				11.00				11.00		0.36				0.36	0.36	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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					29																										29						29					29			29								Preferred Generic, 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	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	023	0	1	01	01	H2649_023_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	11.00		33.00																									11.00		33.00				11.00		0.00				11.00				11.00		0.36				0.36	0.36	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	023	0	1	01	01	H2649_023_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	11.00		33.00																									11.00		33.00				11.00		0.00				11.00				11.00		0.36				0.36	0.36	0.35	Preferred Generic, 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					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	024	0	1	01	01	H2649_024_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	024	0	1	01	01	H2649_024_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	024	0	1	01	01	H2649_024_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	024	0	1	01	01	H2649_024_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	024	0	1	01	01	H2649_024_0	4	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	11.00		33.00																									11.00		33.00				11.00		0.00				11.00				11.00		0.36				0.36	0.36	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	024	0	1	01	01	H2649_024_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	024	0	1	01	01	H2649_024_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	024	0	1	01	01	H2649_024_0	4	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	11.00		33.00																									11.00		33.00				11.00		0.00				11.00				11.00		0.36				0.36	0.36	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	024	0	1	01	01	H2649_024_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	024	0	1	01	01	H2649_024_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	025	0	1	01	01	H2649_025_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	025	0	1	01	01	H2649_025_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	025	0	1	01	01	H2649_025_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	025	0	1	01	01	H2649_025_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	025	0	1	01	01	H2649_025_0	4	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	11.00		33.00																									11.00		33.00				11.00		0.00				11.00				11.00		0.36				0.36	0.36	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	025	0	1	01	01	H2649_025_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	025	0	1	01	01	H2649_025_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	025	0	1	01	01	H2649_025_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	025	0	1	01	01	H2649_025_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	025	0	1	01	01	H2649_025_0	4	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	11.00		33.00																									11.00		33.00				11.00		0.00				11.00				11.00		0.36				0.36	0.36	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	028	0	1	01	01	H2649_028_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	028	0	1	01	01	H2649_028_0	4	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	028	0	1	01	01	H2649_028_0	4	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	028	0	1	01	01	H2649_028_0	4	2	Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	028	0	1	01	01	H2649_028_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, 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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, 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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	029	0	1	01	01	H2649_029_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		0.00				12.00				12.00		0.40				0.40	0.40	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	029	0	1	01	01	H2649_029_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		0.00				12.00				12.00		0.40				0.40	0.40	0.38	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	030	0	1	01	01	H2649_030_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	030	0	1	01	01	H2649_030_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	030	0	1	01	01	H2649_030_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	030	0	1	01	01	H2649_030_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	030	0	1	01	01	H2649_030_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	030	0	1	01	01	H2649_030_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	030	0	1	01	01	H2649_030_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	030	0	1	01	01	H2649_030_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	030	0	1	01	01	H2649_030_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	030	0	1	01	01	H2649_030_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	031	0	1	01	01	H2649_031_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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, 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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	031	0	1	01	01	H2649_031_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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					28																										28						28					28			28								Preferred Generic, 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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	032	0	1	01	01	H2649_032_0	4	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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					28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	032	0	1	01	01	H2649_032_0	4	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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					28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	033	0	1	01	01	H2649_033_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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					28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	033	0	1	01	01	H2649_033_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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					28																										28						28					28			28								Preferred Generic, 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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	034	0	1	01	01	H2649_034_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, 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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, 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					28																										28						28					28			28								Preferred Generic, 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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	034	0	1	01	01	H2649_034_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	036	0	1	01	01	H2649_036_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H2649	036	0	1	01	01	H2649_036_0	4	6	Select Care Drugs	3	4	010010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2649	036	0	1	01	01	H2649_036_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H2649	036	0	1	01	01	H2649_036_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H2649	036	0	1	01	01	H2649_036_0	4	6	Select Care Drugs	1	4	010010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2649	036	0	1	01	01	H2649_036_0	4	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H2649	036	0	1	01	01	H2649_036_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H2649	036	0	1	01	01	H2649_036_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2649	036	0	1	01	01	H2649_036_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2649	036	0	1	01	01	H2649_036_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2649	036	0	1	01	01	H2649_036_0	4	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2649	036	0	1	01	01	H2649_036_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2649	039	0	1	01	01	H2649_039_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	039	0	1	01	01	H2649_039_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	039	0	1	01	01	H2649_039_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		0.00				12.00				12.00		0.40				0.40	0.40	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	039	0	1	01	01	H2649_039_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	039	0	1	01	01	H2649_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	039	0	1	01	01	H2649_039_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	039	0	1	01	01	H2649_039_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		0.00				12.00				12.00		0.40				0.40	0.40	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	039	0	1	01	01	H2649_039_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	039	0	1	01	01	H2649_039_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	039	0	1	01	01	H2649_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	042	0	1	01	01	H2649_042_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, 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					27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	042	0	1	01	01	H2649_042_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, 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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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					27																										27						27					27			27								Preferred Generic, 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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	043	0	1	01	01	H2649_043_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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					26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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					26																										26						26					26			26								Preferred Generic, 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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	043	0	1	01	01	H2649_043_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, 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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	045	0	1	01	01	H2649_045_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	045	0	1	01	01	H2649_045_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	045	0	1	01	01	H2649_045_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	045	0	1	01	01	H2649_045_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	045	0	1	01	01	H2649_045_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	2.00		6.00																									2.00		6.00				2.00		0.00				2.00				2.00		0.06				0.06	0.06	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	045	0	1	01	01	H2649_045_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	045	0	1	01	01	H2649_045_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	045	0	1	01	01	H2649_045_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	045	0	1	01	01	H2649_045_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	045	0	1	01	01	H2649_045_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	2.00		6.00																									2.00		6.00				2.00		0.00				2.00				2.00		0.06				0.06	0.06	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	046	0	1	01	01	H2649_046_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00		9.00																									3.00		9.00				3.00		0.00				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	046	0	1	01	01	H2649_046_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	8.00		24.00																									8.00		24.00				8.00		0.00				8.00				8.00		0.26				0.26	0.26	0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	046	0	1	01	01	H2649_046_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	046	0	1	01	01	H2649_046_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	046	0	1	01	01	H2649_046_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	046	0	1	01	01	H2649_046_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	8.00		24.00																									8.00		24.00				8.00		0.00				8.00				8.00		0.26				0.26	0.26	0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	046	0	1	01	01	H2649_046_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00		9.00																									3.00		9.00				3.00		0.00				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	046	0	1	01	01	H2649_046_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	046	0	1	01	01	H2649_046_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	046	0	1	01	01	H2649_046_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	047	0	1	01	01	H2649_047_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	047	0	1	01	01	H2649_047_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	047	0	1	01	01	H2649_047_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	047	0	1	01	01	H2649_047_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	9.00		27.00																									9.00		27.00				9.00		0.00				9.00				9.00		0.30				0.30	0.30	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	047	0	1	01	01	H2649_047_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00		9.00																									3.00		9.00				3.00		0.00				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	047	0	1	01	01	H2649_047_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	047	0	1	01	01	H2649_047_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	047	0	1	01	01	H2649_047_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	047	0	1	01	01	H2649_047_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	9.00		27.00																									9.00		27.00				9.00		0.00				9.00				9.00		0.30				0.30	0.30	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	047	0	1	01	01	H2649_047_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00		9.00																									3.00		9.00				3.00		0.00				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	048	0	1	01	01	H2649_048_0	4	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	048	0	1	01	01	H2649_048_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	048	0	1	01	01	H2649_048_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	048	0	1	01	01	H2649_048_0	4	2	Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	13.00		39.00																									13.00		39.00				13.00		0.00				13.00				13.00		0.43				0.43	0.43	0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	048	0	1	01	01	H2649_048_0	4	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	049	0	1	01	01	H2649_049_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	049	0	1	01	01	H2649_049_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	049	0	1	01	01	H2649_049_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	049	0	1	01	01	H2649_049_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	049	0	1	01	01	H2649_049_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	049	0	1	01	01	H2649_049_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	049	0	1	01	01	H2649_049_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	049	0	1	01	01	H2649_049_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00		9.00																									3.00		9.00				3.00		0.00				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	049	0	1	01	01	H2649_049_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	049	0	1	01	01	H2649_049_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00		9.00																									3.00		9.00				3.00		0.00				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	050	0	1	01	01	H2649_050_0	3	2	Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	050	0	1	01	01	H2649_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	050	0	1	01	01	H2649_050_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	050	0	1	01	01	H2649_050_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	050	0	1	01	01	H2649_050_0	3	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	051	0	1	01	01	H2649_051_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	051	0	1	01	01	H2649_051_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		0.00				12.00				12.00		0.40				0.40	0.40	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	051	0	1	01	01	H2649_051_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	051	0	1	01	01	H2649_051_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	051	0	1	01	01	H2649_051_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	051	0	1	01	01	H2649_051_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		0.00				12.00				12.00		0.40				0.40	0.40	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	051	0	1	01	01	H2649_051_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	051	0	1	01	01	H2649_051_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	051	0	1	01	01	H2649_051_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	051	0	1	01	01	H2649_051_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	052	0	1	01	01	H2649_052_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00		9.00																									3.00		9.00				3.00		0.00				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	052	0	1	01	01	H2649_052_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	052	0	1	01	01	H2649_052_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	052	0	1	01	01	H2649_052_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	052	0	1	01	01	H2649_052_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	052	0	1	01	01	H2649_052_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00		9.00																									3.00		9.00				3.00		0.00				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	052	0	1	01	01	H2649_052_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	052	0	1	01	01	H2649_052_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	052	0	1	01	01	H2649_052_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	052	0	1	01	01	H2649_052_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	053	0	1	01	01	H2649_053_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	2.00		6.00																									2.00		6.00				2.00		0.00				2.00				2.00		0.06				0.06	0.06	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	053	0	1	01	01	H2649_053_0	4	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	053	0	1	01	01	H2649_053_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	053	0	1	01	01	H2649_053_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	053	0	1	01	01	H2649_053_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	053	0	1	01	01	H2649_053_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	2.00		6.00																									2.00		6.00				2.00		0.00				2.00				2.00		0.06				0.06	0.06	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	053	0	1	01	01	H2649_053_0	4	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	053	0	1	01	01	H2649_053_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	053	0	1	01	01	H2649_053_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	053	0	1	01	01	H2649_053_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	054	0	1	01	01	H2649_054_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00		9.00																									3.00		9.00				3.00		0.00				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	054	0	1	01	01	H2649_054_0	4	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	8.00		24.00																									8.00		24.00				8.00		0.00				8.00				8.00		0.26				0.26	0.26	0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	054	0	1	01	01	H2649_054_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	054	0	1	01	01	H2649_054_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	054	0	1	01	01	H2649_054_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	054	0	1	01	01	H2649_054_0	4	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	8.00		24.00																									8.00		24.00				8.00		0.00				8.00				8.00		0.26				0.26	0.26	0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	054	0	1	01	01	H2649_054_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00		9.00																									3.00		9.00				3.00		0.00				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	054	0	1	01	01	H2649_054_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	054	0	1	01	01	H2649_054_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	054	0	1	01	01	H2649_054_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	055	0	1	01	01	H2649_055_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00		9.00																									3.00		9.00				3.00		0.00				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	055	0	1	01	01	H2649_055_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	055	0	1	01	01	H2649_055_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	055	0	1	01	01	H2649_055_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00		9.00																									3.00		9.00				3.00		0.00				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	055	0	1	01	01	H2649_055_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	055	0	1	01	01	H2649_055_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	055	0	1	01	01	H2649_055_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	055	0	1	01	01	H2649_055_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	055	0	1	01	01	H2649_055_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	055	0	1	01	01	H2649_055_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	056	0	1	02	01	H2649_056_0	9	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	056	0	1	02	01	H2649_056_0	9	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	056	0	1	02	01	H2649_056_0	9	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	056	0	1	02	01	H2649_056_0	9	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	056	0	1	02	01	H2649_056_0	9	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	8.00		24.00																									8.00		24.00				8.00		0.00				8.00				8.00		0.26				0.26	0.26	0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	056	0	1	02	01	H2649_056_0	9	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	056	0	1	02	01	H2649_056_0	9	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	056	0	1	02	01	H2649_056_0	9	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	056	0	1	02	01	H2649_056_0	9	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	056	0	1	02	01	H2649_056_0	9	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	8.00		24.00																									8.00		24.00				8.00		0.00				8.00				8.00		0.26				0.26	0.26	0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	059	1	1	01	01	H2649_059_1	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	059	1	1	01	01	H2649_059_1	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	059	1	1	01	01	H2649_059_1	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	059	1	1	01	01	H2649_059_1	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	11.00		33.00																									11.00		33.00				11.00		0.00				11.00				11.00		0.36				0.36	0.36	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	059	1	1	01	01	H2649_059_1	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	059	1	1	01	01	H2649_059_1	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	059	1	1	01	01	H2649_059_1	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	059	1	1	01	01	H2649_059_1	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	059	1	1	01	01	H2649_059_1	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	11.00		33.00																									11.00		33.00				11.00		0.00				11.00				11.00		0.36				0.36	0.36	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	059	1	1	01	01	H2649_059_1	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	059	2	1	01	01	H2649_059_2	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	059	2	1	01	01	H2649_059_2	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	059	2	1	01	01	H2649_059_2	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	059	2	1	01	01	H2649_059_2	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	11.00		33.00																									11.00		33.00				11.00		0.00				11.00				11.00		0.36				0.36	0.36	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	059	2	1	01	01	H2649_059_2	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	059	2	1	01	01	H2649_059_2	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	059	2	1	01	01	H2649_059_2	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	059	2	1	01	01	H2649_059_2	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	059	2	1	01	01	H2649_059_2	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	11.00		33.00																									11.00		33.00				11.00		0.00				11.00				11.00		0.36				0.36	0.36	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	059	2	1	01	01	H2649_059_2	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	060	0	1	02	01	H2649_060_0	9	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	060	0	1	02	01	H2649_060_0	9	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	060	0	1	02	01	H2649_060_0	9	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	060	0	1	02	01	H2649_060_0	9	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	060	0	1	02	01	H2649_060_0	9	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	060	0	1	02	01	H2649_060_0	9	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	060	0	1	02	01	H2649_060_0	9	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2649	060	0	1	02	01	H2649_060_0	9	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	060	0	1	02	01	H2649_060_0	9	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2649	060	0	1	02	01	H2649_060_0	9	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	010	0	1	01	01	H2654_010_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	010	0	1	01	01	H2654_010_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	010	0	1	01	01	H2654_010_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		.40						.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	010	0	1	01	01	H2654_010_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		.06						.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	010	0	1	01	01	H2654_010_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				496.00	26		26																										26						26			26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	013	0	1	01	01	H2654_013_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		.06						.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	013	0	1	01	01	H2654_013_0	4	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		.40						.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	013	0	1	01	01	H2654_013_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	013	0	1	01	01	H2654_013_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	013	0	1	01	01	H2654_013_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				573.00	26		26																										26						26			26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	033	0	1	01	01	H2654_033_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	033	0	1	01	01	H2654_033_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	033	0	1	01	01	H2654_033_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	033	0	1	01	01	H2654_033_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	033	0	1	01	01	H2654_033_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				533.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	034	0	1	01	01	H2654_034_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	034	0	1	01	01	H2654_034_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	034	0	1	01	01	H2654_034_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	034	0	1	01	01	H2654_034_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	034	0	1	01	01	H2654_034_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				506.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	035	0	1	01	01	H2654_035_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	035	0	1	01	01	H2654_035_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		.06						.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	035	0	1	01	01	H2654_035_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	035	0	1	01	01	H2654_035_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	035	0	1	01	01	H2654_035_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				598.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	036	0	1	01	01	H2654_036_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				598.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	036	0	1	01	01	H2654_036_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	036	0	1	01	01	H2654_036_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	036	0	1	01	01	H2654_036_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	036	0	1	01	01	H2654_036_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	037	0	1	01	01	H2654_037_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				598.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	037	0	1	01	01	H2654_037_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	037	0	1	01	01	H2654_037_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	037	0	1	01	01	H2654_037_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	037	0	1	01	01	H2654_037_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		.06						.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	038	0	1	01	01	H2654_038_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	038	0	1	01	01	H2654_038_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	038	0	1	01	01	H2654_038_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				477.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	038	0	1	01	01	H2654_038_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		.26						.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	038	0	1	01	01	H2654_038_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		.06						.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	039	0	1	01	01	H2654_039_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		.06						.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	039	0	1	01	01	H2654_039_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		.40						.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	039	0	1	01	01	H2654_039_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	039	0	1	01	01	H2654_039_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	039	0	1	01	01	H2654_039_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				447.00	26		26																										26						26			26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	040	0	1	01	01	H2654_040_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		.06						.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	040	0	1	01	01	H2654_040_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		.40						.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	040	0	1	01	01	H2654_040_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	040	0	1	01	01	H2654_040_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2654	040	0	1	01	01	H2654_040_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				496.00	26		26																										26						26			26			26								Preferred Generic, 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											31.75	50	50	50				30.70	50	50	50				50	50	50																50		50								Preferred Generic, 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								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, 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								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	002	0	1	01	01	H2663_002_0	6	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								12.00	24.00	36.00					7.00	14.00	21.00					12.00	24.00	36.00																	12.00			12.00			0.40	0.23	0.40			0.39	Preferred Generic, 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						1.00	33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	005	0	1	01	01	H2663_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											37.41	50	50	50				35.88	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	005	0	1	01	01	H2663_005_0	7	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	005	0	1	01	01	H2663_005_0	7	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								12.00	24.00	36.00					7.00	14.00	21.00					12.00	24.00	36.00																	12.00			12.00			0.40	0.23	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	005	0	1	01	01	H2663_005_0	7	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	005	0	1	01	01	H2663_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	006	0	1	02	01	H2663_006_0	6	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	006	0	1	02	01	H2663_006_0	6	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								12.00	24.00	36.00					7.00	14.00	21.00					12.00	24.00	36.00																	12.00			12.00			0.40	0.23	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	006	0	1	02	01	H2663_006_0	6	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	006	0	1	02	01	H2663_006_0	6	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											36.05	50	50	50				34.99	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	006	0	1	02	01	H2663_006_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	015	0	1	02	01	H2663_015_0	7	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					0.00	0.00	0.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.00	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	015	0	1	02	01	H2663_015_0	7	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								15.00	30.00	45.00					5.00	10.00	15.00					15.00	30.00	45.00																	15.00			15.00			0.50	0.17	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	015	0	1	02	01	H2663_015_0	7	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	015	0	1	02	01	H2663_015_0	7	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											37.10	50	50	50				35.40	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	015	0	1	02	01	H2663_015_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	016	0	1	01	01	H2663_016_0	5	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					5.00	10.00	15.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.17	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	016	0	1	01	01	H2663_016_0	5	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					0.00	0.00	0.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.00	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	016	0	1	01	01	H2663_016_0	5	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	016	0	1	01	01	H2663_016_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	016	0	1	01	01	H2663_016_0	5	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											39.15	50	50	50				36.84	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	017	0	1	01	01	H2663_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											40.28	50	50	50				37.24	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	017	0	1	01	01	H2663_017_0	5	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	017	0	1	01	01	H2663_017_0	5	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								15.00	30.00	45.00					5.00	10.00	15.00					15.00	30.00	45.00																	15.00			15.00			0.50	0.17	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	017	0	1	01	01	H2663_017_0	5	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					0.00	0.00	0.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.00	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2663	017	0	1	01	01	H2663_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2667	001	0	1	01	01	H2667_001_0	4	4	Non-Preferred Brand	1	4	110000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2667	001	0	1	01	01	H2667_001_0	4	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2667	001	0	1	01	01	H2667_001_0	4	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					5.00	10.00	0.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.17	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2667	001	0	1	01	01	H2667_001_0	4	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								5.00	10.00	15.00					0.00	0.00	0.00					5.00	10.00	15.00																	5.00			5.00			0.17	0.00	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2667	001	0	1	01	01	H2667_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2667	017	0	1	02	01	H2667_017_0	6	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								5.00	10.00	15.00					0.00	0.00	0.00					5.00	10.00	15.00																	5.00			5.00			0.17	0.00	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2667	017	0	1	02	01	H2667_017_0	6	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					5.00	10.00	5.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.17	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2667	017	0	1	02	01	H2667_017_0	6	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2667	017	0	1	02	01	H2667_017_0	6	4	Non-Preferred Brand	1	4	110000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2667	017	0	1	02	01	H2667_017_0	6	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31											1.00	33						1.00	33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2667	020	0	1	01	01	H2667_020_0	3	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								5.00	10.00	15.00					0.00	0.00	0.00					5.00	10.00	15.00																	5.00			5.00			0.17	0.00	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2667	020	0	1	01	01	H2667_020_0	3	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					5.00	10.00	5.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.17	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2667	020	0	1	01	01	H2667_020_0	3	4	Non-Preferred Brand	1	4	110000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2667	020	0	1	01	01	H2667_020_0	3	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2667	020	0	1	01	01	H2667_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2672	001	0	1	01	01	H2672_001_0	5	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								15.00	30.00	45.00					9.00	18.00	18.00					15.00	30.00	45.00																	15.00			15.00			0.50	0.30	0.50			0.48	Preferred Generic, 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								10.00	20.00	30.00					4.00	8.00	8.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.13	0.33			0.32	Preferred Generic, 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								47.00	94.00	141.00					47.00	94.00	94.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, 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	2		111	10	111		1				30	60	90	1	30	60	90					10	31								100.00	200.00	300.00					100.00	200.00	200.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2672	008	0	1	01	01	H2672_008_0	5	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								15.00	30.00	45.00					9.00	18.00	27.00					15.00	30.00	45.00																	15.00			15.00			0.50	0.30	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2672	008	0	1	01	01	H2672_008_0	5	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					4.00	8.00	12.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.13	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2672	008	0	1	01	01	H2672_008_0	5	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2672	008	0	1	01	01	H2672_008_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2672	008	0	1	01	01	H2672_008_0	5	4	Non-Preferred Brand	1	4	110000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, 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								10.00	20.00	30.00					4.00	8.00	0.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.13	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2672	009	0	1	01	01	H2672_009_0	5	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								15.00	30.00	45.00					9.00	18.00	0.00					15.00	30.00	45.00																	15.00			15.00			0.50	0.30	0.50			0.48	Preferred Generic, 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	2		111	10	111		1				30	60	90	1	30	60	90					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, 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								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2672	010	0	1	01	01	H2672_010_0	6	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								9.00	18.00	27.00					4.00	8.00	8.00					9.00	18.00	27.00																	9.00			9.00			0.30	0.13	0.30			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2672	010	0	1	01	01	H2672_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2672	010	0	1	01	01	H2672_010_0	6	4	Non-Preferred Brand	1	4	110000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								100.00	200.00	300.00					100.00	200.00	200.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2672	010	0	1	01	01	H2672_010_0	6	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	94.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2672	010	0	1	01	01	H2672_010_0	6	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								15.00	30.00	45.00					9.00	18.00	18.00					15.00	30.00	45.00																	15.00			15.00			0.50	0.30	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2672	018	0	1	01	01	H2672_018_0	6	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								6.00	12.00	15.00					0.00	0.00	0.00					6.00	12.00	15.00																	6.00			6.00			0.20	0.00	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2672	018	0	1	01	01	H2672_018_0	6	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								12.00	24.00	30.00					7.00	14.00	17.50					12.00	24.00	30.00																	12.00			12.00			0.40	0.23	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2672	018	0	1	01	01	H2672_018_0	6	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	117.50					47.00	94.00	117.50					47.00	94.00	117.50																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2672	018	0	1	01	01	H2672_018_0	6	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											43.86	50	50	50				39.07	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2672	018	0	1	01	01	H2672_018_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2672	018	0	1	01	01	H2672_018_0	6	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								6.00	12.00	15.00					0.00	0.00	0.00					6.00	12.00	15.00																	6.00			6.00			0.20	0.00	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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	95.00	190.00	285.00																			95.00		285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2676	001	0	1	04	01	H2676_001_0	5	3	Preferred Brand	1	4	000101	1	2	111		01	110		1	30	60	90				2	30		90				30		31	45.00	90.00	135.00																			45.00		135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2676	001	0	1	04	01	H2676_001_0	5	2	Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	11.00	22.00	27.50																			11.00		27.50																11.00				11.00		0.37			0.37			0.35	Preferred Generic, 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	7.00	14.00	17.50																			7.00		17.50																7.00				7.00		0.23			0.23			0.23	Preferred Generic, 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				468.43	33	33	33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2701	003	0	1	04	01	H2701_003_0	10	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	34	60	90				1	34	60	90				34		34	4.00	8.00	8.00																			4.00	8.00	8.00																4.00				4.00		0.12			0.12			0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2701	003	0	1	04	01	H2701_003_0	10	2	Generic	1	4	000100	1	2	111		01	111		1	34	60	90				1	34	60	90				34		34	15.00	30.00	30.00																			15.00	30.00	30.00																15.00				15.00		0.44			0.44			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2701	003	0	1	04	01	H2701_003_0	10	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	34	60	90				1	34	60	90				34		34	45.00	90.00	112.50																			45.00	90.00	112.50																45.00				45.00		1.32			1.32			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2701	003	0	1	04	01	H2701_003_0	10	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	34	60	90				1	34	60	90				34		34	80.00	160.00	240.00																			80.00	160.00	240.00																80.00				80.00		2.35			2.35			2.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2701	003	0	1	04	01	H2701_003_0	10	5	Specialty Tier	1	4	101101	1	1	010		01	010		1	34							34						34		34				452.73	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2701	003	0	1	04	01	H2701_003_0	10	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2701	006	0	1	04	01	H2701_006_0	10	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	34	60	90				1	34	60	90				34		34	4.00	8.00	8.00																			4.00	8.00	8.00																4.00				4.00		0.12			0.12			0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2701	006	0	1	04	01	H2701_006_0	10	2	Generic	1	4	000100	1	2	111		01	111		1	34	60	90				1	34	60	90				34		34	15.00	30.00	30.00																			15.00	30.00	30.00																15.00				15.00		0.44			0.44			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2701	006	0	1	04	01	H2701_006_0	10	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	34	60	90				1	34	60	90				34		34	45.00	90.00	112.50																			45.00	90.00	112.50																45.00				45.00		1.32			1.32			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2701	006	0	1	04	01	H2701_006_0	10	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	34	60	90				1	34	60	90				34		34	90.00	180.00	270.00																			90.00	180.00	270.00																90.00				90.00		2.65			2.65			2.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2701	006	0	1	04	01	H2701_006_0	10	5	Specialty Tier	1	4	101101	1	1	010		01	010		1	34							34						34		34				600.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2701	006	0	1	04	01	H2701_006_0	10	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2751	002	0	1	48	05	H2751_002_0	6	2	Brand Drugs	1	4	000010			110		01	110		1	30		90				1	30		90				30		31																																														0.00			0.00			0.00	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			
H2751	002	0	1	48	05	H2751_002_0	6	1	Generic Drugs	1	4	010000			110		01	110		1	30		90				1	30		90				30		31																																														0.00			0.00			0.00	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			
H2751	002	0	1	48	05	H2751_002_0	6	3	Non-Medicare Rx/OTC Drugs	1	4	010010			110		01	110		1	30		90				1	30		90				30		31																																														0.00			0.00			0.00	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			
H2758	002	0	1	01	01	H2758_002_0	11	4	Non-Preferred Brand	1	4	110000	1	2	111		01	100		1	31	62	90				1			90				31		31	85.00	170.00	255.00																					255.00																85.00				85.00		2.74						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2758	002	0	1	01	01	H2758_002_0	11	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2758	002	0	1	01	01	H2758_002_0	11	3	Preferred Brand	1	4	010001	1	2	111		01	100		1	31	62	90				1			90				31		31	35.00	70.00	105.00																					105.00																35.00				35.00		1.13						1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2758	002	0	1	01	01	H2758_002_0	11	2	Generic	1	4	000100	1	2	111		01	100		1	31	62	90				1			90				31		31	7.00	14.00	21.00																					21.00																7.00				7.00		0.23						0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2758	002	0	1	01	01	H2758_002_0	11	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2758	002	0	1	01	01	H2758_002_0	11	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2758	004	0	1	01	01	H2758_004_0	11	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2758	004	0	1	01	01	H2758_004_0	11	2	Generic	1	4	000100	1	2	111		01	100		1	31	62	90				1			90				31		31	7.00	14.00	21.00																					21.00																7.00				7.00		0.23						0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2758	004	0	1	01	01	H2758_004_0	11	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2758	004	0	1	01	01	H2758_004_0	11	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2758	004	0	1	01	01	H2758_004_0	11	4	Non-Preferred Brand	1	4	110000	1	2	111		01	100		1	31	62	90				1			90				31		31	85.00	170.00	255.00																					255.00																85.00				85.00		2.74						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2758	004	0	1	01	01	H2758_004_0	11	3	Preferred Brand	1	4	010001	1	2	111		01	100		1	31	62	90				1			90				31		31	35.00	70.00	105.00																					105.00																35.00				35.00		1.13						1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2758	005	0	1	01	01	H2758_005_0	12	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2758	005	0	1	01	01	H2758_005_0	12	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2758	005	0	1	01	01	H2758_005_0	12	4	Non-Preferred Brand	1	4	110000	1	2	111		01	100		1	31	62	90				1			90				31		31	85.00	170.00	255.00																					170.00																85.00				85.00		2.74						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2758	005	0	1	01	01	H2758_005_0	12	3	Preferred Brand	1	4	010001	1	2	111		01	100		1	31	62	90				1			90				31		31	35.00	70.00	105.00																					70.00																35.00				35.00		1.13						1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2758	005	0	1	01	01	H2758_005_0	12	2	Generic	1	4	000100	1	2	111		01	100		1	31	62	90				1			90				31		31	7.00	14.00	21.00																					14.00																7.00				7.00		0.23						0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2758	005	0	1	01	01	H2758_005_0	12	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2773	003	0	1	01	01	H2773_003_0	5	3	Preferred Brand	1	4	000101	1	2	110		01	110		1	31		90				1	31		90				31		31	30.00		90.00																			30.00		90.00																30.00				30.00		.97			.97			.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	003	0	1	01	01	H2773_003_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	31		90				1	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	003	0	1	01	01	H2773_003_0	5	2	Generic	1	4	000100	1	2	110		01	110		1	31		90				1	31		90				31		31	10.00		30.00																			10.00		20.00																10.00				10.00		.32			.32			.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	003	0	1	01	01	H2773_003_0	5	4	Non-Preferred Brand	1	4	100100	3	1	110		01	110		1	31		90				1	31		90				31		31				37.95	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	003	0	1	01	01	H2773_003_0	5	5	Specialty Tier	1	4	110000	1	1	010		01	010		1	31							31						31		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	015	0	1	01	01	H2773_015_0	6	3	Preferred Brand	1	4	000101	1	2	110		01	110		1	31		90				1	31		90				31		31	20.00		60.00																			20.00		60.00																20.00				20.00		.65			.65			.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	015	0	1	01	01	H2773_015_0	6	2	Generic	1	4	000100	1	2	110		01	110		1	31		90				1	31		90				31		31	10.00		30.00																			10.00		20.00																10.00				10.00		.32			.32			.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	015	0	1	01	01	H2773_015_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	31		90				1	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	015	0	1	01	01	H2773_015_0	6	4	Non-Preferred Brand	1	4	100100	3	1	110		01	110		1	31		90				1	31		90				31		31				39.81	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	015	0	1	01	01	H2773_015_0	6	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	31		90				1	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2773	015	0	1	01	01	H2773_015_0	6	5	Specialty Tier	1	4	110000	1	1	010		01	010		1	31							31						31		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	017	0	1	01	01	H2773_017_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	31		90				1	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	017	0	1	01	01	H2773_017_0	6	2	Generic	1	4	000100	1	2	110		01	110		1	31		90				1	31		90				31		31	10.00		30.00																			10.00		20.00																10.00				10.00		.32			.32			.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	017	0	1	01	01	H2773_017_0	6	3	Preferred Brand	1	4	000101	1	2	110		01	110		1	31		90				1	31		90				31		31	25.00		75.00																			25.00		75.00																25.00				25.00		.81			.81			.81	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	017	0	1	01	01	H2773_017_0	6	5	Specialty Tier	1	4	110000	1	1	010		01	010		1	31							31						31		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	017	0	1	01	01	H2773_017_0	6	4	Non-Preferred Brand	1	4	100100	3	1	110		01	110		1	31		90				1	31		90				31		31				37.20	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	017	0	1	01	01	H2773_017_0	6	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	31		90				1	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2773	018	0	1	01	01	H2773_018_0	5	2	Generic	1	4	000100	1	2	110		01	110		1	31		90				1	31		90				31		31	10.00		30.00																			10.00		20.00																10.00				10.00		.32			.32			.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	018	0	1	01	01	H2773_018_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	31		90				1	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	018	0	1	01	01	H2773_018_0	5	3	Preferred Brand	1	4	000101	1	2	110		01	110		1	31		90				1	31		90				31		31	30.00		90.00																			30.00		90.00																30.00				30.00		.97			.97			.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	018	0	1	01	01	H2773_018_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	31		90				1	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2773	018	0	1	01	01	H2773_018_0	5	5	Specialty Tier	1	4	110000	1	1	010		01	010		1	31							31						31		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	018	0	1	01	01	H2773_018_0	5	4	Non-Preferred Brand	1	4	100100	3	1	110		01	110		1	31		90				1	31		90				31		31				43.62	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	019	0	1	01	01	H2773_019_0	7	2	Generic	1	4	000100	1	2	110		01	110		1	31		90				1	31		90				31		31	15.00		45.00																			15.00		30.00																15.00				15.00		.48			.48			.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	019	0	1	01	01	H2773_019_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	31		90				1	31		90				31		31	4.00		12.00																			4.00		8.00																4.00				4.00		.13			.13			.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	019	0	1	01	01	H2773_019_0	7	3	Preferred Brand	1	4	000101	1	2	110		01	110		1	31		90				1	31		90				31		31	30.00		90.00																			30.00		90.00																30.00				30.00		.97			.97			.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	019	0	1	01	01	H2773_019_0	7	4	Non-Preferred Brand	1	4	100100	3	1	110		01	110		1	31		90				1	31		90				31		31				41.94	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	019	0	1	01	01	H2773_019_0	7	5	Specialty Tier	1	4	110000	1	1	010		01	010		1	31							31						31		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	020	0	1	01	01	H2773_020_0	5	2	Generic	1	4	000100	1	2	110		01	110		1	31		90				1	31		90				31		31	10.00		30.00																			10.00		20.00																10.00				10.00		.32			.32			.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	020	0	1	01	01	H2773_020_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	31		90				1	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	020	0	1	01	01	H2773_020_0	5	3	Preferred Brand	1	4	000101	1	2	110		01	110		1	31		90				1	31		90				31		31	30.00		90.00																			30.00		90.00																30.00				30.00		.97			.97			.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	020	0	1	01	01	H2773_020_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	31		90				1	31		90				31		31	4.00		12.00																			4.00		8.00																4.00				4.00		.13			.13			.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2773	020	0	1	01	01	H2773_020_0	5	5	Specialty Tier	1	4	110000	1	1	010		01	010		1	31							31						31		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	020	0	1	01	01	H2773_020_0	5	4	Non-Preferred Brand	1	4	100100	3	1	110		01	110		1	31		90				1	31		90				31		31				39.12	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	082	0	1	04	01	H2775_082_0	6	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	2				30		90	30		34								5.00		12.50					0.00		0.00											5.00		12.50				0.00		0.00				5.00				5.00			0.16	0.00		.16	0.00	.14	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	082	0	1	04	01	H2775_082_0	6	2	Generic	1	4	000100	1	2		110	01		110	1				30		90	2				30		90	30		34								10.00		25.00					5.00		12.50											10.00		25.00				5.00		5.00				10.00				10.00			0.33	0.16		.33	.16	.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	082	0	1	04	01	H2775_082_0	6	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		34								45.00		112.50					35.00		87.50											45.00		112.50				35.00		70.00				45.00				45.00			1.50	1.16		1.50	1.16	1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	082	0	1	04	01	H2775_082_0	6	4	Non-Preferred Brand	1	4	100100	1	2		110	01		110	1				30		90	2				30		90	30		34								85.00		212.50					75.00		187.50											85.00		212.50				75.00		150.00				85.00				85.00			2.83	2.50		2.83	2.50	2.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	082	0	1	04	01	H2775_082_0	6	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	083	0	1	04	01	H2775_083_0	6	2	Generic	1	4	000100	1	2		110	01		110	1				30		90	2				30		90	30		34								10.00		25.00					5.00		12.50											10.00		25.00				5.00		5.00				10.00				10.00			0.33	0.16		.33	.16	.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	083	0	1	04	01	H2775_083_0	6	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		34								45.00		112.50					35.00		87.50											45.00		112.50				35.00		70.00				45.00				45.00			1.50	1.16		1.50	1.16	1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	083	0	1	04	01	H2775_083_0	6	4	Non-Preferred Brand	1	4	100100	1	2		110	01		110	1				30		90	2				30		90	30		34								85.00		212.50					75.00		187.50											85.00		212.50				75.00		150.00				85.00				85.00			2.83	2.50		2.83	2.50	2.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	083	0	1	04	01	H2775_083_0	6	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	083	0	1	04	01	H2775_083_0	6	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	2				30		90	30		34								5.00		12.50					0.00		0.00											5.00		12.50				0.00		0.00				5.00				5.00			0.16	0.00		.16	0.00	.14	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	088	0	1	04	01	H2775_088_0	6	4	Non-Preferred Brand	1	4	100100	1	2		110	01		110	1				30		90	2				30		90	30		34								100.00		250.00					90.00		225.00											100.00		250.00				90.00		180.00				100.00				100.00			3.33	3.00		3.33	3.00	2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	088	0	1	04	01	H2775_088_0	6	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		34								47.00		117.50					37.00		92.50											47.00		117.50				37.00		74.00				47.00				47.00			1.56	1.23		1.56	1.23	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	088	0	1	04	01	H2775_088_0	6	2	Generic	1	4	000100	1	2		110	01		110	1				30		90	2				30		90	30		34								12.00		30.00					7.00		17.50											12.00		30.00				7.00		7.00				12.00				12.00			0.40	0.23		.40	.23	.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	088	0	1	04	01	H2775_088_0	6	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	2				30		90	30		34								7.00		17.50					2.00		5.00											7.00		17.50				2.00		2.00				7.00				7.00			0.23	0.06		.23	.06	.20	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	088	0	1	04	01	H2775_088_0	6	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	089	0	1	04	01	H2775_089_0	6	4	Non-Preferred Brand	1	4	100100	1	2		110	01		110	1				30		90	2				30		90	30		34								100.00		250.00					90.00		225.00											100.00		250.00				90.00		180.00				100.00				100.00			3.33	3.00		3.33	3.00	2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	089	0	1	04	01	H2775_089_0	6	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		34								47.00		117.50					37.00		92.50											47.00		117.50				37.00		74.00				47.00				47.00			1.56	1.23		1.56	1.23	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	089	0	1	04	01	H2775_089_0	6	2	Generic	1	4	000100	1	2		110	01		110	1				30		90	2				30		90	30		34								12.00		30.00					7.00		17.50											12.00		30.00				7.00		7.00				12.00				12.00			0.40	0.23		.40	.23	.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	089	0	1	04	01	H2775_089_0	6	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	2				30		90	30		34								7.00		17.50					2.00		5.00											7.00		17.50				2.00		2.00				7.00				7.00			0.23	0.06		.23	.06	.20	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	089	0	1	04	01	H2775_089_0	6	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	099	0	1	04	01	H2775_099_0	6	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	2				30		90	30		34								5.00		12.50					0.00		0.00											5.00		12.50				0.00		0.00				5.00				5.00			0.16	0.00		.16	0.00	.14	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	099	0	1	04	01	H2775_099_0	6	2	Generic	1	4	000100	1	2		110	01		110	1				30		90	2				30		90	30		34								10.00		25.00					5.00		12.50											10.00		25.00				5.00		5.00				10.00				10.00			0.33	0.16		.33	.16	.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	099	0	1	04	01	H2775_099_0	6	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		34								45.00		112.50					35.00		87.50											45.00		112.50				35.00		70.00				45.00				45.00			1.50	1.16		1.50	1.16	1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	099	0	1	04	01	H2775_099_0	6	4	Non-Preferred Brand	1	4	100100	1	2		110	01		110	1				30		90	2				30		90	30		34								85.00		212.50					75.00		187.50											85.00		212.50				75.00		150.00				85.00				85.00			2.83	2.50		2.83	2.50	2.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	099	0	1	04	01	H2775_099_0	6	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	100	0	1	04	01	H2775_100_0	6	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	2				30		90	30		34								7.00		17.50					2.00		5.00											7.00		17.50				2.00		2.00				7.00				7.00			0.23	0.06		.23	.06	.20	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	100	0	1	04	01	H2775_100_0	6	2	Generic	1	4	000100	1	2		110	01		110	1				30		90	2				30		90	30		34								12.00		30.00					7.00		17.50											12.00		30.00				7.00		7.00				12.00				12.00			0.40	0.23		.40	.23	.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	100	0	1	04	01	H2775_100_0	6	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		34								47.00		117.50					37.00		92.50											47.00		117.50				37.00		74.00				47.00				47.00			1.56	1.23		1.56	1.23	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	100	0	1	04	01	H2775_100_0	6	4	Non-Preferred Brand	1	4	100100	1	2		110	01		110	1				30		90	2				30		90	30		34								100.00		250.00					90.00		225.00											100.00		250.00				90.00		180.00				100.00				100.00			3.33	3.00		3.33	3.00	2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2775	100	0	1	04	01	H2775_100_0	6	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2802	001	0	1	01	01	H2802_001_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2802	001	0	1	01	01	H2802_001_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2802	001	0	1	01	01	H2802_001_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2802	001	0	1	01	01	H2802_001_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2802	001	0	1	01	01	H2802_001_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				409.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2802	007	0	1	01	01	H2802_007_0	3	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2802	007	0	1	01	01	H2802_007_0	3	2	Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2802	007	0	1	01	01	H2802_007_0	3	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2802	007	0	1	01	01	H2802_007_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2802	007	0	1	01	01	H2802_007_0	3	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31				423.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2802	008	0	1	01	01	H2802_008_0	3	2	Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2802	008	0	1	01	01	H2802_008_0	3	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2802	008	0	1	01	01	H2802_008_0	3	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2802	008	0	1	01	01	H2802_008_0	3	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31				423.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2802	008	0	1	01	01	H2802_008_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2802	009	0	1	01	01	H2802_009_0	3	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2802	009	0	1	01	01	H2802_009_0	3	2	Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2802	009	0	1	01	01	H2802_009_0	3	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2802	009	0	1	01	01	H2802_009_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2802	009	0	1	01	01	H2802_009_0	3	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31				478.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2802	010	0	1	01	01	H2802_010_0	3	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2802	010	0	1	01	01	H2802_010_0	3	2	Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2802	010	0	1	01	01	H2802_010_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2802	010	0	1	01	01	H2802_010_0	3	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2802	010	0	1	01	01	H2802_010_0	3	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31				478.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2802	011	0	1	01	01	H2802_011_0	3	2	Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2802	011	0	1	01	01	H2802_011_0	3	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2802	011	0	1	01	01	H2802_011_0	3	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2802	011	0	1	01	01	H2802_011_0	3	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31				478.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2802	011	0	1	01	01	H2802_011_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2802	012	0	1	01	01	H2802_012_0	3	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2802	012	0	1	01	01	H2802_012_0	3	2	Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2802	012	0	1	01	01	H2802_012_0	3	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2802	012	0	1	01	01	H2802_012_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2802	012	0	1	01	01	H2802_012_0	3	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31				488.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2816	013	0	1	09	04	H2816_013_0	6	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2816	013	0	1	09	04	H2816_013_0	6	4	Non-Preferred Brand	1	4	100100	1	2		110	01		110	1				30		90	2				30		90	30		34								85.00		212.50					75.00		187.50											85.00		212.50				75.00		150.00				85.00				85.00			2.83	2.50		2.83	2.50	2.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2816	013	0	1	09	04	H2816_013_0	6	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		34								45.00		112.50					35.00		87.50											45.00		112.50				35.00		70.00				45.00				45.00			1.50	1.16		1.50	1.16	1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2816	013	0	1	09	04	H2816_013_0	6	2	Generic	1	4	000100	1	2		110	01		110	1				30		90	2				30		90	30		34								10.00		25.00					5.00		12.50											10.00		25.00				5.00		5.00				10.00				10.00			0.33	0.16		.33	.16	.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2816	013	0	1	09	04	H2816_013_0	6	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	2				30		90	30		34								5.00		12.50					0.00		0.00											5.00		12.50				0.00		0.00				5.00				5.00			0.16	0.00		.16	0.00	.14	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2816	019	0	1	09	04	H2816_019_0	6	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2816	019	0	1	09	04	H2816_019_0	6	4	Non-Preferred Brand	1	4	100100	1	2		110	01		110	1				30		90	2				30		90	30		34								100.00		250.00					90.00		225.00											100.00		250.00				90.00		180.00				100.00				100.00			3.33	3.00		3.33	3.00	2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2816	019	0	1	09	04	H2816_019_0	6	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		34								47.00		117.50					37.00		92.50											47.00		117.50				37.00		74.00				47.00				47.00			1.56	1.23		1.56	1.23	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2816	019	0	1	09	04	H2816_019_0	6	2	Generic	1	4	000100	1	2		110	01		110	1				30		90	2				30		90	30		34								12.00		30.00					7.00		17.50											12.00		30.00				7.00		7.00				12.00				12.00			0.40	0.23		.40	.23	.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2816	019	0	1	09	04	H2816_019_0	6	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	2				30		90	30		34								7.00		17.50					2.00		5.00											7.00		17.50				2.00		2.00				7.00				7.00			0.23	0.06		.23	.06	.20	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2816	021	0	1	09	04	H2816_021_0	6	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2816	021	0	1	09	04	H2816_021_0	6	4	Non-Preferred Brand	1	4	100100	1	2		110	01		110	1				30		90	2				30		90	30		34								100.00		250.00					90.00		225.00											100.00		250.00				90.00		180.00				100.00				100.00			3.33	3.00		3.33	3.00	2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2816	021	0	1	09	04	H2816_021_0	6	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		34								47.00		117.50					37.00		92.50											47.00		117.50				37.00		74.00				47.00				47.00			1.56	1.23		1.56	1.23	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2816	021	0	1	09	04	H2816_021_0	6	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	2				30		90	30		34								7.00		17.50					2.00		5.00											7.00		17.50				2.00		2.00				7.00				7.00			0.23	0.06		.23	.06	.20	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2816	021	0	1	09	04	H2816_021_0	6	2	Generic	1	4	000100	1	2		110	01		110	1				30		90	2				30		90	30		34								12.00		30.00					7.00		17.50											12.00		30.00				7.00		7.00				12.00				12.00			0.40	0.23		.40	.23	.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2816	027	0	1	09	04	H2816_027_0	6	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	2				30		90	30		34								5.00		12.50					0.00		0.00											5.00		12.50				0.00		0.00				5.00				5.00			0.16	0.00		.16	0.00	.14	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2816	027	0	1	09	04	H2816_027_0	6	2	Generic	1	4	000100	1	2		110	01		110	1				30		90	2				30		90	30		34								10.00		25.00					5.00		12.50											10.00		25.00				5.00		5.00				10.00				10.00			0.33	0.16		.33	.16	.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2816	027	0	1	09	04	H2816_027_0	6	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2816	027	0	1	09	04	H2816_027_0	6	4	Non-Preferred Brand	1	4	100100	1	2		110	01		110	1				30		90	2				30		90	30		34								85.00		212.50					75.00		187.50											85.00		212.50				75.00		150.00				85.00				85.00			2.83	2.50		2.83	2.50	2.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2816	027	0	1	09	04	H2816_027_0	6	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		34								45.00		112.50					35.00		87.50											45.00		112.50				35.00		70.00				45.00				45.00			1.50	1.16		1.50	1.16	1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2905	001	0	1	04	01	H2905_001_0	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		100				1						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2905	001	0	1	04	01	H2905_001_0	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		100				1						100	30		31				691.00	25		25																										25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2905	001	0	1	04	01	H2905_001_0	2	2	Generic	1	3	000100	1	2	110		01		100	1	30		100				1						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2905	001	0	1	04	01	H2905_001_0	2	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		100				1						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2905	001	0	1	04	01	H2905_001_0	2	4	Non-Preferred Brand	1	3	110000	1	2	110		01		100	1	30		100				1						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2906	005	0	1	04	01	H2906_005_0	11	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	3.00		7.50																					6.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2906	005	0	1	04	01	H2906_005_0	11	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2906	005	0	1	04	01	H2906_005_0	11	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	80.00		200.00																					160.00																80.00				80.00		2.67						2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2906	005	0	1	04	01	H2906_005_0	11	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	45.00		112.50																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2906	005	0	1	04	01	H2906_005_0	11	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	12.00		30.00																					24.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2906	005	0	1	04	01	H2906_005_0	11	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	3.00		7.50																					6.00																3.00				3.00		0.06						.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2906	005	0	1	04	01	H2906_005_0	11	2	Generic	3	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	12.00		30.00																					24.00																12.00				12.00		.26						.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2906	006	0	1	04	01	H2906_006_0	10	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	95.00		237.50																					190.00																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2906	006	0	1	04	01	H2906_006_0	10	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	45.00		112.50																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2906	006	0	1	04	01	H2906_006_0	10	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	14.00		35.00																					28.00																14.00				14.00		0.47						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2906	006	0	1	04	01	H2906_006_0	10	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	6.00		15.00																					12.00																6.00				6.00		0.20						0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2906	006	0	1	04	01	H2906_006_0	10	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2906	007	0	1	04	01	H2906_007_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	8.00		20.00																					16.00																8.00				8.00		0.27						0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2906	007	0	1	04	01	H2906_007_0	7	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	16.00		40.00																					32.00																16.00				16.00		0.53						0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2906	007	0	1	04	01	H2906_007_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	45.00		112.50																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2906	007	0	1	04	01	H2906_007_0	7	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	95.00		237.50																					190.00																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2906	007	0	1	04	01	H2906_007_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2931	002	0	1	01	01	H2931_002_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		100				1						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2931	002	0	1	01	01	H2931_002_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		100				1						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2931	002	0	1	01	01	H2931_002_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		100				1						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2931	002	0	1	01	01	H2931_002_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		100				1						100	30		31				925.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2931	002	0	1	01	01	H2931_002_0	3	1	Preferred Generic	3	4	001000	1	2	110		01		100	1	30		100				1						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2931	002	0	1	01	01	H2931_002_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		100				1						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2931	002	0	1	01	01	H2931_002_0	3	2	Generic	3	4	000100	1	2	110		01		100	1	30		100				1						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2931	004	0	1	01	01	H2931_004_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		100				1						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2931	004	0	1	01	01	H2931_004_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		100				1						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2931	004	0	1	01	01	H2931_004_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		100				1						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2931	004	0	1	01	01	H2931_004_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		100				1						100	30		31				715.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2931	004	0	1	01	01	H2931_004_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		100				1						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, 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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, 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, 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	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	004	0	1	09	04	H2944_004_0	4	2	Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.66				0.66	0.66	0.64	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2944	013	0	1	09	04	H2944_013_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	14.00		42.00																									14.00		42.00				14.00		0.00				14.00				14.00		0.46				0.46	0.46	0.45	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, 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					26																										26						26					26			26								Preferred Generic, 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	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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					26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2944	013	0	1	09	04	H2944_013_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	14.00		42.00																									14.00		42.00				14.00		0.00				14.00				14.00		0.46				0.46	0.46	0.45	Preferred Generic, 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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	078	0	1	09	04	H2944_078_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, 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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	078	0	1	09	04	H2944_078_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2944	114	0	1	09	04	H2944_114_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	114	0	1	09	04	H2944_114_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	114	0	1	09	04	H2944_114_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2944	114	0	1	09	04	H2944_114_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2944	114	0	1	09	04	H2944_114_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2944	114	0	1	09	04	H2944_114_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2944	114	0	1	09	04	H2944_114_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2944	114	0	1	09	04	H2944_114_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	114	0	1	09	04	H2944_114_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	114	0	1	09	04	H2944_114_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	124	0	1	09	04	H2944_124_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2944	124	0	1	09	04	H2944_124_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2944	124	0	1	09	04	H2944_124_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	124	0	1	09	04	H2944_124_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, 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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2944	127	0	1	09	04	H2944_127_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2944	127	0	1	09	04	H2944_127_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2944	127	0	1	09	04	H2944_127_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	2.00		6.00																									2.00		6.00				2.00		0.00				2.00				2.00		0.06				0.06	0.06	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	127	0	1	09	04	H2944_127_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	127	0	1	09	04	H2944_127_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	127	0	1	09	04	H2944_127_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	127	0	1	09	04	H2944_127_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2944	127	0	1	09	04	H2944_127_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	2.00		6.00																									2.00		6.00				2.00		0.00				2.00				2.00		0.06				0.06	0.06	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2944	127	0	1	09	04	H2944_127_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H2944	127	0	1	09	04	H2944_127_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2949	012	0	1	01	01	H2949_012_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	8.00		24.00																									8.00		24.00				8.00		0.00				8.00				8.00		0.26				0.26	0.26	0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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	2.00		6.00																									2.00		6.00				2.00		0.00				2.00				2.00		0.06				0.06	0.06	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2949	012	0	1	01	01	H2949_012_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	8.00		24.00																									8.00		24.00				8.00		0.00				8.00				8.00		0.26				0.26	0.26	0.25	Preferred Generic, 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	2.00		6.00																									2.00		6.00				2.00		0.00				2.00				2.00		0.06				0.06	0.06	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2949	013	0	1	01	01	H2949_013_0	5	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2949	013	0	1	01	01	H2949_013_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2949	013	0	1	01	01	H2949_013_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2949	013	0	1	01	01	H2949_013_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	80.00		240.00																									80.00		240.00				80.00		230.00				80.00				80.00		2.66				2.66	2.66	2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2949	013	0	1	01	01	H2949_013_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	40.00		120.00																									40.00		120.00				40.00		110.00				40.00				40.00		1.33				1.33	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2949	013	0	1	01	01	H2949_013_0	5	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2949	013	0	1	01	01	H2949_013_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2949	013	0	1	01	01	H2949_013_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	40.00		120.00																									40.00		120.00				40.00		110.00				40.00				40.00		1.33				1.33	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2949	013	0	1	01	01	H2949_013_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2949	013	0	1	01	01	H2949_013_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	80.00		240.00																									80.00		240.00				80.00		230.00				80.00				80.00		2.66				2.66	2.66	2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2949	014	0	1	01	01	H2949_014_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2949	014	0	1	01	01	H2949_014_0	5	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2949	014	0	1	01	01	H2949_014_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2949	014	0	1	01	01	H2949_014_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	80.00		240.00																									80.00		240.00				80.00		230.00				80.00				80.00		2.66				2.66	2.66	2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2949	014	0	1	01	01	H2949_014_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	40.00		120.00																									40.00		120.00				40.00		110.00				40.00				40.00		1.33				1.33	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2949	014	0	1	01	01	H2949_014_0	5	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2949	014	0	1	01	01	H2949_014_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	40.00		120.00																									40.00		120.00				40.00		110.00				40.00				40.00		1.33				1.33	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2949	014	0	1	01	01	H2949_014_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	80.00		240.00																									80.00		240.00				80.00		230.00				80.00				80.00		2.66				2.66	2.66	2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2949	014	0	1	01	01	H2949_014_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2949	014	0	1	01	01	H2949_014_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H2949	018	0	1	01	01	H2949_018_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2949	018	0	1	01	01	H2949_018_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2949	018	0	1	01	01	H2949_018_0	4	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2949	018	0	1	01	01	H2949_018_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2949	018	0	1	01	01	H2949_018_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2960	004	0	1	01	01	H2960_004_0	10	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	5.00		12.50																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2960	004	0	1	01	01	H2960_004_0	10	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	14.00		35.00																					28.00																14.00				14.00		0.47						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2960	004	0	1	01	01	H2960_004_0	10	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	45.00		112.50																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2960	004	0	1	01	01	H2960_004_0	10	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	95.00		237.50																					190.00																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2960	004	0	1	01	01	H2960_004_0	10	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2960	012	0	1	01	01	H2960_012_0	8	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	6.00		15.00																					12.00																6.00				6.00		0.20						0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2960	012	0	1	01	01	H2960_012_0	8	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	16.00		40.00																					32.00																16.00				16.00		0.53						0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2960	012	0	1	01	01	H2960_012_0	8	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	45.00		112.50																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2960	012	0	1	01	01	H2960_012_0	8	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	95.00		237.50																					190.00																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2960	012	0	1	01	01	H2960_012_0	8	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31				264.00	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2960	018	0	1	01	01	H2960_018_0	8	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	3.00		7.50																					6.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2960	018	0	1	01	01	H2960_018_0	8	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	12.00		30.00																					24.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2960	018	0	1	01	01	H2960_018_0	8	2	Generic	3	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	12.00		30.00																					24.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2960	018	0	1	01	01	H2960_018_0	8	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	3.00		7.50																					6.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2960	018	0	1	01	01	H2960_018_0	8	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31				264.00	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2960	018	0	1	01	01	H2960_018_0	8	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	95.00		237.50																					190.00																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2960	018	0	1	01	01	H2960_018_0	8	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	45.00		112.50																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2962	001	0	1	01	01	H2962_001_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2962	001	0	1	01	01	H2962_001_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2962	001	0	1	01	01	H2962_001_0	6	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31				738.74	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2962	001	0	1	01	01	H2962_001_0	6	4	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	60.00		180.00																					120.00																60.00				60.00		2.00						1.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2962	001	0	1	01	01	H2962_001_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	35.00		105.00																					70.00																35.00				35.00		1.17						1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2962	001	0	1	01	01	H2962_001_0	6	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	15.00		45.00																					30.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2962	001	0	1	01	01	H2962_001_0	6	2	Generic	3	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	15.00		45.00																					30.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2962	002	0	1	01	01	H2962_002_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2962	002	0	1	01	01	H2962_002_0	7	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	10.00		30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2962	002	0	1	01	01	H2962_002_0	7	2	Generic	3	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	10.00		30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2962	002	0	1	01	01	H2962_002_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2962	002	0	1	01	01	H2962_002_0	7	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31				570.70	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2962	002	0	1	01	01	H2962_002_0	7	4	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	50.00		150.00																					100.00																50.00				50.00		1.67						1.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2962	002	0	1	01	01	H2962_002_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	25.00		75.00																					50.00																25.00				25.00		0.83						0.81	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2962	003	0	1	01	01	H2962_003_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	35.00		105.00																					70.00																35.00				35.00		1.17						1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2962	003	0	1	01	01	H2962_003_0	7	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	15.00		45.00																					30.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2962	003	0	1	01	01	H2962_003_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2962	003	0	1	01	01	H2962_003_0	7	4	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	60.00		180.00																					120.00																60.00				60.00		2.00						1.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2962	003	0	1	01	01	H2962_003_0	7	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31				734.26	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2962	003	0	1	01	01	H2962_003_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2962	003	0	1	01	01	H2962_003_0	7	2	Generic	3	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	15.00		45.00																					30.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2962	004	0	1	01	01	H2962_004_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	25.00		75.00																					50.00																25.00				25.00		0.83						0.81	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2962	004	0	1	01	01	H2962_004_0	7	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	10.00		30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2962	004	0	1	01	01	H2962_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2962	004	0	1	01	01	H2962_004_0	7	4	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	50.00		150.00																					100.00																50.00				50.00		1.67						1.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2962	004	0	1	01	01	H2962_004_0	7	2	Generic	3	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	10.00		30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2962	004	0	1	01	01	H2962_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2962	004	0	1	01	01	H2962_004_0	7	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31				634.61	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2968	001	0	1	04	01	H2968_001_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2968	001	0	1	04	01	H2968_001_0	7	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2968	001	0	1	04	01	H2968_001_0	7	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2968	001	0	1	04	01	H2968_001_0	7	2	Generic	1	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	5.00	10.00	12.50																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2968	001	0	1	04	01	H2968_001_0	7	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	30	60	90				1			90				30		31	47.00	94.00	117.50																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2968	001	0	1	04	01	H2968_001_0	7	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	30	60	90				1			90				30		31	95.00	190.00	237.50																					190.00																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2968	001	0	1	04	01	H2968_001_0	7	2	Generic	3	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	5.00	10.00	12.50																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2986	001	0	1	01	01	H2986_001_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	34		90				1	34		90				34		34	2.00		6.00																			2.00		4.00																2.00				2.00		.06			.06			.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2986	001	0	1	01	01	H2986_001_0	5	2	Generic	1	4	000100	1	2	110		01	110		1	34		90				1	34		90				34		34	15.00		45.00																			15.00		30.00																15.00				15.00		.44			.44			.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2986	001	0	1	01	01	H2986_001_0	5	6	Select Diabetic Drugs	3	4	001001	1	2	110		01	110		1	34		90				1	34		90				34		34	2.00		6.00																			2.00		4.00																2.00				2.00		0.06			0.06			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs										1		
H2986	001	0	1	01	01	H2986_001_0	5	2	Generic	3	4	000100	1	2	110		01	110		1	34		90				1	34		90				34		34	15.00		45.00																			15.00		30.00																15.00				15.00		.44			.44			.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs										1		
H2986	001	0	1	01	01	H2986_001_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	34		90				1	34		90				34		34	2.00		6.00																			2.00		4.00																2.00				2.00		.06			.06			.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs										1		
H2986	001	0	1	01	01	H2986_001_0	5	6	Select Diabetic Drugs	1	4	001001	1	2	110		01	110		1	34		90				1	34		90				34		34	2.00		6.00																			2.00		4.00																2.00				2.00		0.06			0.06			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2986	001	0	1	01	01	H2986_001_0	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2986	001	0	1	01	01	H2986_001_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	34		90				1	34		90				34		34	100.00		300.00																			100.00		200.00																100.00				100.00		2.94			2.94			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2986	001	0	1	01	01	H2986_001_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	34		90				1	34		90				34		34	47.00		141.00																			47.00		94.00																47.00				47.00		1.38			1.38			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2986	002	0	1	01	01	H2986_002_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	34		90				1	34		90				34		34	2.00		6.00																			2.00		4.00																2.00				2.00		.06			.06			.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2986	002	0	1	01	01	H2986_002_0	5	2	Generic	3	4	000100	1	2	110		01	110		1	34		90				1	34		90				34		34	15.00		45.00																			15.00		30.00																15.00				15.00		.44			.44			.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs										1		
H2986	002	0	1	01	01	H2986_002_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	34		90				1	34		90				34		34	2.00		6.00																			2.00		4.00																2.00				2.00		0.06			0.06			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs										1		
H2986	002	0	1	01	01	H2986_002_0	5	6	Select Diabetic Drugs	1	4	001001	1	2	110		01	110		1	34		90				1	34		90				34		34	2.00		6.00																			2.00		4.00																2.00				2.00		0.06			0.06			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2986	002	0	1	01	01	H2986_002_0	5	6	Select Diabetic Drugs	3	4	001001	1	2	110		01	110		1	34		90				1	34		90				34		34	2.00		6.00																			2.00		4.00																2.00				2.00		0.06			0.06			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs										1		
H2986	002	0	1	01	01	H2986_002_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	34		90				1	34		90				34		34	100.00		300.00																			100.00		200.00																100.00				100.00		2.94			2.94			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2986	002	0	1	01	01	H2986_002_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	34		90				1	34		90				34		34	47.00		141.00																			47.00		94.00																47.00				47.00		1.38			1.38			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2986	002	0	1	01	01	H2986_002_0	5	2	Generic	1	4	000100	1	2	110		01	110		1	34		90				1	34		90				34		34	15.00		45.00																			15.00		30.00																15.00				15.00		.44			.44			.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2986	002	0	1	01	01	H2986_002_0	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H3018	001	0	1	48	05	H3018_001_0	5	2	Brand Drugs	1	4	000010			110		01	100		1	30		90				1			90				30		31																																														0.00						0.00	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			
H3018	001	0	1	48	05	H3018_001_0	5	3	Non-Medicare Rx Drugs	1	4	010010			110		01	100		1	30		90				1			90				30		31																																														0.00						0.00	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			
H3018	001	0	1	48	05	H3018_001_0	5	4	Non-Medicare OTC Drugs	1	4	010010			110		01	100		1	30		90				1			90				30		31																																														0.00						0.00	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			
H3018	001	0	1	48	05	H3018_001_0	5	1	Generic Drugs	1	4	010000			110		01	100		1	30		90				1			90				30		31																																														0.00						0.00	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			
H3054	001	0	1	01	01	H3054_001_0	5	4	Specialty Tier	1	2	010010	1	1	111		01	100		1	30	60	90				1			90				30		31				780.55	25	25	25																				25															25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3054	001	0	1	01	01	H3054_001_0	5	1	Generic	1	2	010000	1	2	111		01	100		1	30	60	90				1			90				30		31	5.75	11.50	17.25																					11.50																5.75				5.75		0.19						0.19	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3054	001	0	1	01	01	H3054_001_0	5	2	Preferred Brand	1	2	000001	1	2	111		01	100		1	30	60	90				1			90				30		31	45.00	90.00	135.00																					90.00																45.00				45.00		1.50						1.45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3054	001	0	1	01	01	H3054_001_0	5	3	Non-Preferred Brand	1	2	100000	1	2	111		01	100		1	30	60	90				1			90				30		31	95.00	190.00	285.00																					190.00																95.00				95.00		3.17						3.06	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3054	003	0	1	01	01	H3054_003_0	5	4	Specialty Tier	1	2	010010	1	1	111		01	100		1	30	60	90				1			90				30		31				780.55	25	25	25																				25															25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3054	003	0	1	01	01	H3054_003_0	5	3	Non-Preferred Brand	1	2	100000	1	2	111		01	100		1	30	60	90				1			90				30		31	95.00	190.00	285.00																					190.00																95.00				95.00		3.17						3.06	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3054	003	0	1	01	01	H3054_003_0	5	1	Generic	1	2	010000	1	2	111		01	100		1	30	60	90				1			90				30		31	5.75	11.50	17.25																					11.50																5.75				5.75		0.19						0.19	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3054	003	0	1	01	01	H3054_003_0	5	2	Preferred Brand	1	2	000001	1	2	111		01	100		1	30	60	90				1			90				30		31	45.00	90.00	135.00																					90.00																45.00				45.00		1.50						1.45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3067	001	0	1	48	05	H3067_001_0	3	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	7.40	0.00	7.40			0.00	7.40			
H3067	001	0	1	48	05	H3067_001_0	3	3	Non-Medicare Rx/OTC Drugs	1	4	100100			010		01			1	34													34		34																																														0.00						0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00			0.00	0.00			
H3067	001	0	1	48	05	H3067_001_0	3	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	2.95	0.00	2.95			0.00	2.95			
H3071	002	0	1	01	01	H3071_002_0	12	2	Generic	1	4	000101	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	10.00	20.00	30.00																			10.00	20.00	30.00																10.00				10.00		0.32			0.32			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3071	002	0	1	01	01	H3071_002_0	12	1	Preferred Generic	1	4	001001	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	3.00	1.00	1.00																			3.00	0.00	0.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3071	002	0	1	01	01	H3071_002_0	12	3	Preferred Brand	1	4	000101	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3071	002	0	1	01	01	H3071_002_0	12	4	Non-Preferred Brand	1	4	100100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.23			3.23			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3071	002	0	1	01	01	H3071_002_0	12	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	31	60	90				2	31	60	90				31		31				812.51	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3107	004	0	1	01	01	H3107_004_0	3	2	Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3107	004	0	1	01	01	H3107_004_0	3	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3107	004	0	1	01	01	H3107_004_0	3	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3107	004	0	1	01	01	H3107_004_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3107	004	0	1	01	01	H3107_004_0	3	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31				533.00	26		26																										26						26			26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3107	012	0	1	01	01	H3107_012_0	3	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3107	012	0	1	01	01	H3107_012_0	3	2	Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3107	012	0	1	01	01	H3107_012_0	3	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3107	012	0	1	01	01	H3107_012_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3107	012	0	1	01	01	H3107_012_0	3	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31				493.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3107	013	0	1	01	01	H3107_013_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3107	013	0	1	01	01	H3107_013_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3107	013	0	1	01	01	H3107_013_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3107	013	0	1	01	01	H3107_013_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				542.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3107	013	0	1	01	01	H3107_013_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3107	014	0	1	01	01	H3107_014_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3107	014	0	1	01	01	H3107_014_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3107	014	0	1	01	01	H3107_014_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3107	014	0	1	01	01	H3107_014_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3107	014	0	1	01	01	H3107_014_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				547.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3107	015	0	1	01	01	H3107_015_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3107	015	0	1	01	01	H3107_015_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3107	015	0	1	01	01	H3107_015_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3107	015	0	1	01	01	H3107_015_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3107	015	0	1	01	01	H3107_015_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				661.00	33		33																										33						33			33			33								Preferred Generic, 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	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3113	008	0	1	01	01	H3113_008_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, 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				444.00	30		30																										30						30			30			30								Preferred Generic, 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	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3113	008	0	1	01	01	H3113_008_0	3	2	Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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																																														0.00						0.00	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	3	Non-Medicare Rx/OTC Drugs	1	4	010010			010		01			1	30													30		31																																														0.00						0.00	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	2	Brand Drugs	1	4	000010			110		01	100		1	30		90				1			90				30		31																																														0.00						0.00	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	10	1	Generic	1	2	010000	1	1	110		01			1	30		90				2							30		34				8.84	25		25																																			25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3132	001	0	1	01	01	H3132_001_0	10	4	Specialty Tier	1	2	100000	1	1	010		01			1	30													30		34				348.23	25																																					25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3132	001	0	1	01	01	H3132_001_0	10	3	Non-Preferred Brand	1	2	100000	1	1	010		01			1	30													30		34				90.54	25																																					25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3132	001	0	1	01	01	H3132_001_0	10	2	Preferred Brand	1	2	000101	1	1	110		01			1	30		90				2							30		34				70.78	25		25																																			25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3152	022	0	1	01	01	H3152_022_0	6	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	117.50					47.00	94.00	117.50					47.00	94.00	117.50																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3152	022	0	1	01	01	H3152_022_0	6	4	Non-Preferred Brand	1	4	110000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								100.00	200.00	250.00					100.00	200.00	250.00					100.00	200.00	250.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3152	022	0	1	01	01	H3152_022_0	6	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	50.00					13.00	26.00	32.50					20.00	40.00	50.00																	20.00			20.00			0.67	0.43	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3152	022	0	1	01	01	H3152_022_0	6	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								15.00	30.00	37.50					0.00	0.00	0.00					15.00	30.00	37.50																	15.00			15.00			0.50	0.00	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3152	022	0	1	01	01	H3152_022_0	6	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31											1.00	27						1.00	27						27																		27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3152	046	0	1	01	01	H3152_046_0	4	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	25.00					0.00	0.00	0.00					10.00	20.00	25.00																	10.00			10.00			0.33	0.00	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3152	046	0	1	01	01	H3152_046_0	4	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								19.00	38.00	47.50					9.00	18.00	22.50					19.00	38.00	47.50																	19.00			19.00			0.63	0.30	0.63			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3152	046	0	1	01	01	H3152_046_0	4	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	117.50					47.00	94.00	117.50					47.00	94.00	117.50																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3152	046	0	1	01	01	H3152_046_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											52.41	50	50	50				51.26	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3152	046	0	1	01	01	H3152_046_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3152	048	0	1	01	01	H3152_048_0	6	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	50.00					9.00	18.00	22.50					20.00	40.00	50.00																	20.00			20.00			0.67	0.30	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3152	048	0	1	01	01	H3152_048_0	6	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								17.00	34.00	42.50					0.00	0.00	0.00					17.00	34.00	42.50																	17.00			17.00			0.57	0.00	0.57			0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3152	048	0	1	01	01	H3152_048_0	6	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	117.50					47.00	94.00	117.50					47.00	94.00	117.50																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3152	048	0	1	01	01	H3152_048_0	6	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31											1.00	29						1.00	29						29																		29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3152	048	0	1	01	01	H3152_048_0	6	4	Non-Preferred Brand	1	4	110000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								100.00	200.00	250.00					100.00	200.00	250.00					100.00	200.00	250.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3152	077	0	1	01	01	H3152_077_0	5	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	25.00					0.00	0.00	0.00					10.00	20.00	25.00																	10.00			10.00			0.33	0.00	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3152	077	0	1	01	01	H3152_077_0	5	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								18.00	36.00	45.00					8.00	16.00	20.00					18.00	36.00	45.00																	18.00			18.00			0.60	0.27	0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3152	077	0	1	01	01	H3152_077_0	5	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	117.50					47.00	94.00	117.50					47.00	94.00	117.50																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3152	077	0	1	01	01	H3152_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											43.92	50	50	50				40.44	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3152	077	0	1	01	01	H3152_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3152	080	0	1	01	01	H3152_080_0	4	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	25.00					0.00	0.00	0.00					10.00	20.00	25.00																	10.00			10.00			0.33	0.00	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3152	080	0	1	01	01	H3152_080_0	4	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								19.00	38.00	47.50					9.00	18.00	22.50					19.00	38.00	47.50																	19.00			19.00			0.63	0.30	0.63			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3152	080	0	1	01	01	H3152_080_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											37.19	50	50	50				35.69	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3152	080	0	1	01	01	H3152_080_0	4	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	117.50					47.00	94.00	117.50					47.00	94.00	117.50																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3152	080	0	1	01	01	H3152_080_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3152	082	0	1	01	01	H3152_082_0	5	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											38.41	50	50	50				36.31	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3152	082	0	1	01	01	H3152_082_0	5	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	117.50					47.00	94.00	117.50					47.00	94.00	117.50																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3152	082	0	1	01	01	H3152_082_0	5	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								19.00	38.00	47.50					9.00	18.00	22.50					19.00	38.00	47.50																	19.00			19.00			0.63	0.30	0.63			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3152	082	0	1	01	01	H3152_082_0	5	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	25.00					0.00	0.00	0.00					10.00	20.00	25.00																	10.00			10.00			0.33	0.00	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3152	082	0	1	01	01	H3152_082_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	004	0	1	01	01	H3154_004_0	9	4	Non-Preferred Brand	1	2	110000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								90.00	180.00	270.00					80.00	160.00	240.00					90.00	180.00	270.00																90.00				90.00			3.00	2.66	3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	004	0	1	01	01	H3154_004_0	9	3	Preferred Brand	1	2	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								45.00	90.00	135.00					40.00	80.00	120.00					45.00	90.00	135.00																45.00				45.00			1.50	1.33	1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	004	0	1	01	01	H3154_004_0	9	2	Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					10.00	20.00	30.00																20.00				20.00			0.66	0.50	0.33			0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	004	0	1	01	01	H3154_004_0	9	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								12.00	24.00	36.00					0.00	0.00	0.00					6.00	12.00	18.00																12.00				12.00			0.40	0.00	0.20			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	004	0	1	01	01	H3154_004_0	9	5	Specialty Tier	1	2	010010	1	1		010	01			1				30										30		31												25							25																							25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	022	0	1	01	01	H3154_022_0	9	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								12.00	24.00	36.00					0.00	0.00	0.00					6.00	12.00	18.00																12.00				12.00			0.40	0.00	0.20			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	022	0	1	01	01	H3154_022_0	9	2	Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					10.00	20.00	30.00																20.00				20.00			0.66	0.50	0.33			0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	022	0	1	01	01	H3154_022_0	9	3	Preferred Brand	1	2	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								45.00	90.00	135.00					40.00	80.00	120.00					45.00	90.00	135.00																45.00				45.00			1.50	1.33	1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	022	0	1	01	01	H3154_022_0	9	4	Non-Preferred Brand	1	2	110000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								90.00	180.00	270.00					80.00	160.00	240.00					90.00	180.00	270.00																90.00				90.00			3.00	2.66	3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	022	0	1	01	01	H3154_022_0	9	5	Specialty Tier	1	2	010010	1	1		010	01			1				30										30		31												25							25																							25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	024	0	1	01	01	H3154_024_0	5	4	Non-Preferred Brand	1	2	110000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								90.00	180.00	270.00					80.00	160.00	240.00					90.00	180.00	270.00																90.00				90.00			3.00	2.66	3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	024	0	1	01	01	H3154_024_0	5	3	Preferred Brand	1	2	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								45.00	90.00	135.00					40.00	80.00	120.00					45.00	90.00	135.00																45.00				45.00			1.50	1.33	1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	024	0	1	01	01	H3154_024_0	5	2	Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					10.00	20.00	30.00																20.00				20.00			0.66	0.50	0.33			0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	024	0	1	01	01	H3154_024_0	5	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								11.00	22.00	33.00					0.00	0.00	0.00					5.50	11.00	16.50																11.00				11.00			0.36	0.00	0.18			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	024	0	1	01	01	H3154_024_0	5	5	Specialty Tier	1	2	010010	1	1		010	01			1				30										30		31												25							25																							25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	026	0	1	01	01	H3154_026_0	6	2	Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					10.00	20.00	30.00																20.00				20.00			0.66	0.50	0.33			0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	026	0	1	01	01	H3154_026_0	6	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								11.00	22.00	33.00					0.00	0.00	0.00					5.50	11.00	16.50																11.00				11.00			0.36	0.00	0.18			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	026	0	1	01	01	H3154_026_0	6	3	Preferred Brand	1	2	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								45.00	90.00	135.00					40.00	80.00	120.00					45.00	90.00	135.00																45.00				45.00			1.50	1.33	1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	026	0	1	01	01	H3154_026_0	6	4	Non-Preferred Brand	1	2	110000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								90.00	180.00	270.00					80.00	160.00	240.00					90.00	180.00	270.00																90.00				90.00			3.00	2.66	3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	026	0	1	01	01	H3154_026_0	6	5	Specialty Tier	1	2	010010	1	1		010	01			1				30										30		31												25							25																							25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	027	0	1	01	01	H3154_027_0	6	2	Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					10.00	20.00	30.00																20.00				20.00			0.66	0.50	0.33			0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	027	0	1	01	01	H3154_027_0	6	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								11.00	22.00	33.00					0.00	0.00	0.00					5.50	11.00	16.50																11.00				11.00			0.36	0.00	0.18			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	027	0	1	01	01	H3154_027_0	6	3	Preferred Brand	1	2	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								45.00	90.00	135.00					40.00	80.00	120.00					45.00	90.00	135.00																45.00				45.00			1.50	1.33	1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	027	0	1	01	01	H3154_027_0	6	5	Specialty Tier	1	2	010010	1	1		010	01			1				30										30		31												25							25																							25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	027	0	1	01	01	H3154_027_0	6	4	Non-Preferred Brand	1	2	110000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								90.00	180.00	270.00					80.00	160.00	240.00					90.00	180.00	270.00																90.00				90.00			3.00	2.66	3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	028	0	1	01	01	H3154_028_0	6	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								11.00	22.00	33.00					0.00	0.00	0.00					5.50	11.00	16.50																11.00				11.00			0.36	0.00	0.18			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	028	0	1	01	01	H3154_028_0	6	2	Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					10.00	20.00	30.00																20.00				20.00			0.66	0.50	0.33			0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	028	0	1	01	01	H3154_028_0	6	4	Non-Preferred Brand	1	2	110000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								90.00	180.00	270.00					80.00	160.00	240.00					90.00	180.00	270.00																90.00				90.00			3.00	2.66	3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	028	0	1	01	01	H3154_028_0	6	3	Preferred Brand	1	2	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								45.00	90.00	135.00					40.00	80.00	120.00					45.00	90.00	135.00																45.00				45.00			1.50	1.33	1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	028	0	1	01	01	H3154_028_0	6	5	Specialty Tier	1	2	010010	1	1		010	01			1				30										30		31												25							25																							25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3156	030	0	1	01	01	H3156_030_0	4	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31				1.00	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3156	030	0	1	01	01	H3156_030_0	4	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3156	030	0	1	01	01	H3156_030_0	4	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	9.00	18.00	27.00																			9.00	18.00	18.00																9.00				9.00		0.30			0.30			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3156	030	0	1	01	01	H3156_030_0	4	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3156	030	0	1	01	01	H3156_030_0	4	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3156	034	0	1	01	01	H3156_034_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3156	034	0	1	01	01	H3156_034_0	5	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	9.00	18.00	27.00																			9.00	18.00	18.00																9.00				9.00		0.30			0.30			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3156	034	0	1	01	01	H3156_034_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3156	034	0	1	01	01	H3156_034_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3156	034	0	1	01	01	H3156_034_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31				1.00	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3156	036	0	1	01	01	H3156_036_0	3	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3156	036	0	1	01	01	H3156_036_0	3	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	9.00	18.00	27.00																			9.00	18.00	18.00																9.00				9.00		0.30			0.30			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3156	036	0	1	01	01	H3156_036_0	3	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3156	036	0	1	01	01	H3156_036_0	3	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3156	036	0	1	01	01	H3156_036_0	3	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31				1.00	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3204	001	0	1	01	01	H3204_001_0	6	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3204	001	0	1	01	01	H3204_001_0	6	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3204	001	0	1	01	01	H3204_001_0	6	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31				868.06	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3204	001	0	1	01	01	H3204_001_0	6	4	Non-Preferred Brand	1	4	100100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3204	001	0	1	01	01	H3204_001_0	6	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3204	007	0	1	01	01	H3204_007_0	6	2	Generic	3	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3204	007	0	1	01	01	H3204_007_0	6	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3204	007	0	1	01	01	H3204_007_0	6	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31				868.06	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3204	007	0	1	01	01	H3204_007_0	6	4	Non-Preferred Brand	1	4	100100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3204	007	0	1	01	01	H3204_007_0	6	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3204	007	0	1	01	01	H3204_007_0	6	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3204	007	0	1	01	01	H3204_007_0	6	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3206	001	0	1	04	01	H3206_001_0	7	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31				868.06	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3206	001	0	1	04	01	H3206_001_0	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3206	001	0	1	04	01	H3206_001_0	7	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3206	001	0	1	04	01	H3206_001_0	7	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3206	001	0	1	04	01	H3206_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	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3206	002	0	1	04	01	H3206_002_0	8	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31				868.06	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3206	002	0	1	04	01	H3206_002_0	8	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3206	002	0	1	04	01	H3206_002_0	8	2	Generic	3	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3206	002	0	1	04	01	H3206_002_0	8	4	Non-Preferred Brand	1	4	100100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3206	002	0	1	04	01	H3206_002_0	8	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3206	002	0	1	04	01	H3206_002_0	8	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3206	002	0	1	04	01	H3206_002_0	8	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3233	001	0	1	01	01	H3233_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	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3233	001	0	1	01	01	H3233_001_0	9	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3233	001	0	1	01	01	H3233_001_0	9	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	9.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3233	001	0	1	01	01	H3233_001_0	9	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	9.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3233	001	0	1	01	01	H3233_001_0	9	3	Preferred Brand	1	4	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3233	001	0	1	01	01	H3233_001_0	9	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	45.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3237	001	0	1	48	05	H3237_001_0	4	2	Brand Drugs	1	4	000010			111		01	111		1	30	60	90				1	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	7.40	0.00	7.40	0.00	7.40	0.00	7.40			
H3237	001	0	1	48	05	H3237_001_0	4	1	Generic Drugs	1	4	010000			111		01	111		1	30	60	90				1	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	2.95	0.00	2.95	0.00	2.95	0.00	2.95			
H3237	001	0	1	48	05	H3237_001_0	4	3	Non-Medicare Rx/OTC Drugs	1	4	010010			111		01	111		1	30	60	90				1	30	60	90				30		31																																														0.00			0.00			0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H3237	002	0	1	48	05	H3237_002_0	4	2	Brand Drugs	1	4	000010			111		01	111		1	30	60	90				1	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	7.40	0.00	7.40	0.00	7.40	0.00	7.40			
H3237	002	0	1	48	05	H3237_002_0	4	3	Non-Medicare Rx/OTC Drugs	1	4	010010			111		01	111		1	30	60	90				1	30	60	90				30		31																																														0.00			0.00			0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H3237	002	0	1	48	05	H3237_002_0	4	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	2.95	0.00	2.95	0.00	2.95	0.00	2.95			
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								90.00	180.00	270.00					85.00	170.00	255.00					85.00	255.00	255.00																90.00				90.00			3.00	2.83	2.83			2.65	Preferred Generic, 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								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3240	013	0	1	01	01	H3240_013_0	10	2	Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								1.00	2.00	3.00					1.00	2.00	3.00					1.00	3.00	3.00																1.00				1.00			0.03	0.03	0.03			0.03	Preferred Generic, 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								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, 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											648.78	25						648.78	25						25																	25			25								Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3240	016	0	1	01	01	H3240_016_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3240	016	0	1	01	01	H3240_016_0	10	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								96.00	192.00	288.00					91.00	182.00	273.00					91.00	273.00	273.00																96.00				96.00			3.20	3.03	3.03			2.82	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3240	016	0	1	01	01	H3240_016_0	10	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								45.00	90.00	135.00					45.00	90.00	135.00					45.00	135.00	135.00																45.00				45.00			1.50	1.50	1.50			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3240	016	0	1	01	01	H3240_016_0	10	2	Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								1.00	2.00	3.00					1.00	2.00	3.00					1.00	3.00	3.00																1.00				1.00			0.03	0.03	0.03			0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3240	016	0	1	01	01	H3240_016_0	10	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3240	016	0	1	01	01	H3240_016_0	10	5	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34											653.90	25						653.90	25						25																	25			25								Preferred Generic, 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	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3251	002	0	1	01	01	H3251_002_0	9	2	Generic	1	4	000110	1	2	110		01	100		1	30		90				1			90				30		31	6.00		18.00																					18.00																6.00				6.00		0.20						0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3251	002	0	1	01	01	H3251_002_0	9	3	Preferred Brand	1	4	010001	1	2	110		01	100		1	30		90				1			90				30		31	39.00		117.00																					117.00																39.00				39.00		1.30						1.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3251	002	0	1	01	01	H3251_002_0	9	4	Non-Preferred Brand	1	4	110000	1	2	110		01	100		1	30		90				1			90				30		31	85.00		255.00																					255.00																85.00				85.00		2.83						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3251	002	0	1	01	01	H3251_002_0	9	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31				1330.00	33		33																				33															33			33								Preferred Generic, 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	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3251	002	0	1	01	01	H3251_002_0	9	2	Generic	3	4	000110	1	2	110		01	100		1	30		90				1			90				30		31	6.00		18.00																					18.00																6.00				6.00		0.20						0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3251	021	0	1	02	01	H3251_021_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3251	021	0	1	02	01	H3251_021_0	9	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31				1330.00	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3251	021	0	1	02	01	H3251_021_0	9	1	Preferred Generic	1	4	001000	1	2	110		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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3251	021	0	1	02	01	H3251_021_0	9	2	Generic	1	4	000110	1	2	110		01	100		1	30		90				1			90				30		31	6.00		18.00																					18.00																6.00				6.00		0.20						0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3251	021	0	1	02	01	H3251_021_0	9	2	Generic	3	4	000110	1	2	110		01	100		1	30		90				1			90				30		31	6.00		18.00																					18.00																6.00				6.00		0.20						0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3251	021	0	1	02	01	H3251_021_0	9	4	Non-Preferred Brand	1	4	110000	1	2	110		01	100		1	30		90				1			90				30		31	85.00		255.00																					255.00																85.00				85.00		2.83						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3251	021	0	1	02	01	H3251_021_0	9	3	Preferred Brand	1	4	010001	1	2	110		01	100		1	30		90				1			90				30		31	39.00		117.00																					117.00																39.00				39.00		1.30						1.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3305	015	0	1	02	01	H3305_015_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3305	015	0	1	02	01	H3305_015_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3305	015	0	1	02	01	H3305_015_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3305	015	0	1	02	01	H3305_015_0	8	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				50.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3305	015	0	1	02	01	H3305_015_0	8	4	Non-Preferred Brand	1	4	100100	1	2	110		01	110		1	30		90				2	30		90				30		31	90.00		270.00																			90.00		180.00																90.00				90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3305	015	0	1	02	01	H3305_015_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3305	015	0	1	02	01	H3305_015_0	8	2	Generic	1	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		.33			.33			.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3305	015	0	1	02	01	H3305_015_0	8	3	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				2	30		90				30		31	35.00		105.00																			35.00		70.00																35.00				35.00		1.17			1.17			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3307	002	0	1	01	01	H3307_002_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3307	002	0	1	01	01	H3307_002_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				544.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3307	002	0	1	01	01	H3307_002_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3307	002	0	1	01	01	H3307_002_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3307	002	0	1	01	01	H3307_002_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3307	012	0	1	01	01	H3307_012_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				561.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3307	012	0	1	01	01	H3307_012_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3307	012	0	1	01	01	H3307_012_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3307	012	0	1	01	01	H3307_012_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3307	012	0	1	01	01	H3307_012_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3307	015	0	1	01	01	H3307_015_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	93.00		279.00																											279.00						269.00				93.00				93.00		3.10						3.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3307	015	0	1	01	01	H3307_015_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				478.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3307	015	0	1	01	01	H3307_015_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	43.00		129.00																											129.00						119.00				43.00				43.00		1.43						1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3307	015	0	1	01	01	H3307_015_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	13.00		39.00																											39.00						0.00				13.00				13.00		0.43						0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3307	015	0	1	01	01	H3307_015_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3307	023	0	1	01	01	H3307_023_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				573.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3307	023	0	1	01	01	H3307_023_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3307	023	0	1	01	01	H3307_023_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3307	023	0	1	01	01	H3307_023_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3307	023	0	1	01	01	H3307_023_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3307	024	0	1	01	01	H3307_024_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3307	024	0	1	01	01	H3307_024_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				647.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3307	024	0	1	01	01	H3307_024_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3307	024	0	1	01	01	H3307_024_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3307	024	0	1	01	01	H3307_024_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3307	025	0	1	01	01	H3307_025_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3307	025	0	1	01	01	H3307_025_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3307	025	0	1	01	01	H3307_025_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3307	025	0	1	01	01	H3307_025_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3307	025	0	1	01	01	H3307_025_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				561.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3312	002	0	1	01	01	H3312_002_0	3	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					10.00	20.00	30.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.33	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3312	002	0	1	01	01	H3312_002_0	3	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								17.00	34.00	51.00					3.00	6.00	9.00					17.00	34.00	51.00																	17.00			17.00			0.57	0.10	0.57			0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3312	002	0	1	01	01	H3312_002_0	3	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3312	002	0	1	01	01	H3312_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											46.12	50	50	50				45.16	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3312	002	0	1	01	01	H3312_002_0	3	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3312	018	0	1	01	01	H3312_018_0	7	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								9.00	18.00	27.00					2.00	4.00	6.00					9.00	18.00	27.00																	9.00			9.00			0.30	0.07	0.30			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3312	018	0	1	01	01	H3312_018_0	7	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								15.00	30.00	45.00					8.00	16.00	24.00					15.00	30.00	45.00																	15.00			15.00			0.50	0.27	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3312	018	0	1	01	01	H3312_018_0	7	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3312	018	0	1	01	01	H3312_018_0	7	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											61.05	50	50	50				60.91	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3312	018	0	1	01	01	H3312_018_0	7	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31											1.00	29						1.00	29						29																		29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3312	048	0	1	01	01	H3312_048_0	5	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					10.00	20.00	30.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.33	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3312	048	0	1	01	01	H3312_048_0	5	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								14.00	28.00	42.00					5.00	10.00	15.00					14.00	28.00	42.00																	14.00			14.00			0.47	0.17	0.47			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3312	048	0	1	01	01	H3312_048_0	5	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3312	048	0	1	01	01	H3312_048_0	5	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3312	048	0	1	01	01	H3312_048_0	5	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											44.52	50	50	50				42.20	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3312	060	0	1	01	01	H3312_060_0	3	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								11.00	22.00	33.00					4.00	8.00	12.00					11.00	22.00	33.00																	11.00			11.00			0.37	0.13	0.37			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3312	060	0	1	01	01	H3312_060_0	3	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								18.00	36.00	54.00					10.00	20.00	30.00					18.00	36.00	54.00																	18.00			18.00			0.60	0.33	0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3312	060	0	1	01	01	H3312_060_0	3	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3312	060	0	1	01	01	H3312_060_0	3	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											50.48	50	50	50				46.46	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3312	060	0	1	01	01	H3312_060_0	3	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31											1.00	29						1.00	29						29																		29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3312	061	0	1	01	01	H3312_061_0	3	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								12.00	24.00	36.00					2.00	4.00	6.00					12.00	24.00	36.00																	12.00			12.00			0.40	0.07	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3312	061	0	1	01	01	H3312_061_0	3	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								17.00	34.00	51.00					9.00	18.00	27.00					17.00	34.00	51.00																	17.00			17.00			0.57	0.30	0.57			0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3312	061	0	1	01	01	H3312_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											46.62	50	50	50				45.45	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3312	061	0	1	01	01	H3312_061_0	3	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3312	061	0	1	01	01	H3312_061_0	3	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3327	001	0	1	01	01	H3327_001_0	6	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	30	60	90				2			90				30		31	3.00	6.00	9.00																					7.50																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3327	001	0	1	01	01	H3327_001_0	6	2	Generic	1	4	000100	1	2	111		01	100		1	30	60	90				2			90				30		31	20.00	40.00	60.00																					50.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3327	001	0	1	01	01	H3327_001_0	6	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	30	60	90				2			90				30		31	47.00	94.00	141.00																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3327	001	0	1	01	01	H3327_001_0	6	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	30	60	90				2			90				30		31	100.00	200.00	300.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3327	001	0	1	01	01	H3327_001_0	6	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	30	60	90				2			90				30		31				1172.49	33	33	33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3327	002	0	1	01	01	H3327_002_0	6	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	30	60	90				2			90				30		31	3.00	6.00	9.00																					7.50																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3327	002	0	1	01	01	H3327_002_0	6	2	Generic	1	4	000100	1	2	111		01	100		1	30	60	90				2			90				30		31	15.00	30.00	45.00																					37.50																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3327	002	0	1	01	01	H3327_002_0	6	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	30	60	90				2			90				30		31	47.00	94.00	141.00																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3327	002	0	1	01	01	H3327_002_0	6	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	30	60	90				2			90				30		31	100.00	200.00	300.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3327	002	0	1	01	01	H3327_002_0	6	5	Specialty Tier	1	4	010010	1	1	111		01	100		1	30	60	90				2			90				30		31				1172.49	33	33	33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3328	002	0	1	01	01	H3328_002_0	7	5	Specialty Tier	1	2	010010	1	1	010		01	010		1	30							30						30		34				521.81	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3328	002	0	1	01	01	H3328_002_0	7	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3328	002	0	1	01	01	H3328_002_0	7	2	Generic	1	2	000100	1	2	110		01	100		1	30		90				1			90				30		34	20.00		60.00																					40.00																20.00				20.00		0.67						0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3328	002	0	1	01	01	H3328_002_0	7	3	Preferred Brand	1	2	000001	1	2	110		01	100		1	30		90				1			90				30		34	47.00		141.00																					94.00																47.00				47.00		1.57						1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3328	002	0	1	01	01	H3328_002_0	7	4	Non-Preferred Brand	1	2	100000	1	2	110		01	100		1	30		90				1			90				30		34	100.00		300.00																					200.00																100.00				100.00		3.33						2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3328	003	0	1	02	01	H3328_003_0	8	5	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		34				641.79	27																				27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3328	003	0	1	02	01	H3328_003_0	8	4	Non-Preferred Brand	1	3	100000	1	2	110		01	100		1	30		90				1			90				30		34	100.00		300.00																					200.00																100.00				100.00		3.33						2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3328	003	0	1	02	01	H3328_003_0	8	3	Preferred Brand	1	3	000001	1	2	110		01	100		1	30		90				1			90				30		34	35.00		105.00																					70.00																35.00				35.00		1.17						1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3328	003	0	1	02	01	H3328_003_0	8	2	Generic	1	3	000100	1	2	110		01	100		1	30		90				1			90				30		34	15.00		45.00																					30.00																15.00				15.00		0.50						0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3328	003	0	1	02	01	H3328_003_0	8	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3328	016	0	1	01	01	H3328_016_0	7	4	Non-Preferred Brand	1	2	100000	1	2	110		01	100		1	30		90				1			90				30		34	100.00		300.00																					200.00																100.00				100.00		3.33						2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3328	016	0	1	01	01	H3328_016_0	7	5	Specialty Tier	1	2	010010	1	1	010		01	010		1	30							30						30		34				714.27	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3328	016	0	1	01	01	H3328_016_0	7	3	Preferred Brand	1	2	000001	1	2	110		01	100		1	30		90				1			90				30		34	47.00		141.00																					94.00																47.00				47.00		1.57						1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3328	016	0	1	01	01	H3328_016_0	7	2	Generic	1	2	000100	1	2	110		01	100		1	30		90				1			90				30		34	16.00		48.00																					32.00																16.00				16.00		0.53						0.47	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3328	016	0	1	01	01	H3328_016_0	7	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3328	017	0	1	01	01	H3328_017_0	6	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3328	017	0	1	01	01	H3328_017_0	6	3	Preferred Brand	1	3	000001	1	2	110		01	100		1	30		90				1			90				30		34	47.00		141.00																					94.00																47.00				47.00		1.57						1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3328	017	0	1	01	01	H3328_017_0	6	4	Non-Preferred Brand	1	3	100000	1	2	110		01	100		1	30		90				1			90				30		34	100.00		300.00																					200.00																100.00				100.00		3.33						2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3328	017	0	1	01	01	H3328_017_0	6	5	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		34				613.34	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3328	017	0	1	01	01	H3328_017_0	6	2	Generic	1	3	000100	1	2	110		01	100		1	30		90				1			90				30		34	20.00		60.00																					40.00																20.00				20.00		0.67						0.59	Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3328	019	0	1	01	01	H3328_019_0	9	2	Generic	1	3	000100	1	2	110		01	100		1	30		90				1			90				30		34	20.00		60.00																					40.00																20.00				20.00		0.67						0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	47.00		141.00																					94.00																47.00				47.00		1.57						1.38	Preferred Generic, 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				924.90	33																				33																	33			33								Preferred Generic, 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	100.00		300.00																					200.00																100.00				100.00		3.33						2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	021	1	1	01	01	H3330_021_1	6	4	Non-Preferred Brand	1	3	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	021	1	1	01	01	H3330_021_1	6	3	Preferred Brand	1	3	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	021	1	1	01	01	H3330_021_1	6	2	Generic	1	3	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	45.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	021	1	1	01	01	H3330_021_1	6	1	Preferred Generic	1	3	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	021	1	1	01	01	H3330_021_1	6	5	Specialty Tier	1	3	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31				742.50	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	021	2	1	01	01	H3330_021_2	6	4	Non-Preferred Brand	1	3	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	021	2	1	01	01	H3330_021_2	6	3	Preferred Brand	1	3	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	021	2	1	01	01	H3330_021_2	6	2	Generic	1	3	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	45.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	021	2	1	01	01	H3330_021_2	6	1	Preferred Generic	1	3	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	021	2	1	01	01	H3330_021_2	6	5	Specialty Tier	1	3	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31				742.50	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	021	3	1	01	01	H3330_021_3	6	1	Preferred Generic	1	3	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	021	3	1	01	01	H3330_021_3	6	2	Generic	1	3	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	45.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	021	3	1	01	01	H3330_021_3	6	3	Preferred Brand	1	3	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	021	3	1	01	01	H3330_021_3	6	4	Non-Preferred Brand	1	3	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	021	3	1	01	01	H3330_021_3	6	5	Specialty Tier	1	3	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31				742.50	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	021	4	1	01	01	H3330_021_4	6	1	Preferred Generic	1	3	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	021	4	1	01	01	H3330_021_4	6	2	Generic	1	3	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	45.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	021	4	1	01	01	H3330_021_4	6	3	Preferred Brand	1	3	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	021	4	1	01	01	H3330_021_4	6	4	Non-Preferred Brand	1	3	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	021	4	1	01	01	H3330_021_4	6	5	Specialty Tier	1	3	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31				742.50	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	029	0	1	01	01	H3330_029_0	7	4	Non-Preferred Brand	1	2	100000	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31				91.66	30	30	30																		30	30	30															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	029	0	1	01	01	H3330_029_0	7	5	Specialty Tier	1	2	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31				732.58	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	029	0	1	01	01	H3330_029_0	7	1	Preferred Generic	1	2	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	6.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	029	0	1	01	01	H3330_029_0	7	2	Generic	1	2	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	9.00	18.00	27.00																			9.00	18.00	27.00																9.00				9.00		0.30			0.30			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	029	0	1	01	01	H3330_029_0	7	3	Preferred Brand	1	2	000001	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31				54.27	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	032	1	1	01	01	H3330_032_1	9	3	Preferred Brand	1	3	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	032	1	1	01	01	H3330_032_1	9	4	Non-Preferred Brand	1	3	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	032	1	1	01	01	H3330_032_1	9	2	Generic	1	3	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	45.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	032	1	1	01	01	H3330_032_1	9	1	Preferred Generic	1	3	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	032	1	1	01	01	H3330_032_1	9	5	Specialty Tier	1	3	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31				816.43	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	032	2	1	01	01	H3330_032_2	9	2	Generic	1	3	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	45.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	032	2	1	01	01	H3330_032_2	9	1	Preferred Generic	1	3	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	032	2	1	01	01	H3330_032_2	9	3	Preferred Brand	1	3	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	032	2	1	01	01	H3330_032_2	9	5	Specialty Tier	1	3	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31				816.43	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	032	2	1	01	01	H3330_032_2	9	4	Non-Preferred Brand	1	3	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	032	3	1	01	01	H3330_032_3	9	1	Preferred Generic	1	3	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	032	3	1	01	01	H3330_032_3	9	2	Generic	1	3	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	45.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	032	3	1	01	01	H3330_032_3	9	4	Non-Preferred Brand	1	3	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	032	3	1	01	01	H3330_032_3	9	3	Preferred Brand	1	3	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	032	3	1	01	01	H3330_032_3	9	5	Specialty Tier	1	3	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31				816.43	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	032	4	1	01	01	H3330_032_4	8	4	Non-Preferred Brand	1	3	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	032	4	1	01	01	H3330_032_4	8	3	Preferred Brand	1	3	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	032	4	1	01	01	H3330_032_4	8	2	Generic	1	3	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	45.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	032	4	1	01	01	H3330_032_4	8	1	Preferred Generic	1	3	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	032	4	1	01	01	H3330_032_4	8	5	Specialty Tier	1	3	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31				816.43	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	033	1	1	01	01	H3330_033_1	6	4	Non-Preferred Brand	1	3	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	033	1	1	01	01	H3330_033_1	6	3	Preferred Brand	1	3	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	033	1	1	01	01	H3330_033_1	6	2	Generic	1	3	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	45.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	033	1	1	01	01	H3330_033_1	6	1	Preferred Generic	1	3	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	033	1	1	01	01	H3330_033_1	6	5	Specialty Tier	1	3	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31				618.58	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	033	2	1	01	01	H3330_033_2	6	4	Non-Preferred Brand	1	3	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	033	2	1	01	01	H3330_033_2	6	3	Preferred Brand	1	3	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	033	2	1	01	01	H3330_033_2	6	2	Generic	1	3	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	45.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	033	2	1	01	01	H3330_033_2	6	1	Preferred Generic	1	3	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	033	2	1	01	01	H3330_033_2	6	5	Specialty Tier	1	3	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31				618.58	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	033	3	1	01	01	H3330_033_3	6	1	Preferred Generic	1	3	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	033	3	1	01	01	H3330_033_3	6	2	Generic	1	3	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	45.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	033	3	1	01	01	H3330_033_3	6	3	Preferred Brand	1	3	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	033	3	1	01	01	H3330_033_3	6	4	Non-Preferred Brand	1	3	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	033	3	1	01	01	H3330_033_3	6	5	Specialty Tier	1	3	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31				618.58	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	033	4	1	01	01	H3330_033_4	6	1	Preferred Generic	1	3	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	033	4	1	01	01	H3330_033_4	6	2	Generic	1	3	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	45.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	033	4	1	01	01	H3330_033_4	6	3	Preferred Brand	1	3	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	033	4	1	01	01	H3330_033_4	6	4	Non-Preferred Brand	1	3	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3330	033	4	1	01	01	H3330_033_4	6	5	Specialty Tier	1	3	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31				618.58	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	005	0	1	04	01	H3335_005_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	2.00		5.00																					5.00																2.00				2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	005	0	1	04	01	H3335_005_0	6	2	Generic	1	4	000100	3	2	110		01	100		1	30		90				1			90				30		31	8.00		20.00																					20.00																8.00				8.00		0.27						0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	005	0	1	04	01	H3335_005_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	45.00		112.50																					112.50																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	005	0	1	04	01	H3335_005_0	6	4	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	95.00		237.50																					237.50																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	005	0	1	04	01	H3335_005_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	006	0	1	04	01	H3335_006_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	2.00		5.00																					5.00																2.00				2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	006	0	1	04	01	H3335_006_0	6	2	Generic	1	4	000100	3	2	110		01	100		1	30		90				1			90				30		31	8.00		20.00																					20.00																8.00				8.00		0.27						0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	006	0	1	04	01	H3335_006_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	45.00		112.50																					112.50																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	006	0	1	04	01	H3335_006_0	6	4	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	95.00		237.50																					237.50																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	006	0	1	04	01	H3335_006_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	014	0	1	04	01	H3335_014_0	6	2	Generic	1	4	000100	3	2	110		01	100		1	30		90				1			90				30		31	8.00		20.00																					20.00																8.00				8.00		0.27						0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	014	0	1	04	01	H3335_014_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	45.00		112.50																					112.50																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	014	0	1	04	01	H3335_014_0	6	4	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	95.00		237.50																					237.50																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	014	0	1	04	01	H3335_014_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	014	0	1	04	01	H3335_014_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	2.00		5.00																					5.00																2.00				2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	015	0	1	04	01	H3335_015_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	45.00		112.50																					112.50																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	015	0	1	04	01	H3335_015_0	6	2	Generic	1	4	000100	3	2	110		01	100		1	30		90				1			90				30		31	8.00		20.00																					20.00																8.00				8.00		0.27						0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	015	0	1	04	01	H3335_015_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	2.00		5.00																					5.00																2.00				2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	015	0	1	04	01	H3335_015_0	6	4	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	95.00		237.50																					237.50																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	015	0	1	04	01	H3335_015_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	018	0	1	04	01	H3335_018_0	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	018	0	1	04	01	H3335_018_0	5	4	Non-Preferred Brand	1	3	100000	1	2	110		01	100		1	30		90				1			90				30		31	95.00		237.50																					237.50																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	018	0	1	04	01	H3335_018_0	5	3	Preferred Brand	1	3	000001	1	2	110		01	100		1	30		90				1			90				30		31	45.00		112.50																					112.50																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	018	0	1	04	01	H3335_018_0	5	2	Generic	1	3	000100	1	2	110		01	100		1	30		90				1			90				30		31	20.00		50.00																					50.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	018	0	1	04	01	H3335_018_0	5	1	Preferred Generic	1	3	001000	1	2	110		01	100		1	30		90				1			90				30		31	4.00		10.00																					10.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	038	0	1	04	01	H3335_038_0	6	4	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	95.00		237.50																					237.50																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	038	0	1	04	01	H3335_038_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	45.00		112.50																					112.50																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	038	0	1	04	01	H3335_038_0	6	2	Generic	1	4	000100	3	2	110		01	100		1	30		90				1			90				30		31	8.00		20.00																					20.00																8.00				8.00		0.27						0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	038	0	1	04	01	H3335_038_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	3.00		7.50																					7.50																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	038	0	1	04	01	H3335_038_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	051	0	1	04	01	H3335_051_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	051	0	1	04	01	H3335_051_0	6	4	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	95.00		237.50																					237.50																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	051	0	1	04	01	H3335_051_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	45.00		112.50																					112.50																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	051	0	1	04	01	H3335_051_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	3.00		7.50																					7.50																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	051	0	1	04	01	H3335_051_0	6	2	Generic	1	4	000100	3	2	110		01	100		1	30		90				1			90				30		31	8.00		20.00																					20.00																8.00				8.00		0.27						0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	053	0	1	04	01	H3335_053_0	7	2	Generic	1	4	000100	3	2	110		01	100		1	30		90				1			90				30		31	12.00		30.00																					30.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	053	0	1	04	01	H3335_053_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	4.00		10.00																					10.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	053	0	1	04	01	H3335_053_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	47.00		117.50																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	053	0	1	04	01	H3335_053_0	7	4	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	100.00		250.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	053	0	1	04	01	H3335_053_0	7	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31				1.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	054	0	1	04	01	H3335_054_0	6	2	Generic	1	4	000100	3	2	110		01	100		1	30		90				1			90				30		31	12.00		30.00																					30.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	054	0	1	04	01	H3335_054_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	47.00		117.50																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	054	0	1	04	01	H3335_054_0	6	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31				1.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	054	0	1	04	01	H3335_054_0	6	4	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	100.00		250.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3335	054	0	1	04	01	H3335_054_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	4.00		10.00																					10.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3337	001	0	1	01	01	H3337_001_0	9	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3337	001	0	1	01	01	H3337_001_0	9	2	Generic	1	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	10.00		30.00																					30.00																10.00				10.00		0.32						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3337	001	0	1	01	01	H3337_001_0	9	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	31		90				1			90				31		31	45.00		135.00																					135.00																45.00				45.00		1.45						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3337	001	0	1	01	01	H3337_001_0	9	2	Generic	3	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	10.00		30.00																					30.00																10.00				10.00		0.32						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3337	001	0	1	01	01	H3337_001_0	9	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31				467.89	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3337	001	0	1	01	01	H3337_001_0	9	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3337	001	0	1	01	01	H3337_001_0	9	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	31		90				2			90				31		31	85.00		255.00																					255.00																85.00				85.00		2.74						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3342	019	0	1	04	01	H3342_019_0	9	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3342	019	0	1	04	01	H3342_019_0	9	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3342	019	0	1	04	01	H3342_019_0	9	2	Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3342	019	0	1	04	01	H3342_019_0	9	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00	9.00	9.00																8.00				8.00			0.27	0.10	0.10			0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3342	019	0	1	04	01	H3342_019_0	9	5	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34											1386.49	27						1386.49	27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3342	019	0	1	04	01	H3342_019_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3344	005	0	1	04	01	H3344_005_0	7	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		34	90.00		225.00																					225.00																90.00				90.00		3.00						2.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3344	005	0	1	04	01	H3344_005_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		34	45.00		112.50																					112.50																45.00				45.00		1.50						1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3344	005	0	1	04	01	H3344_005_0	7	2	Generic	1	4	001100	1	2	110		01	100		1	30		90				2			90				30		34	12.00		30.00																					30.00																12.00				12.00		0.40						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3344	005	0	1	04	01	H3344_005_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		34	4.00		10.00																					10.00																4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3344	005	0	1	04	01	H3344_005_0	7	5	Specialty Tier	1	4	101101	1	1	010		01			1	30													30		34					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3344	005	0	1	04	01	H3344_005_0	7	2	Generic	3	4	001100	1	2	110		01	100		1	30		90				2			90				30		34	12.00		30.00																					30.00																12.00				12.00		0.40						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H3347	012	0	1	01	01	H3347_012_0	13	1	Preferred Generic	1	2	001000	1	2	110		01	100		1	30		90				2			90				30		31	5.00		15.00																					12.50																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3347	012	0	1	01	01	H3347_012_0	13	2	Generic	1	2	000100	1	2	110		01	100		1	30		90				2			90				30		31	15.00		45.00																					37.50																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3347	012	0	1	01	01	H3347_012_0	13	3	Preferred Brand	1	2	000101	1	2	110		01	100		1	30		90				2			90				30		31	47.00		141.00																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3347	012	0	1	01	01	H3347_012_0	13	4	Non-Preferred Brand	1	2	100100	1	2	110		01	100		1	30		90				2			90				30		31	100.00		300.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3347	012	0	1	01	01	H3347_012_0	13	5	Specialty Tier	1	2	000110	1	1	110		01	100		1	30		90				2			90				30		31				914.53	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3347	013	0	1	02	01	H3347_013_0	16	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3347	013	0	1	02	01	H3347_013_0	16	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	12.00		36.00																					30.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3347	013	0	1	02	01	H3347_013_0	16	3	Preferred Brand	1	4	000101	1	2	110		01	100		1	30		90				2			90				30		31	47.00		141.00																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3347	013	0	1	02	01	H3347_013_0	16	4	Non-Preferred Brand	1	4	100100	1	2	110		01	100		1	30		90				2			90				30		31	100.00		300.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3347	013	0	1	02	01	H3347_013_0	16	5	Specialty Tier	1	4	000110	1	1	110		01	100		1	30		90				2			90				30		31				1124.26	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	002	0	1	02	01	H3351_002_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	3.00		7.50																					7.50																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	002	0	1	02	01	H3351_002_0	6	2	Generic	1	4	000100	3	2	110		01	100		1	30		90				1			90				30		31	8.00		20.00																					20.00																8.00				8.00		0.27						0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	002	0	1	02	01	H3351_002_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	002	0	1	02	01	H3351_002_0	6	4	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	100.00		250.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	002	0	1	02	01	H3351_002_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	47.00		117.50																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	006	0	1	02	01	H3351_006_0	6	4	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	100.00		250.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	006	0	1	02	01	H3351_006_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	47.00		117.50																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	006	0	1	02	01	H3351_006_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	006	0	1	02	01	H3351_006_0	6	2	Generic	1	4	000100	3	2	110		01	100		1	30		90				1			90				30		31	8.00		20.00																					20.00																8.00				8.00		0.27						0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	006	0	1	02	01	H3351_006_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	3.00		7.50																					7.50																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	010	0	1	01	01	H3351_010_0	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	010	0	1	01	01	H3351_010_0	5	2	Generic	1	4	000100	3	2	110		01	100		1	30		90				1			90				30		31	8.00		20.00																					20.00																8.00				8.00		0.27						0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	010	0	1	01	01	H3351_010_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	4.00		10.00																					10.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	010	0	1	01	01	H3351_010_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	47.00		117.50																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	010	0	1	01	01	H3351_010_0	5	4	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	100.00		250.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	011	0	1	01	01	H3351_011_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	4.00		10.00																					10.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	011	0	1	01	01	H3351_011_0	5	2	Generic	1	4	000100	3	2	110		01	100		1	30		90				1			90				30		31	12.00		30.00																					30.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	011	0	1	01	01	H3351_011_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	47.00		117.50																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	011	0	1	01	01	H3351_011_0	5	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31				1.00	28		28																				28															28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	011	0	1	01	01	H3351_011_0	5	4	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	100.00		250.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	012	0	1	01	01	H3351_012_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	4.00		10.00																					10.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	012	0	1	01	01	H3351_012_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	47.00		117.50																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	012	0	1	01	01	H3351_012_0	5	2	Generic	1	4	000100	3	2	110		01	100		1	30		90				1			90				30		31	8.00		20.00																					20.00																8.00				8.00		0.27						0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	012	0	1	01	01	H3351_012_0	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	012	0	1	01	01	H3351_012_0	5	4	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	100.00		250.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	013	0	1	01	01	H3351_013_0	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	013	0	1	01	01	H3351_013_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	4.00		10.00																					10.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	013	0	1	01	01	H3351_013_0	5	4	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	100.00		250.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	013	0	1	01	01	H3351_013_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	47.00		117.50																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	013	0	1	01	01	H3351_013_0	5	2	Generic	1	4	000100	3	2	110		01	100		1	30		90				1			90				30		31	12.00		30.00																					30.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	015	0	1	02	01	H3351_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	015	0	1	02	01	H3351_015_0	7	2	Generic	1	4	000100	3	2	110		01	100		1	30		90				1			90				30		31	8.00		20.00																					20.00																8.00				8.00		0.27						0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	015	0	1	02	01	H3351_015_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	45.00		112.50																					112.50																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	015	0	1	02	01	H3351_015_0	7	4	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	95.00		237.50																					237.50																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	015	0	1	02	01	H3351_015_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	4.00		10.00																					10.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	016	0	1	02	01	H3351_016_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	4.00		10.00																					10.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	016	0	1	02	01	H3351_016_0	6	4	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	100.00		250.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	016	0	1	02	01	H3351_016_0	6	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31				1.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	016	0	1	02	01	H3351_016_0	6	2	Generic	1	4	000100	3	2	110		01	100		1	30		90				1			90				30		31	12.00		30.00																					30.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	016	0	1	02	01	H3351_016_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	47.00		117.50																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	017	0	1	01	01	H3351_017_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	47.00		117.50																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	017	0	1	01	01	H3351_017_0	5	2	Generic	1	4	000100	3	2	110		01	100		1	30		90				1			90				30		31	12.00		30.00																					30.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	017	0	1	01	01	H3351_017_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	4.00		10.00																					10.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	017	0	1	01	01	H3351_017_0	5	4	Non-Preferred Brand	1	4	100000	3	2	110		01	100		1	30		90				1			90				30		31	100.00		250.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3351	017	0	1	01	01	H3351_017_0	5	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31				1.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3359	001	0	1	01	01	H3359_001_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3359	001	0	1	01	01	H3359_001_0	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	95.00		285.00																					238.00																95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3359	001	0	1	01	01	H3359_001_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	45.00		135.00																					113.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3359	001	0	1	01	01	H3359_001_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3359	001	0	1	01	01	H3359_001_0	6	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	10.00		30.00																					25.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3359	036	0	1	01	01	H3359_036_0	9	3	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	90.00		270.00																					225.00																90.00				90.00		3.00						2.90	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3359	036	0	1	01	01	H3359_036_0	9	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												
H3359	036	0	1	01	01	H3359_036_0	9	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	45.00		135.00																					113.00																45.00				45.00		1.50						1.45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3359	036	0	1	01	01	H3359_036_0	9	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												
H3361	043	0	1	01	01	H3361_043_0	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	043	0	1	01	01	H3361_043_0	5	2	Generic	1	3	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		37.50				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	043	0	1	01	01	H3361_043_0	5	3	Preferred Brand	1	3	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	043	0	1	01	01	H3361_043_0	5	4	Non-Preferred Brand	1	3	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				77.50	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	043	0	1	01	01	H3361_043_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	065	0	1	01	01	H3361_065_0	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	065	0	1	01	01	H3361_065_0	4	2	Generic	1	3	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		25.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	065	0	1	01	01	H3361_065_0	4	3	Preferred Brand	1	3	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	46.00		138.00																									46.00		138.00				46.00		115.00				46.00				46.00		1.53				1.53	1.53	1.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	065	0	1	01	01	H3361_065_0	4	4	Non-Preferred Brand	1	3	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				82.20	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	065	0	1	01	01	H3361_065_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	099	0	1	01	01	H3361_099_0	5	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		37.50				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	099	0	1	01	01	H3361_099_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		110	1	30		90				1				30		90	30		31	3.00		9.00																									3.00		9.00				3.00		0.00				3.00				3.00		0.10				0.10	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	099	0	1	01	01	H3361_099_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	099	0	1	01	01	H3361_099_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	099	0	1	01	01	H3361_099_0	5	4	Non-Preferred Brand	1	4	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				62.90	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	106	0	1	02	01	H3361_106_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		110	1	30		90				1				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	106	0	1	02	01	H3361_106_0	5	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		37.50				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	106	0	1	02	01	H3361_106_0	5	4	Non-Preferred Brand	1	4	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				57.90	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	106	0	1	02	01	H3361_106_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	106	0	1	02	01	H3361_106_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	109	0	1	01	01	H3361_109_0	4	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	109	0	1	01	01	H3361_109_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	109	0	1	01	01	H3361_109_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	109	0	1	01	01	H3361_109_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	109	0	1	01	01	H3361_109_0	4	4	Non-Preferred Brand	1	4	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				82.60	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	130	0	1	01	01	H3361_130_0	4	2	Generic	1	2	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		17.50				7.00				7.00		0.23				0.23	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	130	0	1	01	01	H3361_130_0	4	1	Preferred Generic	1	2	001000	1	2	110		01		110	1	30		90				1				30		90	30		31	2.00		6.00																									2.00		6.00				2.00		0.00				2.00				2.00		0.07				0.07	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	130	0	1	01	01	H3361_130_0	4	3	Preferred Brand	1	2	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	36.00		108.00																									36.00		108.00				36.00		90.00				36.00				36.00		1.20				1.20	1.20	1.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	130	0	1	01	01	H3361_130_0	4	4	Non-Preferred Brand	1	2	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				62.90	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	130	0	1	01	01	H3361_130_0	4	5	Specialty Tier	1	2	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	132	0	1	01	01	H3361_132_0	5	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		37.50				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	132	0	1	01	01	H3361_132_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		110	1	30		90				1				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	132	0	1	01	01	H3361_132_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	132	0	1	01	01	H3361_132_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	132	0	1	01	01	H3361_132_0	5	4	Non-Preferred Brand	1	4	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				59.20	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	133	0	1	01	01	H3361_133_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		110	1	30		90				1				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	133	0	1	01	01	H3361_133_0	5	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		37.50				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	133	0	1	01	01	H3361_133_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	133	0	1	01	01	H3361_133_0	5	4	Non-Preferred Brand	1	4	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				67.10	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	133	0	1	01	01	H3361_133_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3362	017	0	1	02	01	H3362_017_0	6	2	Generic	1	4	001100	1	2	110		01	100		1	30		90				2			90				30		34	10.00		25.00																					25.00																10.00				10.00		0.33						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3362	017	0	1	02	01	H3362_017_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		34	47.00		117.50																					117.50																47.00				47.00		1.57						1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3362	017	0	1	02	01	H3362_017_0	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		34	75.00		187.50																					187.50																75.00				75.00		2.50						2.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3362	017	0	1	02	01	H3362_017_0	6	5	Specialty Tier	1	4	101101	1	1	010		01			1	30													30		34					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3362	017	0	1	02	01	H3362_017_0	6	2	Generic	3	4	001100	1	2	110		01	100		1	30		90				2			90				30		34	10.00		25.00																					25.00																10.00				10.00		0.33						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
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	4.00		10.00																					10.00																4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3362	020	0	1	01	01	H3362_020_0	5	5	Specialty Tier	1	4	101101	1	1	010		01			1	30													30		34					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3362	020	0	1	01	01	H3362_020_0	5	4	Non-Preferred Brand	1	4	100000	1	1	110		01	100		1	30		90				2			90				30		34				42.34	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3362	020	0	1	01	01	H3362_020_0	5	3	Preferred Brand	1	4	000001	1	1	110		01	100		1	30		90				2			90				30		34				71.33	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3362	020	0	1	01	01	H3362_020_0	5	2	Generic	1	4	001100	1	2	110		01	100		1	30		90				2			90				30		34	15.00		37.50																					37.50																15.00				15.00		0.50						0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3362	020	0	1	01	01	H3362_020_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		34	4.00		10.00																					10.00																4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3362	020	0	1	01	01	H3362_020_0	5	2	Generic	3	4	001100	1	2	110		01	100		1	30		90				2			90				30		34	15.00		37.50																					37.50																15.00				15.00		0.50						0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H3362	026	0	1	02	01	H3362_026_0	5	5	Specialty Tier	1	4	101101	1	1	010		01			1	30													30		34					29																																					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3362	026	0	1	02	01	H3362_026_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		34	100.00		250.00																					250.00																100.00				100.00		3.33						2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3362	026	0	1	02	01	H3362_026_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		34	47.00		117.50																					117.50																47.00				47.00		1.57						1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3362	026	0	1	02	01	H3362_026_0	5	2	Generic	1	4	001100	1	2	110		01	100		1	30		90				2			90				30		34	20.00		50.00																					50.00																20.00				20.00		0.67						0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3362	026	0	1	02	01	H3362_026_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		34	8.00		20.00																					20.00																8.00				8.00		0.27						0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3362	026	0	1	02	01	H3362_026_0	5	2	Generic	3	4	001100	1	2	110		01	100		1	30		90				2			90				30		34	20.00		50.00																					50.00																20.00				20.00		0.67						0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H3362	027	0	1	01	01	H3362_027_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		34	4.00		10.00																					10.00																4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3362	027	0	1	01	01	H3362_027_0	5	2	Generic	1	4	001100	1	2	110		01	100		1	30		90				2			90				30		34	10.00		25.00																					25.00																10.00				10.00		0.33						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3362	027	0	1	01	01	H3362_027_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		34	45.00		112.50																					112.50																45.00				45.00		1.50						1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3362	027	0	1	01	01	H3362_027_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		34	90.00		225.00																					225.00																90.00				90.00		3.00						2.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3362	027	0	1	01	01	H3362_027_0	5	5	Specialty Tier	1	4	101101	1	1	010		01			1	30													30		34					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3362	027	0	1	01	01	H3362_027_0	5	2	Generic	3	4	001100	1	2	110		01	100		1	30		90				2			90				30		34	10.00		25.00																					25.00																10.00				10.00		0.33						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H3362	029	0	1	02	01	H3362_029_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		34	4.00		10.00																					10.00																4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3362	029	0	1	02	01	H3362_029_0	5	2	Generic	1	4	001100	1	2	110		01	100		1	30		90				2			90				30		34	15.00		37.50																					37.50																15.00				15.00		0.50						0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3362	029	0	1	02	01	H3362_029_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		34	45.00		112.50																					112.50																45.00				45.00		1.50						1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3362	029	0	1	02	01	H3362_029_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		34	95.00		237.50																					237.50																95.00				95.00		3.17						2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3362	029	0	1	02	01	H3362_029_0	5	5	Specialty Tier	1	4	101101	1	1	010		01			1	30													30		34					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3362	029	0	1	02	01	H3362_029_0	5	2	Generic	3	4	001100	1	2	110		01	100		1	30		90				2			90				30		34	15.00		37.50																					37.50																15.00				15.00		0.50						0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
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								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	028	0	1	01	01	H3370_028_0	8	2	Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								4.00	8.00	12.00					4.00	8.00	12.00					4.00	12.00	12.00																4.00				4.00			0.13	0.13	0.13			0.12	Preferred Generic, 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								45.00	90.00	135.00					45.00	90.00	135.00					45.00	135.00	135.00																45.00				45.00			1.50	1.50	1.50			1.32	Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
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											805.84	25						805.84	25						25																	25			25								Preferred Generic, 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								99.00	198.00	297.00					94.00	188.00	282.00					94.00	282.00	282.00																99.00				99.00			3.30	3.13	3.13			2.91	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	029	1	1	01	01	H3370_029_1	8	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	029	1	1	01	01	H3370_029_1	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3370	029	1	1	01	01	H3370_029_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	029	1	1	01	01	H3370_029_1	8	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34											1115.32	27						1115.32	27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	029	1	1	01	01	H3370_029_1	8	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	029	1	1	01	01	H3370_029_1	8	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	029	1	1	01	01	H3370_029_1	8	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	029	2	1	01	01	H3370_029_2	8	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	029	2	1	01	01	H3370_029_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	029	2	1	01	01	H3370_029_2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3370	029	2	1	01	01	H3370_029_2	8	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	029	2	1	01	01	H3370_029_2	8	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34											1115.32	27						1115.32	27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	029	2	1	01	01	H3370_029_2	8	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	029	2	1	01	01	H3370_029_2	8	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	029	3	1	01	01	H3370_029_3	8	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	029	3	1	01	01	H3370_029_3	8	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	029	3	1	01	01	H3370_029_3	8	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	029	3	1	01	01	H3370_029_3	8	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34											1115.32	27						1115.32	27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	029	3	1	01	01	H3370_029_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	029	3	1	01	01	H3370_029_3	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3370	029	3	1	01	01	H3370_029_3	8	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	030	0	1	01	01	H3370_030_0	8	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	15.00	15.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	030	0	1	01	01	H3370_030_0	8	2	Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	030	0	1	01	01	H3370_030_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	030	0	1	01	01	H3370_030_0	8	5	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34											1308.91	27						1308.91	27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	030	0	1	01	01	H3370_030_0	8	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	030	0	1	01	01	H3370_030_0	8	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	031	0	1	01	01	H3370_031_0	8	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	031	0	1	01	01	H3370_031_0	8	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	031	0	1	01	01	H3370_031_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3370	031	0	1	01	01	H3370_031_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	031	0	1	01	01	H3370_031_0	8	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34											1226.95	26						1226.95	26						26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	031	0	1	01	01	H3370_031_0	8	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	031	0	1	01	01	H3370_031_0	8	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	032	0	1	01	01	H3370_032_0	8	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	032	0	1	01	01	H3370_032_0	8	2	Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	032	0	1	01	01	H3370_032_0	8	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	032	0	1	01	01	H3370_032_0	8	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	032	0	1	01	01	H3370_032_0	8	5	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34											1296.32	27						1296.32	27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	032	0	1	01	01	H3370_032_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	035	0	1	01	01	H3370_035_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	035	0	1	01	01	H3370_035_0	8	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34											1102.38	27						1102.38	27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	035	0	1	01	01	H3370_035_0	8	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								99.00	198.00	297.00					94.00	188.00	282.00					94.00	282.00	282.00																99.00				99.00			3.30	3.13	3.13			2.91	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	035	0	1	01	01	H3370_035_0	8	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	035	0	1	01	01	H3370_035_0	8	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	035	0	1	01	01	H3370_035_0	8	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3370	035	0	1	01	01	H3370_035_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
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	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3379	001	0	1	01	01	H3379_001_0	3	2	Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, 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	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3379	001	0	1	01	01	H3379_001_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, 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				505.00	25		25																										25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	013	0	1	01	01	H3384_013_0	5	3	Preferred Brand	1	4	000001	1	2		110	10	110		1				30		90	2	30		90					29	31								47.00		141.00					42.00		126.00					42.00		105.00																	47.00			47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	013	0	1	01	01	H3384_013_0	5	4	Non-Preferred Brand	1	4	100000	1	2		110	10	110		1				30		90	2	30		90					29	31								100.00		300.00					94.00		282.00					94.00		235.00																	100.00			100.00			3.33	3.13	3.13			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	013	0	1	01	01	H3384_013_0	5	2	Generic	1	4	000100	1	2		110	10	110		1				30		90	2	30		90					29	31								20.00		60.00					15.00		45.00					15.00		37.50																	20.00			20.00			0.67	0.50	0.50			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	013	0	1	01	01	H3384_013_0	5	1	Preferred Generic	1	4	001000	1	2		110	10	110		1				30		90	2	30		90					29	31								10.00		30.00					5.00		15.00					5.00		12.50																	10.00			10.00			0.33	0.17	0.17			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	013	0	1	01	01	H3384_013_0	5	5	Specialty Tier	1	4	010010	1	1		110	10	110		1				30		90	2	30		90					29	31												33		33					33		33				33		33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	019	0	1	01	01	H3384_019_0	4	2	Generic	1	4	000100	1	2		110	10	110		1				30		90	2	30		90					29	31								20.00		60.00					15.00		45.00					15.00		37.50																	20.00			20.00			0.67	0.50	0.50			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	019	0	1	01	01	H3384_019_0	4	1	Preferred Generic	1	4	001000	1	2		110	10	110		1				30		90	2	30		90					29	31								12.00		36.00					7.00		21.00					7.00		17.50																	12.00			12.00			0.40	0.23	0.23			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	019	0	1	01	01	H3384_019_0	4	3	Preferred Brand	1	4	000001	1	2		110	10	110		1				30		90	2	30		90					29	31								47.00		141.00					42.00		126.00					42.00		105.00																	47.00			47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	019	0	1	01	01	H3384_019_0	4	5	Specialty Tier	1	4	010010	1	1		110	10	110		1				30		90	2	30		90					29	31												33		33					33		33				33		33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	019	0	1	01	01	H3384_019_0	4	4	Non-Preferred Brand	1	4	100000	1	2		110	10	110		1				30		90	2	30		90					29	31								100.00		300.00					94.00		282.00					94.00		235.00																	100.00			100.00			3.33	3.13	3.13			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	057	0	1	02	01	H3384_057_0	4	1	Preferred Generic	1	4	001000	1	2		110	10	110		1				30		90	2	30		90					29	31								12.00		36.00					7.00		21.00					7.00		17.50																	12.00			12.00			0.40	0.23	0.23			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	057	0	1	02	01	H3384_057_0	4	2	Generic	1	4	000100	1	2		110	10	110		1				30		90	2	30		90					29	31								20.00		60.00					15.00		45.00					15.00		37.50																	20.00			20.00			0.67	0.50	0.50			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	057	0	1	02	01	H3384_057_0	4	4	Non-Preferred Brand	1	4	100000	1	2		110	10	110		1				30		90	2	30		90					29	31								100.00		300.00					94.00		282.00					94.00		235.00																	100.00			100.00			3.33	3.13	3.13			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	057	0	1	02	01	H3384_057_0	4	3	Preferred Brand	1	4	000001	1	2		110	10	110		1				30		90	2	30		90					29	31								47.00		141.00					42.00		126.00					42.00		105.00																	47.00			47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	057	0	1	02	01	H3384_057_0	4	5	Specialty Tier	1	4	010010	1	1		110	10	110		1				30		90	2	30		90					29	31												33		33					33		33				33		33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	058	0	1	01	01	H3384_058_0	5	4	Non-Preferred Brand	1	4	100000	1	2		110	10	110		1				30		90	2	30		90					29	31								100.00		300.00					94.00		282.00					94.00		235.00																	100.00			100.00			3.33	3.13	3.13			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	058	0	1	01	01	H3384_058_0	5	3	Preferred Brand	1	4	000001	1	2		110	10	110		1				30		90	2	30		90					29	31								47.00		141.00					42.00		126.00					42.00		105.00																	47.00			47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	058	0	1	01	01	H3384_058_0	5	2	Generic	1	4	000100	1	2		110	10	110		1				30		90	2	30		90					29	31								20.00		60.00					15.00		45.00					15.00		37.50																	20.00			20.00			0.67	0.50	.50			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	058	0	1	01	01	H3384_058_0	5	1	Preferred Generic	1	4	001000	1	2		110	10	110		1				30		90	2	30		90					29	31								15.00		45.00					10.00		30.00					10.00		25.00																	15.00			15.00			0.50	0.33	0.33			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	058	0	1	01	01	H3384_058_0	5	5	Specialty Tier	1	4	010010	1	1		110	10	110		1				30		90	2	30		90					29	31												33		33					33		33				33		33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	059	0	1	02	01	H3384_059_0	4	4	Non-Preferred Brand	1	4	100000	1	2		110	10	110		1				30		90	2	30		90					29	31								100.00		300.00					94.00		282.00					94.00		235.00																	100.00			100.00			3.33	3.13	3.13			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	059	0	1	02	01	H3384_059_0	4	3	Preferred Brand	1	4	000001	1	2		110	10	110		1				30		90	2	30		90					29	31								47.00		141.00					42.00		126.00					42.00		105.00																	47.00			47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	059	0	1	02	01	H3384_059_0	4	2	Generic	1	4	000100	1	2		110	10	110		1				30		90	2	30		90					29	31								20.00		60.00					15.00		45.00					15.00		37.50																	20.00			20.00			0.67	0.50	.50			.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	059	0	1	02	01	H3384_059_0	4	1	Preferred Generic	1	4	001000	1	2		110	10	110		1				30		90	2	30		90					29	31								15.00		45.00					10.00		30.00					10.00		25.00																	15.00			15.00			0.50	0.33	0.33			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3384	059	0	1	02	01	H3384_059_0	4	5	Specialty Tier	1	4	010010	1	1		110	10	110		1				30		90	2	30		90					29	31												33		33					33		33				33		33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3388	002	0	1	01	01	H3388_002_0	11	4	Non-Preferred Brand	1	4	110000	1	2	110		01	110		1	30		90				1	30		90				30		31	95.00		285.00																			95.00		237.50																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3388	002	0	1	01	01	H3388_002_0	11	3	Preferred Brand	1	4	010001	1	2	110		01	110		1	30		90				1	30		90				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3388	002	0	1	01	01	H3388_002_0	11	2	Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	11.00		33.00																			11.00		22.00																11.00				11.00		0.37			0.37			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3388	002	0	1	01	01	H3388_002_0	11	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3388	002	0	1	01	01	H3388_002_0	11	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				657.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3388	004	0	1	01	01	H3388_004_0	12	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	2.00		6.00																			2.00		4.00																2.00				2.00		0.06			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3388	004	0	1	01	01	H3388_004_0	12	2	Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	12.00		36.00																			12.00		24.00																12.00				12.00		0.40			0.40			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3388	004	0	1	01	01	H3388_004_0	12	3	Preferred Brand	1	4	010001	1	2	110		01	110		1	30		90				1	30		90				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3388	004	0	1	01	01	H3388_004_0	12	4	Non-Preferred Brand	1	4	110000	1	2	110		01	110		1	30		90				1	30		90				30		31	95.00		285.00																			95.00		237.50																95.00				95.00		3.16			3.16			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3388	004	0	1	01	01	H3388_004_0	12	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				657.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3388	013	0	1	01	01	H3388_013_0	13	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	2.00		6.00																			2.00		4.00																2.00				2.00		0.06			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3388	013	0	1	01	01	H3388_013_0	13	2	Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3388	013	0	1	01	01	H3388_013_0	13	3	Preferred Brand	1	4	010001	1	2	110		01	110		1	30		90				1	30		90				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3388	013	0	1	01	01	H3388_013_0	13	4	Non-Preferred Brand	1	4	110000	1	2	110		01	110		1	30		90				1	30		90				30		31	95.00		285.00																			95.00		285.00																95.00				95.00		3.16			3.16			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3388	013	0	1	01	01	H3388_013_0	13	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				631.00	33																				33																	33			33								Preferred Generic, 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								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3404	001	0	1	04	01	H3404_001_0	10	2	Generic	1	4	000100	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31								20.00	40.00	60.00					6.00	12.00	18.00											20.00	40.00	60.00				6.00	12.00	18.00				20.00				20.00			0.67	0.20		0.67	0.20	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3404	001	0	1	04	01	H3404_001_0	10	6	Select Care Drugs	1	4	010000	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
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								95.00	190.00	285.00					80.00	160.00	240.00											95.00	190.00	285.00				80.00	160.00	240.00				95.00				95.00			3.17	2.67		3.17	2.67	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
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								45.00	90.00	135.00					40.00	80.00	120.00											45.00	90.00	135.00				40.00	80.00	120.00				45.00				45.00			1.50	1.33		1.50	1.33	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3421	002	0	1	09	04	H3421_002_0	5	1	Generic	1	4	001000	3	2	110		01	110		1	30		90				1	30		90				30		31	6.00		18.00																			6.00		15.00																6.00				6.00		0.20			0.20			0.19	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3421	002	0	1	09	04	H3421_002_0	5	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31				960.26	33		33																		33		33															33			33								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3421	002	0	1	09	04	H3421_002_0	5	3	Non-Preferred Brand	1	4	100100	3	2	110		01	110		1	30		90				1	30		90				30		31	95.00		285.00																			95.00		237.50																95.00				95.00		3.17			3.17			3.06	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3421	002	0	1	09	04	H3421_002_0	5	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	45.00		135.00																			45.00		112.50																45.00				45.00		1.50			1.50			1.45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3447	001	0	1	01	01	H3447_001_0	5	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					85.00		255.00							212.50																95.00				95.00			3.06	2.74				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3447	001	0	1	01	01	H3447_001_0	5	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31								45.00		135.00					40.00		120.00							100.00																45.00				45.00			1.45	1.29				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3447	001	0	1	01	01	H3447_001_0	5	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3447	001	0	1	01	01	H3447_001_0	5	2	Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			.40	.24				.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3447	001	0	1	01	01	H3447_001_0	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H3447	001	0	1	01	01	H3447_001_0	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3447	001	0	1	01	01	H3447_001_0	5	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3447	001	0	1	01	01	H3447_001_0	5	2	Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			.40	.24				.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3447	001	0	1	01	01	H3447_001_0	5	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											584.00	33						584.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3447	003	0	1	01	01	H3447_003_0	5	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					85.00		255.00							212.50																95.00				95.00			3.06	2.74				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3447	003	0	1	01	01	H3447_003_0	5	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31								45.00		135.00					40.00		120.00							100.00																45.00				45.00			1.45	1.29				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3447	003	0	1	01	01	H3447_003_0	5	2	Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			.40	.24				.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3447	003	0	1	01	01	H3447_003_0	5	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3447	003	0	1	01	01	H3447_003_0	5	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											584.00	33						584.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3447	003	0	1	01	01	H3447_003_0	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H3447	003	0	1	01	01	H3447_003_0	5	2	Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			.40	.24				.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3447	003	0	1	01	01	H3447_003_0	5	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3447	003	0	1	01	01	H3447_003_0	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3447	004	0	1	01	01	H3447_004_0	5	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3447	004	0	1	01	01	H3447_004_0	5	2	Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			.40	.24				.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3447	004	0	1	01	01	H3447_004_0	5	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31								45.00		135.00					40.00		120.00							100.00																45.00				45.00			1.45	1.29				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3447	004	0	1	01	01	H3447_004_0	5	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					85.00		255.00							212.50																95.00				95.00			3.06	2.74				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3447	004	0	1	01	01	H3447_004_0	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H3447	004	0	1	01	01	H3447_004_0	5	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3447	004	0	1	01	01	H3447_004_0	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3447	004	0	1	01	01	H3447_004_0	5	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											584.00	33						584.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3447	004	0	1	01	01	H3447_004_0	5	2	Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			.40	.24				.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3447	005	0	1	01	01	H3447_005_0	5	2	Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								15.50		46.50					10.50		31.50							26.25																15.50				15.50			.50	.33				.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3447	005	0	1	01	01	H3447_005_0	5	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								10.00		30.00					5.00		15.00							12.50																10.00				10.00			0.32	0.16				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3447	005	0	1	01	01	H3447_005_0	5	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31								45.00		135.00					40.00		120.00							100.00																45.00				45.00			1.45	1.29				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3447	005	0	1	01	01	H3447_005_0	5	6	Select Care Drugs	1	4	010010	1	2		110	01	100		1				30		90	1			90				30		31								10.00		30.00					10.00		30.00							25.00																10.00				10.00			0.32	0.32				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3447	005	0	1	01	01	H3447_005_0	5	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											584.00	33						584.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3447	005	0	1	01	01	H3447_005_0	5	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					90.00		270.00							225.00																95.00				95.00			3.06	2.90				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3447	010	0	1	01	01	H3447_010_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	40.00		120.00																					100.00																40.00				40.00		1.29						1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3447	010	0	1	01	01	H3447_010_0	5	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	7.50		22.50																					18.75																7.50				7.50		.24						.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3447	010	0	1	01	01	H3447_010_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3447	010	0	1	01	01	H3447_010_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	85.00		255.00																					212.50																85.00				85.00		2.74						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3447	010	0	1	01	01	H3447_010_0	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H3447	010	0	1	01	01	H3447_010_0	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3447	010	0	1	01	01	H3447_010_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3447	010	0	1	01	01	H3447_010_0	5	2	Generic	3	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	7.50		22.50																					18.75																7.50				7.50		.24						.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3447	010	0	1	01	01	H3447_010_0	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				584.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
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								45.00	90.00	135.00					40.00	80.00	120.00											45.00	90.00	135.00				40.00	80.00	120.00				45.00				45.00			1.50	1.33		1.50	1.33	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3449	005	0	1	01	01	H3449_005_0	9	2	Generic	1	4	000100	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31								20.00	40.00	60.00					6.00	12.00	18.00											20.00	40.00	60.00				6.00	12.00	18.00				20.00				20.00			0.67	0.20		0.67	0.20	0.65	Preferred Generic, 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								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
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								95.00	190.00	285.00					80.00	160.00	240.00											95.00	190.00	285.00				80.00	160.00	240.00				95.00				95.00			3.17	2.67		3.17	2.67	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
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								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3449	005	0	1	01	01	H3449_005_0	9	6	Select Care Drugs	1	4	010000	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
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								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				8.00			0.27	0.10		0.27	.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3449	013	0	1	01	01	H3449_013_0	9	2	Generic	1	4	000100	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31								20.00	40.00	60.00					6.00	12.00	18.00											20.00	40.00	60.00				6.00	12.00	18.00				20.00				20.00			0.67	0.20		0.67	0.20	0.65	Preferred Generic, 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								45.00	90.00	135.00					40.00	80.00	120.00											45.00	90.00	135.00				40.00	80.00	120.00				45.00				45.00			1.50	1.33		1.50	1.33	1.45	Preferred Generic, 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								95.00	190.00	285.00					80.00	160.00	240.00											95.00	190.00	285.00				80.00	160.00	240.00				95.00				95.00			3.17	2.67		3.17	2.67	3.06	Preferred Generic, 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	25	25	25				1.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3449	016	0	1	01	01	H3449_016_0	11	1	Preferred Generic	1	3	001000	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				8.00			0.27	0.10		0.27	.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3449	016	0	1	01	01	H3449_016_0	11	2	Generic	1	3	000100	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31								20.00	40.00	60.00					6.00	12.00	18.00											20.00	40.00	60.00				6.00	12.00	18.00				20.00				20.00			0.67	0.20		0.67	0.20	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3449	016	0	1	01	01	H3449_016_0	11	3	Preferred Brand	1	3	000001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31								45.00	90.00	135.00					40.00	80.00	120.00											45.00	90.00	135.00				40.00	80.00	120.00				45.00				45.00			1.50	1.33		1.50	1.33	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3449	016	0	1	01	01	H3449_016_0	11	4	Non-Preferred Brand	1	3	110000	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31								95.00	190.00	285.00					80.00	160.00	240.00											95.00	190.00	285.00				80.00	160.00	240.00				95.00				95.00			3.17	2.67		3.17	2.67	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3449	016	0	1	01	01	H3449_016_0	11	5	Specialty Tier	1	3	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3471	001	0	1	01	01	H3471_001_0	4	4	Non-Preferred Brand	1	3	100000	1	2		110	01	110		1				30		90	1	30		90				30		31								100.00		300.00					100.00		200.00					100.00		300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3471	001	0	1	01	01	H3471_001_0	4	3	Preferred Brand	1	3	000001	1	2		110	01	110		1				30		90	1	30		90				30		31								47.00		141.00					47.00		94.00					47.00		141.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3471	001	0	1	01	01	H3471_001_0	4	2	Generic	1	3	000100	1	2		110	01	110		1				30		90	1	30		90				30		31								20.00		60.00					20.00		40.00					20.00		60.00																20.00				20.00			.67	.67	.67			.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3471	001	0	1	01	01	H3471_001_0	4	1	Preferred Generic	1	3	001000	1	2		110	01	110		1				30		90	1	30		90				30		31								19.00		57.00					0.00		0.00					19.00		57.00																19.00				19.00			.63	0.00	.63			.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3471	001	0	1	01	01	H3471_001_0	4	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3471	002	0	1	01	01	H3471_002_0	4	4	Non-Preferred Brand	1	3	100000	1	2		110	01	110		1				30		90	1	30		90				30		31								100.00		300.00					100.00		200.00					100.00		300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3471	002	0	1	01	01	H3471_002_0	4	3	Preferred Brand	1	3	000001	1	2		110	01	110		1				30		90	1	30		90				30		31								47.00		141.00					47.00		94.00					47.00		141.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3471	002	0	1	01	01	H3471_002_0	4	2	Generic	1	3	000100	1	2		110	01	110		1				30		90	1	30		90				30		31								20.00		60.00					20.00		40.00					20.00		60.00																20.00				20.00			.67	.67	.67			.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3471	002	0	1	01	01	H3471_002_0	4	1	Preferred Generic	1	3	001000	1	2		110	01	110		1				30		90	1	30		90				30		31								18.00		54.00					0.00		0.00					18.00		54.00																18.00				18.00			.60	0.00	.60			.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3471	002	0	1	01	01	H3471_002_0	4	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3471	004	0	1	01	01	H3471_004_0	4	1	Preferred Generic	1	3	001000	1	2		110	01	110		1				30		90	1	30		90				30		31								19.00		57.00					0.00		0.00					19.00		57.00																19.00				19.00			.63	0.00	.63			.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3471	004	0	1	01	01	H3471_004_0	4	2	Generic	1	3	000100	1	2		110	01	110		1				30		90	1	30		90				30		31								20.00		60.00					20.00		40.00					20.00		60.00																20.00				20.00			.67	.67	.67			.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3471	004	0	1	01	01	H3471_004_0	4	3	Preferred Brand	1	3	000001	1	2		110	01	110		1				30		90	1	30		90				30		31								47.00		141.00					47.00		94.00					47.00		141.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3471	004	0	1	01	01	H3471_004_0	4	4	Non-Preferred Brand	1	3	100000	1	2		110	01	110		1				30		90	1	30		90				30		31								100.00		300.00					100.00		200.00					100.00		300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3471	004	0	1	01	01	H3471_004_0	4	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3471	005	0	1	01	01	H3471_005_0	4	1	Preferred Generic	1	3	001000	1	2		110	01	110		1				30		90	1	30		90				30		31								18.00		54.00					0.00		0.00					18.00		54.00																18.00				18.00			.60	0.00	.60			.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3471	005	0	1	01	01	H3471_005_0	4	2	Generic	1	3	000100	1	2		110	01	110		1				30		90	1	30		90				30		31								20.00		60.00					20.00		40.00					20.00		60.00																20.00				20.00			.67	.67	.67			.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3471	005	0	1	01	01	H3471_005_0	4	3	Preferred Brand	1	3	000001	1	2		110	01	110		1				30		90	1	30		90				30		31								47.00		141.00					47.00		94.00					47.00		141.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3471	005	0	1	01	01	H3471_005_0	4	4	Non-Preferred Brand	1	3	100000	1	2		110	01	110		1				30		90	1	30		90				30		31								100.00		300.00					100.00		200.00					100.00		300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3471	005	0	1	01	01	H3471_005_0	4	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3471	007	0	1	01	01	H3471_007_0	4	1	Preferred Generic	1	3	001000	1	2		110	01	110		1				30		90	1	30		90				30		31								19.00		57.00					0.00		0.00					19.00		57.00																19.00				19.00			.63	0.00	.63			.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3471	007	0	1	01	01	H3471_007_0	4	2	Generic	1	3	000100	1	2		110	01	110		1				30		90	1	30		90				30		31								20.00		60.00					20.00		40.00					20.00		60.00																20.00				20.00			.67	.67	.67			.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3471	007	0	1	01	01	H3471_007_0	4	3	Preferred Brand	1	3	000001	1	2		110	01	110		1				30		90	1	30		90				30		31								47.00		141.00					47.00		94.00					47.00		141.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3471	007	0	1	01	01	H3471_007_0	4	4	Non-Preferred Brand	1	3	100000	1	2		110	01	110		1				30		90	1	30		90				30		31								100.00		300.00					100.00		200.00					100.00		300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3471	007	0	1	01	01	H3471_007_0	4	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3471	008	0	1	01	01	H3471_008_0	4	1	Preferred Generic	1	3	001000	1	2		110	01	110		1				30		90	1	30		90				30		31								18.00		54.00					0.00		0.00					18.00		54.00																18.00				18.00			.60	0.00	.60			.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3471	008	0	1	01	01	H3471_008_0	4	2	Generic	1	3	000100	1	2		110	01	110		1				30		90	1	30		90				30		31								20.00		60.00					20.00		40.00					20.00		60.00																20.00				20.00			.67	.67	.67			.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3471	008	0	1	01	01	H3471_008_0	4	3	Preferred Brand	1	3	000001	1	2		110	01	110		1				30		90	1	30		90				30		31								47.00		141.00					47.00		94.00					47.00		141.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3471	008	0	1	01	01	H3471_008_0	4	4	Non-Preferred Brand	1	3	100000	1	2		110	01	110		1				30		90	1	30		90				30		31								100.00		300.00					100.00		200.00					100.00		300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3471	008	0	1	01	01	H3471_008_0	4	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3471	010	0	1	01	01	H3471_010_0	4	1	Preferred Generic	1	3	001000	1	2		110	01	110		1				30		90	1	30		90				30		31								19.50		58.50					0.00		0.00					19.50		58.50																19.50				19.50			.65	0.00	.65			.63	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3471	010	0	1	01	01	H3471_010_0	4	2	Generic	1	3	000100	1	2		110	01	110		1				30		90	1	30		90				30		31								20.00		60.00					20.00		40.00					20.00		60.00																20.00				20.00			.67	.67	.67			.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3471	010	0	1	01	01	H3471_010_0	4	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3471	010	0	1	01	01	H3471_010_0	4	4	Non-Preferred Brand	1	3	100000	1	2		110	01	110		1				30		90	1	30		90				30		31								100.00		300.00					100.00		200.00					100.00		300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3471	010	0	1	01	01	H3471_010_0	4	3	Preferred Brand	1	3	000001	1	2		110	01	110		1				30		90	1	30		90				30		31								47.00		141.00					47.00		94.00					47.00		141.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3471	012	0	1	01	01	H3471_012_0	4	4	Non-Preferred Brand	1	3	100000	1	2		110	01	110		1				30		90	1	30		90				30		31								100.00		300.00					100.00		200.00					100.00		300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3471	012	0	1	01	01	H3471_012_0	4	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3471	012	0	1	01	01	H3471_012_0	4	3	Preferred Brand	1	3	000001	1	2		110	01	110		1				30		90	1	30		90				30		31								47.00		141.00					47.00		94.00					47.00		141.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3471	012	0	1	01	01	H3471_012_0	4	2	Generic	1	3	000100	1	2		110	01	110		1				30		90	1	30		90				30		31								20.00		60.00					20.00		40.00					20.00		60.00																20.00				20.00			.67	.67	.67			.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3471	012	0	1	01	01	H3471_012_0	4	1	Preferred Generic	1	3	001000	1	2		110	01	110		1				30		90	1	30		90				30		31								19.50		58.50					0.00		0.00					19.50		58.50																19.50				19.50			.65	0.00	.65			.63	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3480	001	0	1	48	05	H3480_001_0	4	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	2.95	0.00	2.95	0.00	2.95	0.00	2.95			
H3480	001	0	1	48	05	H3480_001_0	4	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	7.40	0.00	7.40	0.00	7.40	0.00	7.40			
H3480	001	0	1	48	05	H3480_001_0	4	3	Non-Medicare Rx Drugs	1	4	010010			110		01	110		1	30		90				2	30		90				30		31																																														0.00			0.00			0.00	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	4	4	Non-Medicare OTC Drugs	1	4	010010			110		01	110		1	30		90				2	30		90				30		31																																														0.00			0.00			0.00	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	8	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	250.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3528	001	0	1	01	01	H3528_001_0	8	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	118.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3528	001	0	1	01	01	H3528_001_0	8	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3528	001	0	1	01	01	H3528_001_0	8	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	40.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3528	001	0	1	01	01	H3528_001_0	8	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3528	002	0	1	01	01	H3528_002_0	8	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	250.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3528	002	0	1	01	01	H3528_002_0	8	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	118.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3528	002	0	1	01	01	H3528_002_0	8	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	40.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3528	002	0	1	01	01	H3528_002_0	8	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3528	002	0	1	01	01	H3528_002_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3528	002	0	1	01	01	H3528_002_0	8	2	Generic	3	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	40.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3528	002	0	1	01	01	H3528_002_0	8	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3528	006	0	1	02	01	H3528_006_0	9	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3528	006	0	1	02	01	H3528_006_0	9	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	40.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3528	006	0	1	02	01	H3528_006_0	9	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	118.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3528	006	0	1	02	01	H3528_006_0	9	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	250.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3528	006	0	1	02	01	H3528_006_0	9	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3528	006	0	1	02	01	H3528_006_0	9	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3528	006	0	1	02	01	H3528_006_0	9	2	Generic	3	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	40.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3528	008	0	1	02	01	H3528_008_0	8	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	40.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, 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	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, 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	47.00	94.00	141.00																			47.00	94.00	118.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, 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								Preferred Generic, 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	100.00	200.00	300.00																			100.00	200.00	250.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	001	0	1	01	01	H3533_001_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	001	0	1	01	01	H3533_001_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.66				0.66	0.66	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	001	0	1	01	01	H3533_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H3533	001	0	1	01	01	H3533_001_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H3533	001	0	1	01	01	H3533_001_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H3533	001	0	1	01	01	H3533_001_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.66				0.66	0.66	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H3533	001	0	1	01	01	H3533_001_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H3533	001	0	1	01	01	H3533_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	001	0	1	01	01	H3533_001_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	001	0	1	01	01	H3533_001_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	002	0	1	01	01	H3533_002_0	3	2	Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	002	0	1	01	01	H3533_002_0	3	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	30.00		90.00																									30.00		90.00				30.00		80.00				30.00				30.00		1.00				1.00	1.00	0.96	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	002	0	1	01	01	H3533_002_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	80.00		240.00																									80.00		240.00				80.00		230.00				80.00				80.00		2.66				2.66	2.66	2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	002	0	1	01	01	H3533_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	002	0	1	01	01	H3533_002_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	004	0	1	01	01	H3533_004_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	004	0	1	01	01	H3533_004_0	3	2	Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	19.00		57.00																									19.00		57.00				19.00		0.00				19.00				19.00		0.63				0.63	0.63	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	004	0	1	01	01	H3533_004_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	004	0	1	01	01	H3533_004_0	3	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	004	0	1	01	01	H3533_004_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, 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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, 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	8.00		24.00																									8.00		24.00				8.00		0.00				8.00				8.00		0.26				0.26	0.26	0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H3533	005	0	1	01	01	H3533_005_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	18.00		54.00																									18.00		54.00				18.00		0.00				18.00				18.00		0.60				0.60	0.60	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	8.00		24.00																									8.00		24.00				8.00		0.00				8.00				8.00		0.26				0.26	0.26	0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	005	0	1	01	01	H3533_005_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	18.00		54.00																									18.00		54.00				18.00		0.00				18.00				18.00		0.60				0.60	0.60	0.58	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	006	0	1	01	01	H3533_006_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	18.00		54.00																									18.00		54.00				18.00		0.00				18.00				18.00		0.60				0.60	0.60	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, 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, 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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H3533	006	0	1	01	01	H3533_006_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	18.00		54.00																									18.00		54.00				18.00		0.00				18.00				18.00		0.60				0.60	0.60	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, 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, 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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	007	0	1	01	01	H3533_007_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	8.00		24.00																									8.00		24.00				8.00		0.00				8.00				8.00		0.26				0.26	0.26	0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	007	0	1	01	01	H3533_007_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H3533	007	0	1	01	01	H3533_007_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H3533	007	0	1	01	01	H3533_007_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	18.00		54.00																									18.00		54.00				18.00		0.00				18.00				18.00		0.60				0.60	0.60	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H3533	007	0	1	01	01	H3533_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H3533	007	0	1	01	01	H3533_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	007	0	1	01	01	H3533_007_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	007	0	1	01	01	H3533_007_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	007	0	1	01	01	H3533_007_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	18.00		54.00																									18.00		54.00				18.00		0.00				18.00				18.00		0.60				0.60	0.60	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	007	0	1	01	01	H3533_007_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	8.00		24.00																									8.00		24.00				8.00		0.00				8.00				8.00		0.26				0.26	0.26	0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H3533	010	0	1	01	01	H3533_010_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.66				0.66	0.66	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	010	0	1	01	01	H3533_010_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	010	0	1	01	01	H3533_010_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	010	0	1	01	01	H3533_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H3533	010	0	1	01	01	H3533_010_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H3533	010	0	1	01	01	H3533_010_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H3533	010	0	1	01	01	H3533_010_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.66				0.66	0.66	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H3533	010	0	1	01	01	H3533_010_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H3533	010	0	1	01	01	H3533_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	010	0	1	01	01	H3533_010_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	013	0	1	01	01	H3533_013_0	3	2	Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	19.00		57.00																									19.00		57.00				19.00		0.00				19.00				19.00		0.63				0.63	0.63	0.61	Preferred Generic, 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	9.00		27.00																									9.00		27.00				9.00		0.00				9.00				9.00		0.30				0.30	0.30	0.29	Preferred Generic, 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, 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	8.00		24.00																									8.00		24.00				8.00		0.00				8.00				8.00		0.26				0.26	0.26	0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	017	0	1	01	01	H3533_017_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	18.00		54.00																									18.00		54.00				18.00		0.00				18.00				18.00		0.60				0.60	0.60	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H3533	017	0	1	01	01	H3533_017_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	18.00		54.00																									18.00		54.00				18.00		0.00				18.00				18.00		0.60				0.60	0.60	0.58	Preferred Generic, 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	8.00		24.00																									8.00		24.00				8.00		0.00				8.00				8.00		0.26				0.26	0.26	0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H3533	020	0	1	01	01	H3533_020_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	020	0	1	01	01	H3533_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	020	0	1	01	01	H3533_020_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	8.00		24.00																									8.00		24.00				8.00		0.00				8.00				8.00		0.26				0.26	0.26	0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H3533	020	0	1	01	01	H3533_020_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	18.00		54.00																									18.00		54.00				18.00		0.00				18.00				18.00		0.60				0.60	0.60	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H3533	020	0	1	01	01	H3533_020_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H3533	020	0	1	01	01	H3533_020_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H3533	020	0	1	01	01	H3533_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H3533	020	0	1	01	01	H3533_020_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	8.00		24.00																									8.00		24.00				8.00		0.00				8.00				8.00		0.26				0.26	0.26	0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	020	0	1	01	01	H3533_020_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	18.00		54.00																									18.00		54.00				18.00		0.00				18.00				18.00		0.60				0.60	0.60	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	020	0	1	01	01	H3533_020_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	021	0	1	01	01	H3533_021_0	3	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	9.00		27.00																									9.00		27.00				9.00		0.00				9.00				9.00		0.30				0.30	0.30	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	021	0	1	01	01	H3533_021_0	3	2	Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	19.00		57.00																									19.00		57.00				19.00		0.00				19.00				19.00		0.63				0.63	0.63	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	021	0	1	01	01	H3533_021_0	3	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	021	0	1	01	01	H3533_021_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	021	0	1	01	01	H3533_021_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	022	0	1	01	01	H3533_022_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	022	0	1	01	01	H3533_022_0	3	2	Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.66				0.66	0.66	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	022	0	1	01	01	H3533_022_0	3	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	30.00		90.00																									30.00		90.00				30.00		80.00				30.00				30.00		1.00				1.00	1.00	0.96	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	022	0	1	01	01	H3533_022_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	80.00		240.00																									80.00		240.00				80.00		230.00				80.00				80.00		2.66				2.66	2.66	2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3533	022	0	1	01	01	H3533_022_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3536	002	0	1	01	01	H3536_002_0	10	2	Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3536	002	0	1	01	01	H3536_002_0	10	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	15.00	15.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3536	002	0	1	01	01	H3536_002_0	10	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3536	002	0	1	01	01	H3536_002_0	10	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3536	002	0	1	01	01	H3536_002_0	10	5	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34											1418.21	29						1418.21	29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3536	002	0	1	01	01	H3536_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3536	003	0	1	01	01	H3536_003_0	9	2	Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3536	003	0	1	01	01	H3536_003_0	9	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	15.00	15.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3536	003	0	1	01	01	H3536_003_0	9	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3536	003	0	1	01	01	H3536_003_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3536	003	0	1	01	01	H3536_003_0	9	5	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34											1444.60	29						1444.60	29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3536	003	0	1	01	01	H3536_003_0	9	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3536	004	0	1	01	01	H3536_004_0	6	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3536	004	0	1	01	01	H3536_004_0	6	2	Generic	1	3	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34								1.00	2.00	3.00					1.00	2.00	3.00					1.00	3.00	3.00																1.00				1.00			0.03	0.03	0.03			0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3536	004	0	1	01	01	H3536_004_0	6	5	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34											872.48	25						872.48	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3536	004	0	1	01	01	H3536_004_0	6	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34								93.00	186.00	279.00					88.00	176.00	264.00					88.00	264.00	264.00																93.00				93.00			3.10	2.93	2.93			2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3536	004	0	1	01	01	H3536_004_0	6	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	2	30	60	90				30		34								45.00	90.00	135.00					45.00	90.00	135.00					45.00	135.00	135.00																45.00				45.00			1.50	1.50	1.50			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3536	004	0	1	01	01	H3536_004_0	6	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3561	001	0	1	01	01	H3561_001_0	3	1	Preferred Generic	1	3	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3561	001	0	1	01	01	H3561_001_0	3	2	Generic	1	3	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	40.00	40.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3561	001	0	1	01	01	H3561_001_0	3	3	Preferred Brand	1	3	000101	1	2	111		01		111	1	30	60	90				1				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	94.00	131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3561	001	0	1	01	01	H3561_001_0	3	4	Non-Preferred Brand	1	3	100100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		31	100.00	200.00	300.00																									100.00	200.00	300.00				100.00	200.00	290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3561	001	0	1	01	01	H3561_001_0	3	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3561	001	0	1	01	01	H3561_001_0	3	6	Select Care Drugs	1	3	010010	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		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3561	002	0	1	01	01	H3561_002_0	3	4	Non-Preferred Brand	1	3	100100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		31	100.00	200.00	300.00																									100.00	200.00	300.00				100.00	200.00	290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3561	002	0	1	01	01	H3561_002_0	3	3	Preferred Brand	1	3	000101	1	2	111		01		111	1	30	60	90				1				30	60	90	30		31	47.00	94.00	141.00																									47.00	94.00	141.00				47.00	94.00	131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3561	002	0	1	01	01	H3561_002_0	3	2	Generic	1	3	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	40.00	40.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3561	002	0	1	01	01	H3561_002_0	3	1	Preferred Generic	1	3	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3561	002	0	1	01	01	H3561_002_0	3	5	Specialty Tier	1	3	010010	1	1	111		01		111	1	30	60	90				1				30	60	90	30		31					26	26	26																								26	26	26				26	26	26			26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3561	002	0	1	01	01	H3561_002_0	3	6	Select Care Drugs	1	3	010010	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		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3597	001	0	1	01	01	H3597_001_0	6	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					0.00	0.00	0.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.00	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3597	001	0	1	01	01	H3597_001_0	6	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					13.00	26.00	39.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.43	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3597	001	0	1	01	01	H3597_001_0	6	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3597	001	0	1	01	01	H3597_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											42.57	50	50	50				39.33	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3597	001	0	1	01	01	H3597_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3597	005	0	1	01	01	H3597_005_0	3	4	Non-Preferred Brand	1	3	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											37.82	50	50	50				34.80	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3597	005	0	1	01	01	H3597_005_0	3	3	Preferred Brand	1	3	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3597	005	0	1	01	01	H3597_005_0	3	2	Generic	1	3	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					15.00	30.00	45.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.50	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3597	005	0	1	01	01	H3597_005_0	3	1	Preferred Generic	1	3	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								15.00	30.00	45.00					5.00	10.00	15.00					15.00	30.00	45.00																	15.00			15.00			0.50	0.17	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3597	005	0	1	01	01	H3597_005_0	3	5	Specialty Tier	1	3	010010	1	1		010	10	010		1				30				30							10	31											1.00	33						1.00	33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3597	007	0	1	01	01	H3597_007_0	4	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					13.00	26.00	39.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.43	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3597	007	0	1	01	01	H3597_007_0	4	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					0.00	0.00	0.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.00	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3597	007	0	1	01	01	H3597_007_0	4	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3597	007	0	1	01	01	H3597_007_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											44.04	50	50	50				41.57	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3597	007	0	1	01	01	H3597_007_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3597	008	0	1	01	01	H3597_008_0	4	2	Generic	1	3	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					15.00	30.00	45.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.50	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3597	008	0	1	01	01	H3597_008_0	4	1	Preferred Generic	1	3	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								15.00	30.00	45.00					5.00	10.00	15.00					15.00	30.00	45.00																	15.00			15.00			0.50	0.17	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3597	008	0	1	01	01	H3597_008_0	4	3	Preferred Brand	1	3	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3597	008	0	1	01	01	H3597_008_0	4	5	Specialty Tier	1	3	010010	1	1		010	10	010		1				30				30							10	31											1.00	33						1.00	33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3597	008	0	1	01	01	H3597_008_0	4	4	Non-Preferred Brand	1	3	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											43.98	50	50	50				41.52	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3597	009	0	1	01	01	H3597_009_0	4	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					0.00	0.00	0.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.00	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3597	009	0	1	01	01	H3597_009_0	4	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					13.00	26.00	39.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.43	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3597	009	0	1	01	01	H3597_009_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											44.10	50	50	50				41.63	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3597	009	0	1	01	01	H3597_009_0	4	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3597	009	0	1	01	01	H3597_009_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3653	004	0	1	01	01	H3653_004_0	6	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	15.00		45.00																					30.00																15.00				15.00		.50						.48	Preferred Generic, Generic, Preferred Brand, Injectable Drugs, Specialty Tier												
H3653	004	0	1	01	01	H3653_004_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	2.00		6.00																					4.00																2.00				2.00		0.06						.06	Preferred Generic, Generic, Preferred Brand, Injectable Drugs, Specialty Tier												
H3653	004	0	1	01	01	H3653_004_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	45.00		135.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Injectable Drugs, Specialty Tier												
H3653	004	0	1	01	01	H3653_004_0	6	4	Injectable Drugs	1	4	010010	1	1	010		01			1	30													30		31				43.61	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Injectable Drugs, Specialty Tier												
H3653	004	0	1	01	01	H3653_004_0	6	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31				1674.21	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Injectable Drugs, Specialty Tier												
H3653	015	0	1	01	01	H3653_015_0	5	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	20.00		60.00																					40.00																20.00				20.00		.66						.64	Preferred Generic, Generic, Preferred Brand, Injectable Drugs, Specialty Tier												
H3653	015	0	1	01	01	H3653_015_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	5.00		15.00																					10.00																5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Injectable Drugs, Specialty Tier												
H3653	015	0	1	01	01	H3653_015_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	45.00		135.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Injectable Drugs, Specialty Tier												
H3653	015	0	1	01	01	H3653_015_0	5	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31				2371.39	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Injectable Drugs, Specialty Tier												
H3653	015	0	1	01	01	H3653_015_0	5	4	Injectable Drugs	1	4	010010	1	1	010		01			1	30													30		31				83.60	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Injectable Drugs, Specialty Tier												
H3655	032	0	1	01	01	H3655_032_0	9	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3655	032	0	1	01	01	H3655_032_0	9	2	Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3655	032	0	1	01	01	H3655_032_0	9	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3655	032	0	1	01	01	H3655_032_0	9	5	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34											1623.21	31						1623.21	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3655	032	0	1	01	01	H3655_032_0	9	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3655	032	0	1	01	01	H3655_032_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3655	033	0	1	01	01	H3655_033_0	9	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3655	033	0	1	01	01	H3655_033_0	9	2	Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								1.00	2.00	3.00					1.00	2.00	3.00					1.00	3.00	3.00																1.00				1.00			0.03	0.03	0.03			0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3655	033	0	1	01	01	H3655_033_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3655	033	0	1	01	01	H3655_033_0	9	5	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34											777.67	25						777.67	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3655	033	0	1	01	01	H3655_033_0	9	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3655	033	0	1	01	01	H3655_033_0	9	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								45.00	90.00	135.00					45.00	90.00	135.00					45.00	135.00	135.00																45.00				45.00			1.50	1.50	1.50			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3655	034	0	1	01	01	H3655_034_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3655	034	0	1	01	01	H3655_034_0	8	5	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34											1807.87	31						1807.87	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3655	034	0	1	01	01	H3655_034_0	8	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3655	034	0	1	01	01	H3655_034_0	8	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3655	034	0	1	01	01	H3655_034_0	8	2	Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3655	034	0	1	01	01	H3655_034_0	8	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3655	035	0	1	01	01	H3655_035_0	9	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3655	035	0	1	01	01	H3655_035_0	9	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								97.00	194.00	291.00					92.00	184.00	276.00					92.00	276.00	276.00																97.00				97.00			3.23	3.07	3.07			2.85	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3655	035	0	1	01	01	H3655_035_0	9	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34											1769.78	32						1769.78	32						32																	32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3655	035	0	1	01	01	H3655_035_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3655	035	0	1	01	01	H3655_035_0	9	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								16.00	32.00	48.00					11.00	22.00	33.00					11.00	33.00	33.00																16.00				16.00			0.53	0.37	0.37			0.47	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3655	035	0	1	01	01	H3655_035_0	9	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3655	035	0	1	01	01	H3655_035_0	9	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00	9.00	9.00																8.00				8.00			0.27	0.10	0.10			0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3660	028	0	1	02	01	H3660_028_0	12	6	Vaccines	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	028	0	1	02	01	H3660_028_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3660	028	0	1	02	01	H3660_028_0	12	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	10.00		30.00																					25.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	028	0	1	02	01	H3660_028_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	028	0	1	02	01	H3660_028_0	12	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	95.00		285.00																					285.00																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	028	0	1	02	01	H3660_028_0	12	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	45.00		135.00																					112.50																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	028	0	1	02	01	H3660_028_0	12	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	029	0	1	02	01	H3660_029_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	029	0	1	02	01	H3660_029_0	9	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	20.00		60.00																					50.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	029	0	1	02	01	H3660_029_0	9	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	47.00		141.00																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	029	0	1	02	01	H3660_029_0	9	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	029	0	1	02	01	H3660_029_0	9	6	Vaccines	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	029	0	1	02	01	H3660_029_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3660	029	0	1	02	01	H3660_029_0	9	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	044	0	1	01	01	H3660_044_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3660	044	0	1	01	01	H3660_044_0	9	6	Vaccines	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	044	0	1	01	01	H3660_044_0	9	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	47.00		141.00																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	044	0	1	01	01	H3660_044_0	9	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	044	0	1	01	01	H3660_044_0	9	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	044	0	1	01	01	H3660_044_0	9	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	20.00		60.00																					50.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	044	0	1	01	01	H3660_044_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	047	0	1	01	01	H3660_047_0	9	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	047	0	1	01	01	H3660_047_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	047	0	1	01	01	H3660_047_0	9	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	20.00		60.00																					50.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	047	0	1	01	01	H3660_047_0	9	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	47.00		141.00																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	047	0	1	01	01	H3660_047_0	9	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	047	0	1	01	01	H3660_047_0	9	6	Vaccines	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	047	0	1	01	01	H3660_047_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3660	048	0	1	02	01	H3660_048_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3660	048	0	1	02	01	H3660_048_0	9	6	Vaccines	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	048	0	1	02	01	H3660_048_0	9	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	048	0	1	02	01	H3660_048_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	048	0	1	02	01	H3660_048_0	9	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	20.00		60.00																					50.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	048	0	1	02	01	H3660_048_0	9	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	47.00		141.00																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	048	0	1	02	01	H3660_048_0	9	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	049	0	1	01	01	H3660_049_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	049	0	1	01	01	H3660_049_0	9	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	20.00		60.00																					50.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	049	0	1	01	01	H3660_049_0	9	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	47.00		141.00																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	049	0	1	01	01	H3660_049_0	9	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	049	0	1	01	01	H3660_049_0	9	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	049	0	1	01	01	H3660_049_0	9	6	Vaccines	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	049	0	1	01	01	H3660_049_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3660	050	0	1	01	01	H3660_050_0	9	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	20.00		60.00																					50.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	050	0	1	01	01	H3660_050_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	050	0	1	01	01	H3660_050_0	9	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	47.00		141.00																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	050	0	1	01	01	H3660_050_0	9	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	050	0	1	01	01	H3660_050_0	9	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	050	0	1	01	01	H3660_050_0	9	6	Vaccines	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	050	0	1	01	01	H3660_050_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3664	017	0	1	02	01	H3664_017_0	6	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	24.00																8.00				8.00		.26			.26			.25	Preferred Generic, 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				2008.61	33	33	33																		33	33	33															33			33								Preferred Generic, 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	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.16			3.16			3.06	Preferred Generic, 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	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3664	020	0	1	02	01	H3664_020_0	6	5	Specialty Tier	1	4	000010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31				1626.14	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3664	020	0	1	02	01	H3664_020_0	6	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3664	020	0	1	02	01	H3664_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	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.16			3.16			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3664	020	0	1	02	01	H3664_020_0	6	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	6.00																2.00				2.00		.06			.06			.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3664	020	0	1	02	01	H3664_020_0	6	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	24.00																8.00				8.00		.26			.26			.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3664	021	0	1	02	01	H3664_021_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	9.00																3.00				3.00		.10			.10			.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3664	021	0	1	02	01	H3664_021_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3664	021	0	1	02	01	H3664_021_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.16			3.16			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3664	021	0	1	02	01	H3664_021_0	5	5	Specialty Tier	1	4	000010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31				2069.84	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3664	021	0	1	02	01	H3664_021_0	5	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	45.00																15.00				15.00		.50			.50			.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	005	0	1	01	01	H3668_005_0	11	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3668	005	0	1	01	01	H3668_005_0	11	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				660.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	005	0	1	01	01	H3668_005_0	11	4	Non-Preferred Brand	1	4	100100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	75.00	150.00	225.00																			75.00	150.00	150.00																75.00				75.00		2.50			2.50			2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	005	0	1	01	01	H3668_005_0	11	3	Preferred Brand	1	4	000101	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	005	0	1	01	01	H3668_005_0	11	2	Generic	1	4	000101	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	005	0	1	01	01	H3668_005_0	11	1	Preferred Generic	1	4	001001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	011	0	1	01	01	H3668_011_0	9	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3668	011	0	1	01	01	H3668_011_0	9	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				660.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	011	0	1	01	01	H3668_011_0	9	4	Non-Preferred Brand	1	4	100100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	011	0	1	01	01	H3668_011_0	9	3	Preferred Brand	1	4	000101	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	011	0	1	01	01	H3668_011_0	9	2	Generic	1	4	000101	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	18.00	36.00	54.00																			18.00	36.00	36.00																18.00				18.00		0.60			0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	011	0	1	01	01	H3668_011_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	014	0	1	01	01	H3668_014_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3668	014	0	1	01	01	H3668_014_0	8	4	Non-Preferred Brand	1	4	100100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	75.00	150.00	225.00																			75.00	150.00	150.00																75.00				75.00		2.50			2.50			2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	014	0	1	01	01	H3668_014_0	8	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				660.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	014	0	1	01	01	H3668_014_0	8	3	Preferred Brand	1	4	000101	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	014	0	1	01	01	H3668_014_0	8	2	Generic	1	4	000101	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	014	0	1	01	01	H3668_014_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	015	0	1	01	01	H3668_015_0	8	3	Preferred Brand	1	4	000101	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	015	0	1	01	01	H3668_015_0	8	4	Non-Preferred Brand	1	4	100100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	015	0	1	01	01	H3668_015_0	8	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				660.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	015	0	1	01	01	H3668_015_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3668	015	0	1	01	01	H3668_015_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	015	0	1	01	01	H3668_015_0	8	2	Generic	1	4	000101	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	18.00	36.00	54.00																			18.00	36.00	36.00																18.00				18.00		0.60			0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	016	0	1	01	01	H3668_016_0	10	1	Preferred Generic	1	4	001001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	016	0	1	01	01	H3668_016_0	10	2	Generic	1	4	000101	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	016	0	1	01	01	H3668_016_0	10	3	Preferred Brand	1	4	000101	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	016	0	1	01	01	H3668_016_0	10	4	Non-Preferred Brand	1	4	100100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	75.00	150.00	225.00																			75.00	150.00	150.00																75.00				75.00		2.50			2.50			2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	016	0	1	01	01	H3668_016_0	10	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				660.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	016	0	1	01	01	H3668_016_0	10	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3668	017	0	1	01	01	H3668_017_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	017	0	1	01	01	H3668_017_0	8	2	Generic	1	4	000101	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	18.00	36.00	54.00																			18.00	36.00	36.00																18.00				18.00		0.60			0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	017	0	1	01	01	H3668_017_0	8	3	Preferred Brand	1	4	000101	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	017	0	1	01	01	H3668_017_0	8	4	Non-Preferred Brand	1	4	100100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	017	0	1	01	01	H3668_017_0	8	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				660.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	017	0	1	01	01	H3668_017_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3672	013	0	1	01	01	H3672_013_0	11	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											1000.00	33						1000.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3672	013	0	1	01	01	H3672_013_0	11	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	2			90				30		31								95.00		285.00					85.00		255.00							170.00																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3672	013	0	1	01	01	H3672_013_0	11	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31								45.00		135.00					35.00		105.00							70.00																45.00				45.00			1.50	1.17				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3672	013	0	1	01	01	H3672_013_0	11	2	Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								20.00		60.00					10.00		30.00							20.00																20.00				20.00			0.67	0.33				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3672	013	0	1	01	01	H3672_013_0	11	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								13.00		39.00					3.00		9.00							6.00																13.00				13.00			0.43	0.10				0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3672	013	0	1	01	01	H3672_013_0	11	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								13.00		39.00					3.00		9.00							6.00																13.00				13.00			0.43	0.10				0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3672	013	0	1	01	01	H3672_013_0	11	2	Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								20.00		60.00					10.00		30.00							20.00																20.00				20.00			0.67	0.33				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3672	018	0	1	01	01	H3672_018_0	10	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											1000.00	33						1000.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3672	018	0	1	01	01	H3672_018_0	10	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	2			90				30		31								95.00		285.00					85.00		255.00							170.00																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3672	018	0	1	01	01	H3672_018_0	10	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31								45.00		135.00					35.00		105.00							70.00																45.00				45.00			1.50	1.17				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3672	018	0	1	01	01	H3672_018_0	10	2	Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								20.00		60.00					10.00		30.00							20.00																20.00				20.00			0.67	0.33				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3672	018	0	1	01	01	H3672_018_0	10	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								15.00		45.00					5.00		15.00							10.00																15.00				15.00			0.50	0.17				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3672	018	0	1	01	01	H3672_018_0	10	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								15.00		45.00					5.00		15.00							10.00																15.00				15.00			0.50	0.17				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3672	020	0	1	01	01	H3672_020_0	12	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								13.00		39.00					3.00		9.00							6.00																13.00				13.00			0.43	0.10				0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3672	020	0	1	01	01	H3672_020_0	12	2	Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								20.00		60.00					10.00		30.00							20.00																20.00				20.00			0.67	0.33				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3672	020	0	1	01	01	H3672_020_0	12	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31								45.00		135.00					35.00		105.00							70.00																45.00				45.00			1.50	1.17				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3672	020	0	1	01	01	H3672_020_0	12	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	2			90				30		31								95.00		285.00					85.00		255.00							170.00																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3672	020	0	1	01	01	H3672_020_0	12	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											1000.00	33						1000.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3672	020	0	1	01	01	H3672_020_0	12	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								13.00		39.00					3.00		9.00							6.00																13.00				13.00			0.43	0.10				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3672	023	0	1	01	01	H3672_023_0	8	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								13.00		39.00					3.00		9.00							6.00																13.00				13.00			0.43	0.10				0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3672	023	0	1	01	01	H3672_023_0	8	2	Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								20.00		60.00					10.00		30.00							20.00																20.00				20.00			0.67	0.33				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3672	023	0	1	01	01	H3672_023_0	8	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31								45.00		135.00					35.00		105.00							70.00																45.00				45.00			1.50	1.17				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3672	023	0	1	01	01	H3672_023_0	8	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	2			90				30		31								95.00		285.00					85.00		255.00							170.00																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3672	023	0	1	01	01	H3672_023_0	8	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											1000.00	33						1000.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3672	023	0	1	01	01	H3672_023_0	8	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								13.00		39.00					3.00		9.00							6.00																13.00				13.00			0.43	0.10				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3706	001	0	1	01	01	H3706_001_0	9	5	Specialty Tier	1	4	100000	1	1		010	01		010	1				30							30			30		34											435.00	29						435.00	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3706	001	0	1	01	01	H3706_001_0	9	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	2				30		90	30		34								100.00		242.50					95.00		237.50											95.00		100.00				95.00		95.00				95.00				95.00			3.33	3.17		3.17	3.17	2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3706	001	0	1	01	01	H3706_001_0	9	3	Preferred Brand	1	4	000001	1	2		110	01		110	1				30		90	2				30		90	30		34								47.00		110.00					42.00		105.00											42.00		47.00				42.00		42.00				42.00				42.00			1.57	1.40		1.40	1.40	1.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3706	001	0	1	01	01	H3706_001_0	9	2	Generic	1	4	000100	1	2		110	01		110	1				30		90	2				30		90	30		34								17.00		35.00					12.00		30.00											12.00		17.00				12.00		12.00				12.00				12.00			0.57	0.40		0.40	0.40	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3706	001	0	1	01	01	H3706_001_0	9	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	2				30		90	30		34								10.00		17.50					5.00		12.50											5.00		10.00				5.00		5.00				5.00				5.00			0.33	0.17		.17	.17	.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3749	001	0	1	01	01	H3749_001_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				553.00	30		30																										30						30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3749	001	0	1	01	01	H3749_001_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3749	001	0	1	01	01	H3749_001_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3749	001	0	1	01	01	H3749_001_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3749	001	0	1	01	01	H3749_001_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3749	017	0	1	01	01	H3749_017_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				497.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3749	017	0	1	01	01	H3749_017_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3749	017	0	1	01	01	H3749_017_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3749	017	0	1	01	01	H3749_017_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3749	017	0	1	01	01	H3749_017_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3749	018	0	1	01	01	H3749_018_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3749	018	0	1	01	01	H3749_018_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				555.00	30		30																										30						30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3749	018	0	1	01	01	H3749_018_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3749	018	0	1	01	01	H3749_018_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3749	018	0	1	01	01	H3749_018_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3755	001	0	1	01	01	H3755_001_0	5	6	Injectable Drugs	1	4	100000	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31				83.86	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H3755	001	0	1	01	01	H3755_001_0	5	5	Specialty Tier	1	4	100000	1	1	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H3755	001	0	1	01	01	H3755_001_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H3755	001	0	1	01	01	H3755_001_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	40.00	80.00	120.00																			40.00	80.00	80.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H3755	001	0	1	01	01	H3755_001_0	5	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H3755	001	0	1	01	01	H3755_001_0	5	1	Preferred Generic	1	4	001000	1	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H3755	004	0	1	01	01	H3755_004_0	5	5	Specialty Tier	1	4	100000	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H3755	004	0	1	01	01	H3755_004_0	5	6	Injectable Drugs	1	4	100000	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31				98.40	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H3755	004	0	1	01	01	H3755_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	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H3755	004	0	1	01	01	H3755_004_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	40.00	80.00	120.00																			40.00	80.00	80.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H3755	004	0	1	01	01	H3755_004_0	5	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H3755	004	0	1	01	01	H3755_004_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H3755	005	0	1	01	01	H3755_005_0	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H3755	005	0	1	01	01	H3755_005_0	7	6	Injectable Drugs	1	4	100000	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31				87.10	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H3755	005	0	1	01	01	H3755_005_0	7	5	Specialty Tier	1	4	100000	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H3755	005	0	1	01	01	H3755_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	90.00	180.00	270.00																			90.00	180.00	180.00																90.00				90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H3755	005	0	1	01	01	H3755_005_0	7	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	40.00	80.00	120.00																			40.00	80.00	80.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H3755	005	0	1	01	01	H3755_005_0	7	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	13.00	26.00	39.00																			13.00	26.00	26.00																13.00				13.00		0.43			0.43			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H3765	001	0	1	01	01	H3765_001_0	5	5	Specialty Tier	1	4	000010	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3765	001	0	1	01	01	H3765_001_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	38.00	76.00	95.00																			38.00	76.00	114.00																38.00				38.00		1.23			1.23			1.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3765	001	0	1	01	01	H3765_001_0	5	4	Non-Preferred Brand	1	4	100000	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31				95.09	35	35	35																		35	35	35															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3765	001	0	1	01	01	H3765_001_0	5	2	Generic	1	4	000100	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	10.00	20.00	25.00																			10.00	20.00	30.00																10.00				10.00		0.32			0.32			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3765	001	0	1	01	01	H3765_001_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	2.00	4.00	5.00																			2.00	4.00	6.00																2.00				2.00		0.06			0.06			0.06	Preferred Generic, 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	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3794	003	0	1	01	01	H3794_003_0	3	2	Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, 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	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3794	003	0	1	01	01	H3794_003_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, 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				448.00	31		31																										31						31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	001	0	1	01	01	H3805_001_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	001	0	1	01	01	H3805_001_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	001	0	1	01	01	H3805_001_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				438.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	001	0	1	01	01	H3805_001_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	001	0	1	01	01	H3805_001_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	007	0	1	01	01	H3805_007_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	007	0	1	01	01	H3805_007_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				516.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	007	0	1	01	01	H3805_007_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	007	0	1	01	01	H3805_007_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	007	0	1	01	01	H3805_007_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	012	0	1	01	01	H3805_012_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	012	0	1	01	01	H3805_012_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				367.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	012	0	1	01	01	H3805_012_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	012	0	1	01	01	H3805_012_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	012	0	1	01	01	H3805_012_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	013	0	1	01	01	H3805_013_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	013	0	1	01	01	H3805_013_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				434.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	013	0	1	01	01	H3805_013_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	013	0	1	01	01	H3805_013_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	013	0	1	01	01	H3805_013_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	014	0	1	01	01	H3805_014_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	014	0	1	01	01	H3805_014_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				473.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	014	0	1	01	01	H3805_014_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	014	0	1	01	01	H3805_014_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	014	0	1	01	01	H3805_014_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	015	0	1	01	01	H3805_015_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	015	0	1	01	01	H3805_015_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				468.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	015	0	1	01	01	H3805_015_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	015	0	1	01	01	H3805_015_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	015	0	1	01	01	H3805_015_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	016	0	1	01	01	H3805_016_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	016	0	1	01	01	H3805_016_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				457.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	016	0	1	01	01	H3805_016_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	016	0	1	01	01	H3805_016_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	016	0	1	01	01	H3805_016_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	017	0	1	01	01	H3805_017_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	017	0	1	01	01	H3805_017_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				457.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	017	0	1	01	01	H3805_017_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	017	0	1	01	01	H3805_017_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	017	0	1	01	01	H3805_017_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	018	0	1	01	01	H3805_018_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	018	0	1	01	01	H3805_018_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				457.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	018	0	1	01	01	H3805_018_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	018	0	1	01	01	H3805_018_0	4	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	018	0	1	01	01	H3805_018_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	019	0	1	01	01	H3805_019_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	019	0	1	01	01	H3805_019_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	019	0	1	01	01	H3805_019_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				457.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	019	0	1	01	01	H3805_019_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	019	0	1	01	01	H3805_019_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	020	0	1	01	01	H3805_020_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	020	0	1	01	01	H3805_020_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	020	0	1	01	01	H3805_020_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	020	0	1	01	01	H3805_020_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3805	020	0	1	01	01	H3805_020_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				457.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3810	003	0	1	01	01	H3810_003_0	7	3	Preferred Brand	1	4	000001	1	2	111		01		111	1	30	60	90				1				30	60	90	30		31	45.00	90.00	90.00																									45.00	90.00	135.00				45.00	90.00	90.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3810	003	0	1	01	01	H3810_003_0	7	4	Non-Preferred Brand	1	4	100000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		31	95.00	190.00	190.00																									95.00	190.00	285.00				95.00	190.00	190.00				95.00				95.00		3.17				3.17	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3810	003	0	1	01	01	H3810_003_0	7	2	Generic	1	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		31	15.00	30.00	30.00																									15.00	30.00	45.00				15.00	30.00	30.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3810	003	0	1	01	01	H3810_003_0	7	1	Preferred Generic	1	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		31	5.00	10.00	0.00																									5.00	10.00	15.00				5.00	10.00	0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3810	003	0	1	01	01	H3810_003_0	7	5	Specialty Tier	1	4	100000	1	1	111		01		111	1	30	60	90				1				30	60	90	30		31				600.00	25	25	25																								25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3810	003	0	1	01	01	H3810_003_0	7	1	Preferred Generic	3	4	001000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		31	10.00	20.00	20.00																									10.00	20.00	30.00				10.00	20.00	20.00				10.00				10.00		.33				.33	.33	.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3811	002	0	1	01	01	H3811_002_0	10	2	Generic	1	4	000100	1	2	111		01	100		1	34	60	90				2			90				34		31	9.00	18.00	27.00																					27.00																9.00				9.00		0.26						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3811	002	0	1	01	01	H3811_002_0	10	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	34	60	90				1			90				34		31	3.00	6.00	9.00																					9.00																3.00				3.00		.09						.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3811	002	0	1	01	01	H3811_002_0	10	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	34	60	90				2			90				34		31	45.00	90.00	135.00																					135.00																45.00				45.00		1.32						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3811	002	0	1	01	01	H3811_002_0	10	5	Specialty Tier	1	4	000001	1	1	010		01			1	34													34		31				68.51	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3811	002	0	1	01	01	H3811_002_0	10	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	34	60	90				2			90				34		31	100.00	200.00	300.00																					300.00																100.00				100.00		2.94						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3811	009	0	1	01	01	H3811_009_0	11	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	34	60	90				1			90				34		31	3.00	6.00	9.00																					9.00																3.00				3.00		0.09						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3811	009	0	1	01	01	H3811_009_0	11	2	Generic	1	4	000100	1	2	111		01	100		1	34	60	90				2			90				34		31	9.00	18.00	27.00																					27.00																9.00				9.00		0.26						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3811	009	0	1	01	01	H3811_009_0	11	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	34	60	90				2			90				34		31	45.00	90.00	135.00																					135.00																45.00				45.00		1.32						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3811	009	0	1	01	01	H3811_009_0	11	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	34	60	90				2			90				34		31	100.00	200.00	300.00																					300.00																100.00				100.00		2.94						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3811	009	0	1	01	01	H3811_009_0	11	1	Preferred Generic	3	4	001000	1	2	111		01	100		1	34	60	90				1			90				34		31	3.00	6.00	9.00																					9.00																3.00				3.00		0.09						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3811	009	0	1	01	01	H3811_009_0	11	5	Specialty Tier	1	4	000010	1	1	010		01			1	34													34		31				68.51	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3811	009	0	1	01	01	H3811_009_0	11	2	Generic	3	4	000100	1	2	111		01	100		1	34	60	90				2			90				34		31	9.00	18.00	27.00																					27.00																9.00				9.00		0.26						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3813	006	0	1	04	01	H3813_006_0	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3813	006	0	1	04	01	H3813_006_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	62	93				1	31	62	93				31		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.45			1.45			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3813	006	0	1	04	01	H3813_006_0	5	2	Generic	1	4	000100	1	2	111		01	111		1	31	62	93				1	31	62	93				31		31	10.00	20.00	30.00																			10.00	20.00	30.00																10.00				10.00		.32			.32			.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3813	006	0	1	04	01	H3813_006_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	62	93				1	31	62	93				31		31	2.00	4.00	6.00																			2.00	4.00	6.00																2.00				2.00		.06			.06			.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3813	006	0	1	04	01	H3813_006_0	5	5	Specialty Tier	1	4	100100	1	1	010		01	010		1	31							31						31		31				300.00	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3815	001	0	1	01	01	H3815_001_0	7	4	Non-Preferred Brand	1	4	100000	1	2	111		10		111	1	30	60	90				1				30	60	90		20	31	75.00	150.00	225.00																									75.00	150.00	225.00				75.00	150.00	150.00					75.00			75.00		2.50				2.50	2.50	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3815	001	0	1	01	01	H3815_001_0	7	3	Preferred Brand	1	4	000001	1	2	111		10		111	1	30	60	90				1				30	60	90		20	31	30.00	60.00	90.00																									30.00	60.00	90.00				30.00	60.00	60.00					30.00			30.00		1.00				1.00	1.00	.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3815	001	0	1	01	01	H3815_001_0	7	2	Generic	1	4	000100	1	2	111		10		111	1	30	60	90				1				30	60	90		20	31	5.00	10.00	15.00																									5.00	10.00	15.00				5.00	10.00	10.00					5.00			5.00		0.17				0.17	0.17	.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3815	001	0	1	01	01	H3815_001_0	7	1	Preferred Generic	1	4	001000	1	2	111		10		111	1	30	60	90				1				30	60	90		20	31	3.00	6.00	9.00																									3.00	6.00	9.00				3.00	6.00	6.00					3.00			3.00		0.10				0.10	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3815	001	0	1	01	01	H3815_001_0	7	5	Specialty Tier	1	4	100100	1	1	010		10			1	30														20	31				999.00	33																																						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3815	001	0	1	01	01	H3815_001_0	7	1	Preferred Generic	3	4	001000	1	2	111		10		111	1	30	60	90				1				30	60	90		20	31	3.00	6.00	9.00																									3.00	6.00	9.00				3.00	6.00	6.00					3.00			3.00		0.10				0.10	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3815	006	0	1	01	01	H3815_006_0	7	4	Non-Preferred Brand	1	4	100000	1	2	111		10		111	1	30	60	90				1				30	60	90		20	31	75.00	150.00	225.00																									75.00	150.00	225.00				75.00	150.00	150.00					75.00			75.00		2.50				2.50	2.50	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3815	006	0	1	01	01	H3815_006_0	7	3	Preferred Brand	1	4	000001	1	2	111		10		111	1	30	60	90				1				30	60	90		20	31	30.00	60.00	90.00																									30.00	60.00	90.00				30.00	60.00	60.00					30.00			30.00		1.00				1.00	1.00	.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3815	006	0	1	01	01	H3815_006_0	7	2	Generic	1	4	000100	1	2	111		10		111	1	30	60	90				1				30	60	90		20	31	10.00	20.00	30.00																									10.00	20.00	30.00				10.00	20.00	20.00					10.00			10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3815	006	0	1	01	01	H3815_006_0	7	1	Preferred Generic	1	4	001000	1	2	111		10		111	1	30	60	90				1				30	60	90		20	31	5.00	10.00	15.00																									5.00	10.00	15.00				5.00	10.00	10.00					5.00			5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3815	006	0	1	01	01	H3815_006_0	7	5	Specialty Tier	1	4	100100	1	1	010		10			1	30														20	31				999.00	33																																						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3815	007	0	1	01	01	H3815_007_0	7	5	Specialty Tier	1	4	100100	1	1	010		10			1	30														20	31				999.00	33																																						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3815	007	0	1	01	01	H3815_007_0	7	4	Non-Preferred Brand	1	4	100000	1	2	111		10		111	1	30	60	90				1				30	60	90		20	31	75.00	150.00	225.00																									75.00	150.00	225.00				75.00	150.00	150.00					75.00			75.00		2.50				2.50	2.50	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3815	007	0	1	01	01	H3815_007_0	7	3	Preferred Brand	1	4	000001	1	2	111		10		111	1	30	60	90				1				30	60	90		20	31	30.00	60.00	90.00																									30.00	60.00	90.00				30.00	60.00	60.00					30.00			30.00		1.00				1.00	1.00	.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3815	007	0	1	01	01	H3815_007_0	7	2	Generic	1	4	000100	1	2	111		10		111	1	30	60	90				1				30	60	90		20	31	5.00	10.00	15.00																									5.00	10.00	15.00				5.00	10.00	10.00					5.00			5.00		0.17				0.17	0.17	.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3815	007	0	1	01	01	H3815_007_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3815	008	0	1	01	01	H3815_008_0	6	5	Specialty Tier	1	4	100100	1	1	010		10			1	30														20	31				999.00	33																																						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3815	008	0	1	01	01	H3815_008_0	6	4	Non-Preferred Brand	1	4	100000	1	2	111		10		111	1	30	60	90				1				30	60	90		20	31	75.00	150.00	225.00																									75.00	150.00	225.00				75.00	150.00	150.00					75.00			75.00		2.50				2.50	2.50	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3815	008	0	1	01	01	H3815_008_0	6	3	Preferred Brand	1	4	000001	1	2	111		10		111	1	30	60	90				1				30	60	90		20	31	30.00	60.00	90.00																									30.00	60.00	90.00				30.00	60.00	60.00					30.00			30.00		1.00				1.00	1.00	.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3815	008	0	1	01	01	H3815_008_0	6	2	Generic	1	4	000100	1	2	111		10		111	1	30	60	90				1				30	60	90		20	31	5.00	10.00	15.00																									5.00	10.00	15.00				5.00	10.00	10.00					5.00			5.00		0.17				0.17	0.17	.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3815	008	0	1	01	01	H3815_008_0	6	1	Preferred Generic	3	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3815	008	0	1	01	01	H3815_008_0	6	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3815	010	0	1	01	01	H3815_010_0	7	4	Non-Preferred Brand	1	4	100000	1	2	111		10		111	1	30	60	90				1				30	60	90		20	31	75.00	150.00	225.00																									75.00	150.00	225.00				75.00	150.00	150.00					75.00			75.00		2.50				2.50	2.50	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3815	010	0	1	01	01	H3815_010_0	7	5	Specialty Tier	1	4	100100	1	1	010		10			1	30														20	31				999.00	33																																						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3815	010	0	1	01	01	H3815_010_0	7	1	Preferred Generic	3	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3815	010	0	1	01	01	H3815_010_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3815	010	0	1	01	01	H3815_010_0	7	2	Generic	1	4	000100	1	2	111		10		111	1	30	60	90				1				30	60	90		20	31	5.00	10.00	15.00																									5.00	10.00	15.00				5.00	10.00	10.00					5.00			5.00		0.17				0.17	0.17	.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3815	010	0	1	01	01	H3815_010_0	7	3	Preferred Brand	1	4	000001	1	2	111		10		111	1	30	60	90				1				30	60	90		20	31	30.00	60.00	90.00																									30.00	60.00	90.00				30.00	60.00	60.00					30.00			30.00		1.00				1.00	1.00	.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3815	011	0	1	01	01	H3815_011_0	8	3	Preferred Brand	1	4	000001	1	2	111		10		111	1	30	60	90				1				30	60	90		20	31	30.00	60.00	90.00																									30.00	60.00	90.00				30.00	60.00	60.00					30.00			30.00		1.00				1.00	1.00	.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3815	011	0	1	01	01	H3815_011_0	8	2	Generic	1	4	000100	1	2	111		10		111	1	30	60	90				1				30	60	90		20	31	10.00	20.00	30.00																									10.00	20.00	30.00				10.00	20.00	20.00					10.00			10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3815	011	0	1	01	01	H3815_011_0	8	1	Preferred Generic	1	4	001000	1	2	111		10		111	1	30	60	90				1				30	60	90		20	31	5.00	10.00	15.00																									5.00	10.00	15.00				5.00	10.00	10.00					5.00			5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3815	011	0	1	01	01	H3815_011_0	8	5	Specialty Tier	1	4	100100	1	1	010		10			1	30														20	31				999.00	33																																						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3815	011	0	1	01	01	H3815_011_0	8	4	Non-Preferred Brand	1	4	100000	1	2	111		10		111	1	30	60	90				1				30	60	90		20	31	75.00	150.00	225.00																									75.00	150.00	225.00				75.00	150.00	150.00					75.00			75.00		2.50				2.50	2.50	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3815	012	0	1	01	01	H3815_012_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3815	012	0	1	01	01	H3815_012_0	9	3	Preferred Brand	1	4	000001	1	2	111		10		111	1	30	60	90				1				30	60	90		20	31	30.00	60.00	90.00																									30.00	60.00	90.00				30.00	60.00	60.00					30.00			30.00		1.00				1.00	1.00	.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3815	012	0	1	01	01	H3815_012_0	9	4	Non-Preferred Brand	1	4	100000	1	2	111		10		111	1	30	60	90				1				30	60	90		20	31	75.00	150.00	225.00																									75.00	150.00	225.00				75.00	150.00	150.00					75.00			75.00		2.50				2.50	2.50	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3815	012	0	1	01	01	H3815_012_0	9	5	Specialty Tier	1	4	100100	1	1	010		10			1	30														20	31				999.00	33																																						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3815	012	0	1	01	01	H3815_012_0	9	1	Preferred Generic	3	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3815	012	0	1	01	01	H3815_012_0	9	2	Generic	1	4	000100	1	2	111		10		111	1	30	60	90				1				30	60	90		20	31	5.00	10.00	15.00																									5.00	10.00	15.00				5.00	10.00	10.00					5.00			5.00		0.17				0.17	0.17	.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3817	008	1	1	04	01	H3817_008_1	6	6	Select Care Drugs	1	3	010000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3817	008	1	1	04	01	H3817_008_1	6	4	Non-Preferred Brand	1	3	110000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	100.00	200.00	250.00																			100.00	200.00	250.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3817	008	1	1	04	01	H3817_008_1	6	5	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3817	008	1	1	04	01	H3817_008_1	6	3	Preferred Brand	1	3	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	94.00	117.50																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3817	008	1	1	04	01	H3817_008_1	6	2	Generic	1	3	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	15.00	30.00	30.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3817	008	1	1	04	01	H3817_008_1	6	1	Preferred Generic	1	3	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	10.00	20.00	20.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3817	008	2	1	04	01	H3817_008_2	6	1	Preferred Generic	1	3	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	10.00	20.00	20.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3817	008	2	1	04	01	H3817_008_2	6	2	Generic	1	3	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	15.00	30.00	30.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3817	008	2	1	04	01	H3817_008_2	6	3	Preferred Brand	1	3	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	94.00	117.50																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3817	008	2	1	04	01	H3817_008_2	6	4	Non-Preferred Brand	1	3	110000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	100.00	200.00	250.00																			100.00	200.00	250.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3817	008	2	1	04	01	H3817_008_2	6	5	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3817	008	2	1	04	01	H3817_008_2	6	6	Select Care Drugs	1	3	010000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3817	009	1	1	04	01	H3817_009_1	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	5.00	10.00	10.00																			5.00	10.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3817	009	1	1	04	01	H3817_009_1	7	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	12.00	24.00	24.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3817	009	1	1	04	01	H3817_009_1	7	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	94.00	117.50																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3817	009	1	1	04	01	H3817_009_1	7	4	Non-Preferred Brand	1	4	110000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	100.00	200.00	250.00																			100.00	200.00	250.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3817	009	1	1	04	01	H3817_009_1	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3817	009	1	1	04	01	H3817_009_1	7	6	Select Care Drugs	1	4	010000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3817	009	2	1	04	01	H3817_009_2	7	4	Non-Preferred Brand	1	4	110000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	100.00	200.00	250.00																			100.00	200.00	250.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3817	009	2	1	04	01	H3817_009_2	7	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	94.00	117.50																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3817	009	2	1	04	01	H3817_009_2	7	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	12.00	24.00	24.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3817	009	2	1	04	01	H3817_009_2	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	5.00	10.00	10.00																			5.00	10.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3817	009	2	1	04	01	H3817_009_2	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3817	009	2	1	04	01	H3817_009_2	7	6	Select Care Drugs	1	4	010000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3818	002	0	1	01	01	H3818_002_0	7	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3818	002	0	1	01	01	H3818_002_0	7	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3818	002	0	1	01	01	H3818_002_0	7	2	Generic	1	4	000100	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3818	002	0	1	01	01	H3818_002_0	7	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3818	002	0	1	01	01	H3818_002_0	7	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3818	002	0	1	01	01	H3818_002_0	7	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3818	003	0	1	01	01	H3818_003_0	8	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3818	003	0	1	01	01	H3818_003_0	8	2	Generic	1	3	000101	1	2	111		10	111		1	30	60	90				1	30	60	90					10	31	20.00	40.00	60.00																			20.00	20.00	20.00																	20.00			20.00		.22			.22			.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3818	003	0	1	01	01	H3818_003_0	8	3	Preferred Brand	1	3	000101	1	2	111		10	111		1	30	60	90				1	30	60	90					10	31	35.00	70.00	105.00																			35.00	35.00	35.00																	35.00			35.00		.99			.99			.96	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3818	003	0	1	01	01	H3818_003_0	8	4	Non-Preferred Brand	1	3	100100	1	2	111		10	111		1	30	60	90				1	30	60	90					10	31	90.00	180.00	270.00																			90.00	90.00	90.00																	90.00			90.00		2.33			2.33			2.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3818	003	0	1	01	01	H3818_003_0	8	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3818	014	0	1	01	01	H3818_014_0	9	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3818	014	0	1	01	01	H3818_014_0	9	2	Generic	1	4	000101	1	2	111		10	111		1	30	60	90				1	30	60	90					10	31	7.00	14.00	21.00																			7.00	7.00	7.00																	7.00			7.00		.22			.22			.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3818	014	0	1	01	01	H3818_014_0	9	3	Preferred Brand	1	4	000101	1	2	111		10	111		1	30	60	90				1	30	60	90					10	31	30.00	60.00	90.00																			30.00	30.00	30.00																	30.00			30.00		.99			.99			.96	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3818	014	0	1	01	01	H3818_014_0	9	4	Non-Preferred Brand	1	4	100100	1	2	111		10	111		1	30	60	90				1	30	60	90					10	31	70.00	140.00	210.00																			70.00	70.00	70.00																	70.00			70.00		2.33			2.33			2.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3818	014	0	1	01	01	H3818_014_0	9	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	001	0	1	01	01	H3822_001_0	7	1	Preferred Generic	3	4	001010	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3822	001	0	1	01	01	H3822_001_0	7	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31											1330.00	33		33				1330.00	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	001	0	1	01	01	H3822_001_0	7	1	Preferred Generic	1	4	001010	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	001	0	1	01	01	H3822_001_0	7	2	Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								11.00		33.00					6.00		18.00							33.00																11.00				11.00			0.37	0.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	001	0	1	01	01	H3822_001_0	7	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31								44.00		132.00					39.00		117.00							132.00																44.00				44.00			1.47	1.30				1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	001	0	1	01	01	H3822_001_0	7	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					85.00		255.00							285.00																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	001	0	1	01	01	H3822_001_0	7	2	Generic	3	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								11.00		33.00					6.00		18.00							33.00																11.00				11.00			0.37	0.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3822	002	0	1	01	01	H3822_002_0	6	1	Preferred Generic	1	4	001010	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	002	0	1	01	01	H3822_002_0	6	2	Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								11.00		33.00					6.00		18.00							33.00																11.00				11.00			0.37	0.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	002	0	1	01	01	H3822_002_0	6	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31								44.00		132.00					39.00		117.00							132.00																44.00				44.00			1.47	1.30				1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	002	0	1	01	01	H3822_002_0	6	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					85.00		255.00							285.00																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	002	0	1	01	01	H3822_002_0	6	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31											1330.00	33		33				1330.00	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	002	0	1	01	01	H3822_002_0	6	1	Preferred Generic	3	4	001010	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			.16	.00				.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3822	002	0	1	01	01	H3822_002_0	6	2	Generic	3	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								11.00		33.00					6.00		18.00							33.00																11.00				11.00			.36	.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3822	003	0	1	01	01	H3822_003_0	6	2	Generic	3	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								11.00		33.00					6.00		18.00							33.00																11.00				11.00			.36	.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3822	003	0	1	01	01	H3822_003_0	6	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			.16	.00				.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3822	003	0	1	01	01	H3822_003_0	6	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31											1330.00	33		33				1330.00	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	003	0	1	01	01	H3822_003_0	6	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					85.00		255.00							285.00																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	003	0	1	01	01	H3822_003_0	6	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31								44.00		132.00					39.00		117.00							132.00																44.00				44.00			1.47	1.30				1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	003	0	1	01	01	H3822_003_0	6	2	Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								11.00		33.00					6.00		18.00							33.00																11.00				11.00			0.37	0.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	003	0	1	01	01	H3822_003_0	6	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	007	0	1	02	01	H3822_007_0	7	2	Generic	3	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								11.00		33.00					6.00		18.00							33.00																11.00				11.00			0.37	0.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3822	007	0	1	02	01	H3822_007_0	7	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3822	007	0	1	02	01	H3822_007_0	7	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31											1330.00	33		33				1330.00	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	007	0	1	02	01	H3822_007_0	7	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					85.00		255.00							285.00																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	007	0	1	02	01	H3822_007_0	7	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31								44.00		132.00					39.00		117.00							132.00																44.00				44.00			1.47	1.30				1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	007	0	1	02	01	H3822_007_0	7	2	Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								11.00		33.00					6.00		18.00							33.00																11.00				11.00			0.37	0.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	007	0	1	02	01	H3822_007_0	7	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	008	0	1	02	01	H3822_008_0	9	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					85.00		255.00							285.00																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	008	0	1	02	01	H3822_008_0	9	2	Generic	3	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								11.00		33.00					6.00		18.00							33.00																11.00				11.00			0.37	0.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3822	008	0	1	02	01	H3822_008_0	9	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3822	008	0	1	02	01	H3822_008_0	9	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31											1330.00	33		33				1330.00	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	008	0	1	02	01	H3822_008_0	9	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	008	0	1	02	01	H3822_008_0	9	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31								44.00		132.00					39.00		117.00							132.00																44.00				44.00			1.47	1.30				1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	008	0	1	02	01	H3822_008_0	9	2	Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								11.00		33.00					6.00		18.00							33.00																11.00				11.00			0.37	0.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	009	0	1	01	01	H3822_009_0	10	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3822	009	0	1	01	01	H3822_009_0	10	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31											1330.00	33		33				1330.00	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	009	0	1	01	01	H3822_009_0	10	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					85.00		255.00							285.00																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	009	0	1	01	01	H3822_009_0	10	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31								44.00		132.00					39.00		117.00							132.00																44.00				44.00			1.47	1.30				1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	009	0	1	01	01	H3822_009_0	10	2	Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								11.00		33.00					6.00		18.00							33.00																11.00				11.00			0.37	0.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	009	0	1	01	01	H3822_009_0	10	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	009	0	1	01	01	H3822_009_0	10	2	Generic	3	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								11.00		33.00					6.00		18.00							33.00																11.00				11.00			0.37	0.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3832	007	0	1	04	01	H3832_007_0	9	5	Specialty Tier	1	3	010010	1	1	110		01	100		1	30		90				2			90				30		34					25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3832	007	0	1	04	01	H3832_007_0	9	4	Non-Preferred Brand	1	3	100000	1	2	110		01	100		1	30		90				2			90				30		34	100.00		300.00																					200.00																100.00				100.00		3.33						2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3832	007	0	1	04	01	H3832_007_0	9	3	Preferred Brand	1	3	000001	1	2	110		01	100		1	30		90				2			90				30		34	47.00		141.00																					94.00																47.00				47.00		1.57						1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3832	007	0	1	04	01	H3832_007_0	9	2	Generic	1	3	000100	1	2	110		01	100		1	30		90				2			90				30		34	20.00		60.00																					40.00																20.00				20.00		0.67						0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3832	007	0	1	04	01	H3832_007_0	9	1	Preferred Generic	1	3	001000	1	2	110		01	100		1	30		90				2			90				30		34	5.00		15.00																					5.00																5.00				5.00		0.17						0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3832	008	0	1	04	01	H3832_008_0	7	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3832	008	0	1	04	01	H3832_008_0	7	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		34	95.00		285.00																					190.00																95.00				95.00		3.17						2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3832	008	0	1	04	01	H3832_008_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		34	45.00		135.00																					90.00																45.00				45.00		1.50						1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3832	008	0	1	04	01	H3832_008_0	7	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		34	11.00		33.00																					22.00																11.00				11.00		0.37						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3832	008	0	1	04	01	H3832_008_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		34	4.00		12.00																					4.00																4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3832	008	0	1	04	01	H3832_008_0	7	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		34	4.00		12.00																					4.00																4.00				4.00		.13						.11	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3832	009	0	1	04	01	H3832_009_0	8	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				2			90				30		34					25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3832	009	0	1	04	01	H3832_009_0	8	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		34	100.00		300.00																					200.00																100.00				100.00		3.33						2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3832	009	0	1	04	01	H3832_009_0	8	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		34	47.00		141.00																					94.00																47.00				47.00		1.57						1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3832	009	0	1	04	01	H3832_009_0	8	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		34	12.00		36.00																					24.00																12.00				12.00		0.40						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3832	009	0	1	04	01	H3832_009_0	8	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		34	4.50		13.50																					4.50																4.50				4.50		0.15						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3832	010	0	1	04	01	H3832_010_0	8	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				2			90				30		34					33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3832	010	0	1	04	01	H3832_010_0	8	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		34	95.00		285.00																					190.00																95.00				95.00		3.17						2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3832	010	0	1	04	01	H3832_010_0	8	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		34	45.00		135.00																					90.00																45.00				45.00		1.50						1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3832	010	0	1	04	01	H3832_010_0	8	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		34	11.00		33.00																					22.00																11.00				11.00		0.37						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3832	010	0	1	04	01	H3832_010_0	8	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		34	4.00		12.00																					4.00																4.00				4.00		.13						.11	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3832	010	0	1	04	01	H3832_010_0	8	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		34	4.00		12.00																					4.00																4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3864	006	0	1	01	01	H3864_006_0	10	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	2				30		90	30		31								7.00		21.00					2.00		6.00											7.00		21.00				2.00		6.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3864	006	0	1	01	01	H3864_006_0	10	2	Generic	1	4	000100	1	2		110	01		110	1				30		90	2				30		90	30		31								17.00		51.00					12.00		36.00											17.00		51.00				12.00		36.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3864	006	0	1	01	01	H3864_006_0	10	3	Preferred Brand	1	4	000001	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					37.00		111.00											47.00		141.00				37.00		111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3864	006	0	1	01	01	H3864_006_0	10	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	2				30		90	30		31								100.00		300.00					90.00		270.00											100.00		300.00				90.00		270.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3864	006	0	1	01	01	H3864_006_0	10	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3864	006	0	1	01	01	H3864_006_0	10	4	Non-Preferred Brand	3	4	100000	1	2		110	01		110	1				30		90	2				30		90	30		31								100.00		300.00					90.00		270.00											100.00		300.00				90.00		270.00				100.00				100.00			3.33	3.00		3.33	3.00	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H3864	006	0	1	01	01	H3864_006_0	10	3	Preferred Brand	3	4	000001	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					37.00		111.00											47.00		141.00				37.00		111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H3864	006	0	1	01	01	H3864_006_0	10	6	Select Care Drugs	1	4	010000	1	2		110	01		110	1				30		90	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3864	006	0	1	01	01	H3864_006_0	10	6	Select Care Drugs	3	4	010000	1	2		110	01		110	1				30		90	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3864	014	0	1	01	01	H3864_014_0	8	6	Select Care Drugs	3	4	010000	1	2		110	01		110	1				30		90	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3864	014	0	1	01	01	H3864_014_0	8	4	Non-Preferred Brand	3	4	100000	1	2		110	01		110	1				30		90	2				30		90	30		31								100.00		300.00					90.00		270.00											100.00		300.00				90.00		270.00				100.00				100.00			3.33	3.00		3.33	3.00	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H3864	014	0	1	01	01	H3864_014_0	8	3	Preferred Brand	3	4	000001	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					37.00		111.00											47.00		141.00				37.00		111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H3864	014	0	1	01	01	H3864_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3864	014	0	1	01	01	H3864_014_0	8	6	Select Care Drugs	1	4	010000	1	2		110	01		110	1				30		90	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3864	014	0	1	01	01	H3864_014_0	8	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	2				30		90	30		31								100.00		300.00					90.00		270.00											100.00		300.00				90.00		270.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3864	014	0	1	01	01	H3864_014_0	8	3	Preferred Brand	1	4	000001	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					37.00		111.00											47.00		141.00				37.00		111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3864	014	0	1	01	01	H3864_014_0	8	2	Generic	1	4	000100	1	2		110	01		110	1				30		90	2				30		90	30		31								17.00		51.00					12.00		36.00											17.00		51.00				12.00		36.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3864	014	0	1	01	01	H3864_014_0	8	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	2				30		90	30		31								7.00		21.00					2.00		6.00											7.00		21.00				2.00		6.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3864	015	0	1	01	01	H3864_015_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3864	015	0	1	01	01	H3864_015_0	7	6	Select Care Drugs	1	4	010000	1	2		110	01		110	1				30		90	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
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								100.00		300.00					90.00		270.00											100.00		300.00				90.00		270.00				100.00				100.00			3.33	3.00		3.33	3.00	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
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								47.00		141.00					37.00		111.00											47.00		141.00				37.00		111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H3864	015	0	1	01	01	H3864_015_0	7	6	Select Care Drugs	3	4	010000	1	2		110	01		110	1				30		90	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3864	015	0	1	01	01	H3864_015_0	7	2	Generic	1	4	000100	1	2		110	01		110	1				30		90	2				30		90	30		31								17.00		51.00					12.00		36.00											17.00		51.00				12.00		36.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
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								47.00		141.00					37.00		111.00											47.00		141.00				37.00		111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
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								100.00		300.00					90.00		270.00											100.00		300.00				90.00		270.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
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								7.00		21.00					2.00		6.00											7.00		21.00				2.00		6.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3864	016	0	1	01	01	H3864_016_0	8	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	2				30		90	30		31								7.00		21.00					2.00		6.00											7.00		21.00				2.00		6.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3864	016	0	1	01	01	H3864_016_0	8	2	Generic	1	4	000100	1	2		110	01		110	1				30		90	2				30		90	30		31								17.00		51.00					12.00		36.00											17.00		51.00				12.00		36.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3864	016	0	1	01	01	H3864_016_0	8	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	2				30		90	30		31								100.00		300.00					90.00		270.00											100.00		300.00				90.00		270.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3864	016	0	1	01	01	H3864_016_0	8	3	Preferred Brand	1	4	000001	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					37.00		111.00											47.00		141.00				37.00		111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3864	016	0	1	01	01	H3864_016_0	8	4	Non-Preferred Brand	3	4	100000	1	2		110	01		110	1				30		90	2				30		90	30		31								100.00		300.00					90.00		270.00											100.00		300.00				90.00		270.00				100.00				100.00			3.33	3.00		3.33	3.00	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H3864	016	0	1	01	01	H3864_016_0	8	3	Preferred Brand	3	4	000001	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					37.00		111.00											47.00		141.00				37.00		111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H3864	016	0	1	01	01	H3864_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3864	016	0	1	01	01	H3864_016_0	8	6	Select Care Drugs	3	4	010000	1	2		110	01		110	1				30		90	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3864	016	0	1	01	01	H3864_016_0	8	6	Select Care Drugs	1	4	010000	1	2		110	01		110	1				30		90	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3864	019	0	1	01	01	H3864_019_0	8	3	Preferred Brand	3	4	000001	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					37.00		111.00											47.00		141.00				37.00		111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H3864	019	0	1	01	01	H3864_019_0	8	4	Non-Preferred Brand	3	4	100000	1	2		110	01		110	1				30		90	2				30		90	30		31								100.00		300.00					90.00		270.00											100.00		300.00				90.00		270.00				100.00				100.00			3.33	3.00		3.33	3.00	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H3864	019	0	1	01	01	H3864_019_0	8	6	Select Care Drugs	3	4	010000	1	2		110	01		110	1				30		90	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3864	019	0	1	01	01	H3864_019_0	8	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	2				30		90	30		31								7.00		21.00					2.00		6.00											7.00		21.00				2.00		6.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3864	019	0	1	01	01	H3864_019_0	8	2	Generic	1	4	000100	1	2		110	01		110	1				30		90	2				30		90	30		31								17.00		51.00					12.00		36.00											17.00		51.00				12.00		36.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3864	019	0	1	01	01	H3864_019_0	8	3	Preferred Brand	1	4	000001	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					37.00		111.00											47.00		141.00				37.00		111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3864	019	0	1	01	01	H3864_019_0	8	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	2				30		90	30		31								100.00		300.00					90.00		270.00											100.00		300.00				90.00		270.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3864	019	0	1	01	01	H3864_019_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3864	019	0	1	01	01	H3864_019_0	8	6	Select Care Drugs	1	4	010000	1	2		110	01		110	1				30		90	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3864	020	0	1	01	01	H3864_020_0	8	4	Non-Preferred Brand	3	4	100000	1	2		110	01		110	1				30		90	2				30		90	30		31								100.00		300.00					90.00		270.00											100.00		300.00				90.00		270.00				100.00				100.00			3.33	3.00		3.33	3.00	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H3864	020	0	1	01	01	H3864_020_0	8	3	Preferred Brand	3	4	000001	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					37.00		111.00											47.00		141.00				37.00		111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H3864	020	0	1	01	01	H3864_020_0	8	6	Select Care Drugs	3	4	010000	1	2		110	01		110	1				30		90	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3864	020	0	1	01	01	H3864_020_0	8	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	2				30		90	30		31								7.00		21.00					2.00		6.00											7.00		21.00				2.00		6.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3864	020	0	1	01	01	H3864_020_0	8	2	Generic	1	4	000100	1	2		110	01		110	1				30		90	2				30		90	30		31								17.00		51.00					12.00		36.00											17.00		51.00				12.00		36.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3864	020	0	1	01	01	H3864_020_0	8	3	Preferred Brand	1	4	000001	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					37.00		111.00											47.00		141.00				37.00		111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3864	020	0	1	01	01	H3864_020_0	8	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	2				30		90	30		31								100.00		300.00					90.00		270.00											100.00		300.00				90.00		270.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3864	020	0	1	01	01	H3864_020_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3864	020	0	1	01	01	H3864_020_0	8	6	Select Care Drugs	1	4	010000	1	2		110	01		110	1				30		90	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3864	021	0	1	01	01	H3864_021_0	8	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	2				30		90	30		31								7.00		21.00					2.00		6.00											7.00		21.00				2.00		6.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3864	021	0	1	01	01	H3864_021_0	8	4	Non-Preferred Brand	3	4	100000	1	2		110	01		110	1				30		90	2				30		90	30		31								100.00		300.00					90.00		270.00											100.00		300.00				90.00		270.00				100.00				100.00			3.33	3.00		3.33	3.00	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H3864	021	0	1	01	01	H3864_021_0	8	3	Preferred Brand	3	4	000001	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					37.00		111.00											47.00		141.00				37.00		111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H3864	021	0	1	01	01	H3864_021_0	8	6	Select Care Drugs	1	4	010000	1	2		110	01		110	1				30		90	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3864	021	0	1	01	01	H3864_021_0	8	6	Select Care Drugs	3	4	010000	1	2		110	01		110	1				30		90	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3864	021	0	1	01	01	H3864_021_0	8	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	2				30		90	30		31								100.00		300.00					90.00		270.00											100.00		300.00				90.00		270.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3864	021	0	1	01	01	H3864_021_0	8	3	Preferred Brand	1	4	000001	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					37.00		111.00											47.00		141.00				37.00		111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3864	021	0	1	01	01	H3864_021_0	8	2	Generic	1	4	000100	1	2		110	01		110	1				30		90	2				30		90	30		31								17.00		51.00					12.00		36.00											17.00		51.00				12.00		36.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3864	021	0	1	01	01	H3864_021_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3864	022	0	1	01	01	H3864_022_0	9	4	Non-Preferred Brand	3	4	100000	1	2		110	01		110	1				30		90	2				30		90	30		31								100.00		300.00					90.00		270.00											100.00		300.00				90.00		270.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H3864	022	0	1	01	01	H3864_022_0	9	3	Preferred Brand	3	4	000001	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					37.00		111.00											47.00		141.00				37.00		111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H3864	022	0	1	01	01	H3864_022_0	9	6	Select Care Drugs	1	4	010000	1	2		110	01		110	1				30		90	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3864	022	0	1	01	01	H3864_022_0	9	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3864	022	0	1	01	01	H3864_022_0	9	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	2				30		90	30		31								100.00		300.00					90.00		270.00											100.00		300.00				90.00		270.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3864	022	0	1	01	01	H3864_022_0	9	3	Preferred Brand	1	4	000001	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					37.00		111.00											47.00		141.00				37.00		111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3864	022	0	1	01	01	H3864_022_0	9	2	Generic	1	4	000100	1	2		110	01		110	1				30		90	2				30		90	30		31								17.00		51.00					12.00		36.00											17.00		51.00				12.00		36.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3864	022	0	1	01	01	H3864_022_0	9	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3864	022	0	1	01	01	H3864_022_0	9	6	Select Care Drugs	3	4	010000	1	2		110	01		110	1				30		90	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3864	023	0	1	01	01	H3864_023_0	9	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	2				30		90	30		31								100.00		300.00					90.00		270.00											100.00		300.00				90.00		270.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3864	023	0	1	01	01	H3864_023_0	9	3	Preferred Brand	1	4	000001	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					37.00		111.00											47.00		141.00				37.00		111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3864	023	0	1	01	01	H3864_023_0	9	2	Generic	1	4	000100	1	2		110	01		110	1				30		90	2				30		90	30		31								17.00		51.00					12.00		36.00											17.00		51.00				12.00		36.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3864	023	0	1	01	01	H3864_023_0	9	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3864	023	0	1	01	01	H3864_023_0	9	6	Select Care Drugs	3	4	010000	1	2		110	01		110	1				30		90	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3864	023	0	1	01	01	H3864_023_0	9	6	Select Care Drugs	1	4	010000	1	2		110	01		110	1				30		90	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3864	023	0	1	01	01	H3864_023_0	9	3	Preferred Brand	3	4	000001	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					37.00		111.00											47.00		141.00				37.00		111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H3864	023	0	1	01	01	H3864_023_0	9	4	Non-Preferred Brand	3	4	100000	1	2		110	01		110	1				30		90	2				30		90	30		31								100.00		300.00					90.00		270.00											100.00		300.00				90.00		270.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H3864	023	0	1	01	01	H3864_023_0	9	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
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								100.00		300.00					90.00		270.00											100.00		300.00				90.00		270.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
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								47.00		141.00					37.00		111.00											47.00		141.00				37.00		111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3864	024	0	1	02	01	H3864_024_0	10	2	Generic	1	4	000100	1	2		110	01		110	1				30		90	2				30		90	30		31								17.00		51.00					12.00		36.00											17.00		51.00				12.00		36.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
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								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3864	024	0	1	02	01	H3864_024_0	10	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3864	024	0	1	02	01	H3864_024_0	10	6	Select Care Drugs	3	4	010000	1	2		110	01		110	1				30		90	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
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								100.00		300.00					90.00		270.00											100.00		300.00				90.00		270.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										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								47.00		141.00					37.00		111.00											47.00		141.00				37.00		111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H3864	024	0	1	02	01	H3864_024_0	10	6	Select Care Drugs	1	4	010000	1	2		110	01		110	1				30		90	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3864	025	0	1	02	01	H3864_025_0	8	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	2				30		90	30		31								7.00		21.00					2.00		6.00											7.00		21.00				2.00		6.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3864	025	0	1	02	01	H3864_025_0	8	2	Generic	1	4	000100	1	2		110	01		110	1				30		90	2				30		90	30		31								17.00		51.00					12.00		36.00											17.00		51.00				12.00		36.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3864	025	0	1	02	01	H3864_025_0	8	3	Preferred Brand	1	4	000001	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					37.00		111.00											47.00		141.00				37.00		111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3864	025	0	1	02	01	H3864_025_0	8	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	2				30		90	30		31								100.00		300.00					90.00		270.00											100.00		300.00				90.00		270.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3864	025	0	1	02	01	H3864_025_0	8	6	Select Care Drugs	3	4	010000	1	2		110	01		110	1				30		90	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3864	025	0	1	02	01	H3864_025_0	8	3	Preferred Brand	3	4	000001	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					37.00		111.00											47.00		141.00				37.00		111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H3864	025	0	1	02	01	H3864_025_0	8	6	Select Care Drugs	1	4	010000	1	2		110	01		110	1				30		90	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3864	025	0	1	02	01	H3864_025_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3864	025	0	1	02	01	H3864_025_0	8	4	Non-Preferred Brand	3	4	100000	1	2		110	01		110	1				30		90	2				30		90	30		31								100.00		300.00					90.00		270.00											100.00		300.00				90.00		270.00				100.00				100.00			3.33	3.00		3.33	3.00	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H3890	001	0	1	04	01	H3890_001_0	10	1	Preferred Generic	1	4	001001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	7.00	14.00	21.00																			7.00	14.00	21.00																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3890	001	0	1	04	01	H3890_001_0	10	2	Generic	1	4	000101	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	45.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3890	001	0	1	04	01	H3890_001_0	10	3	Preferred Brand	1	4	000101	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3890	001	0	1	04	01	H3890_001_0	10	4	Non-Preferred Brand	1	4	100100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3890	001	0	1	04	01	H3890_001_0	10	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				750.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3890	002	0	1	04	01	H3890_002_0	11	1	Preferred Generic	1	4	001001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	12.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3890	002	0	1	04	01	H3890_002_0	11	2	Generic	1	4	000101	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	12.00	24.00	36.00																			12.00	24.00	36.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3890	002	0	1	04	01	H3890_002_0	11	3	Preferred Brand	1	4	000101	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	42.00	84.00	126.00																			42.00	84.00	126.00																42.00				42.00		1.40			1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3890	002	0	1	04	01	H3890_002_0	11	4	Non-Preferred Brand	1	4	100100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	92.00	184.00	276.00																			92.00	184.00	276.00																92.00				92.00		3.07			3.07			2.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3890	002	0	1	04	01	H3890_002_0	11	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30						2	30						30		31				750.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3907	006	0	1	01	01	H3907_006_0	10	2	Preferred Brand	1	4	010001	1	2	110		01	100		1	30		90				1			90				30		31	47.00		141.00																					117.50																47.00				47.00		1.57						1.52	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3907	006	0	1	01	01	H3907_006_0	10	3	Non-Preferred Brand	1	4	110000	1	2	110		01	100		1	30		90				1			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3907	006	0	1	01	01	H3907_006_0	10	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				665.41	33																				33																	33			33								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3907	006	0	1	01	01	H3907_006_0	10	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	10	1	Generic	1	4	010000	1	2	110		01	100		1	30		90				1			90				30		31	12.00		36.00																					24.00																12.00				12.00		0.40						0.39	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	010001	1	2	110		01	100		1	30		90				1			90				30		31	47.00		141.00																					117.50																47.00				47.00		1.57						1.52	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	12.00		36.00																					24.00																12.00				12.00		0.40						0.39	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				581.02	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	029	0	1	01	01	H3907_029_0	7	3	Non-Preferred Brand	1	4	110000	1	2	110		01	100		1	30		90				1			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	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	010001	1	2	110		01	100		1	30		90				1			90				30		31	47.00		141.00																					117.50																47.00				47.00		1.57						1.52	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	110000	1	2	110		01	100		1	30		90				1			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	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				654.52	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	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	14.00		42.00																					28.00																14.00				14.00		0.47						0.45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3907	039	0	1	01	01	H3907_039_0	7	5	Select Care Drugs	1	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	7	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				674.30	33																				33																	33			33								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3907	039	0	1	01	01	H3907_039_0	7	3	Non-Preferred Brand	1	4	110000	1	2	110		01	100		1	30		90				1			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3907	039	0	1	01	01	H3907_039_0	7	2	Preferred Brand	1	4	010001	1	2	110		01	100		1	30		90				1			90				30		31	47.00		141.00																					117.50																47.00				47.00		1.57						1.52	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3907	039	0	1	01	01	H3907_039_0	7	1	Generic	1	4	010000	1	2	110		01	100		1	30		90				1			90				30		31	14.00		42.00																					28.00																14.00				14.00		0.47						0.45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3909	001	0	1	04	01	H3909_001_0	4	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31				1.00	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3909	001	0	1	04	01	H3909_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	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3909	001	0	1	04	01	H3909_001_0	4	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3909	001	0	1	04	01	H3909_001_0	4	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	9.00	18.00	27.00																			9.00	18.00	18.00																9.00				9.00		0.30			0.30			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3909	001	0	1	04	01	H3909_001_0	4	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, 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	3.00	6.00	9.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3909	009	0	1	04	01	H3909_009_0	4	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	9.00	18.00	27.00																			9.00	18.00	18.00																9.00				9.00		0.30			0.30			0.29	Preferred Generic, 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	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, 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	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, 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				1.00	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	001	0	1	04	01	H3916_001_0	9	3	Preferred Brand	1	4	010001	1	2	110		01	100		1	31		90				1			90				31		31	47.00		141.00																					117.50																47.00				47.00		1.52						1.52	Preferred Generic, 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	3.00		9.00																					7.50																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	001	0	1	04	01	H3916_001_0	9	2	Generic	1	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	15.00		45.00																					37.50																15.00				15.00		0.48						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	001	0	1	04	01	H3916_001_0	9	4	Non-Preferred Brand	1	4	110000	1	1	110		01	100		1	31		90				1			90				31		31				92.91	45		45																				45															45			45								Preferred Generic, 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	010		01	010		1	31							31						31		31				990.20	33																				33																	33			33								Preferred Generic, 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	3.00		9.00																					7.50																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3916	001	0	1	04	01	H3916_001_0	9	2	Generic	3	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	15.00		45.00																					37.50																15.00				15.00		0.48						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3916	002	0	1	04	01	H3916_002_0	8	3	Preferred Brand	1	4	010001	1	2	110		01	100		1	31		90				1			90				31		31	47.00		141.00																					117.50																47.00				47.00		1.52						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	002	0	1	04	01	H3916_002_0	8	2	Generic	1	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	15.00		45.00																					37.50																15.00				15.00		0.48						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	002	0	1	04	01	H3916_002_0	8	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	31		90				1			90				31		31	3.00		9.00																					7.50																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	002	0	1	04	01	H3916_002_0	8	4	Non-Preferred Brand	1	4	110000	1	1	110		01	100		1	31		90				1			90				31		31				96.88	45		45																				45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	002	0	1	04	01	H3916_002_0	8	2	Generic	3	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	15.00		45.00																					37.50																15.00				15.00		0.48						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3916	002	0	1	04	01	H3916_002_0	8	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	31		90				1			90				31		31	3.00		9.00																					7.50																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3916	002	0	1	04	01	H3916_002_0	8	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31				868.27	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	005	0	1	04	01	H3916_005_0	8	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	31		90				1			90				31		31	3.00		9.00																					7.50																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	005	0	1	04	01	H3916_005_0	8	2	Generic	1	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	15.00		45.00																					37.50																15.00				15.00		0.48						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	005	0	1	04	01	H3916_005_0	8	3	Preferred Brand	1	4	010001	1	2	110		01	100		1	31		90				1			90				31		31	47.00		141.00																					117.50																47.00				47.00		1.52						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	005	0	1	04	01	H3916_005_0	8	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31				854.25	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	005	0	1	04	01	H3916_005_0	8	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	31		90				1			90				31		31	3.00		9.00																					7.50																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3916	005	0	1	04	01	H3916_005_0	8	4	Non-Preferred Brand	1	4	110000	1	1	110		01	100		1	31		90				1			90				31		31				89.32	45		45																				45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	005	0	1	04	01	H3916_005_0	8	2	Generic	3	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	15.00		45.00																					37.50																15.00				15.00		0.48						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3916	015	0	1	04	01	H3916_015_0	9	3	Preferred Brand	1	4	010001	1	2	110		01	100		1	31		90				1			90				31		31	47.00		141.00																					117.50																47.00				47.00		1.52						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	015	0	1	04	01	H3916_015_0	9	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31				1057.77	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	015	0	1	04	01	H3916_015_0	9	4	Non-Preferred Brand	1	4	110000	1	1	110		01	100		1	31		90				1			90				31		31				86.09	45		45																				45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	015	0	1	04	01	H3916_015_0	9	2	Generic	1	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	15.00		45.00																					37.50																15.00				15.00		0.48						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	015	0	1	04	01	H3916_015_0	9	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	31		90				1			90				31		31	3.00		9.00																					7.50																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	018	0	1	04	01	H3916_018_0	9	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	31		90				1			90				31		31	3.00		9.00																					7.50																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	018	0	1	04	01	H3916_018_0	9	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31				940.69	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	018	0	1	04	01	H3916_018_0	9	2	Generic	1	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	15.00		45.00																					37.50																15.00				15.00		0.48						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	018	0	1	04	01	H3916_018_0	9	3	Preferred Brand	1	4	010001	1	2	110		01	100		1	31		90				1			90				31		31	47.00		141.00																					117.50																47.00				47.00		1.52						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	018	0	1	04	01	H3916_018_0	9	4	Non-Preferred Brand	1	4	110000	1	1	110		01	100		1	31		90				1			90				31		31				95.13	45		45																				45															45			45								Preferred Generic, 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	3.00		9.00																					7.50																3.00				3.00		0.10						0.10	Preferred Generic, 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	010		01	010		1	31							31						31		31				798.31	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	022	0	1	04	01	H3916_022_0	9	4	Non-Preferred Brand	1	4	110000	1	1	110		01	100		1	31		90				1			90				31		31				95.20	45		45																				45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	022	0	1	04	01	H3916_022_0	9	2	Generic	1	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	15.00		45.00																					37.50																15.00				15.00		0.48						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	022	0	1	04	01	H3916_022_0	9	3	Preferred Brand	1	4	010001	1	2	110		01	100		1	31		90				1			90				31		31	47.00		141.00																					117.50																47.00				47.00		1.52						1.52	Preferred Generic, 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	010		01	010		1	31							31						31		31				1072.50	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	024	0	1	04	01	H3916_024_0	9	4	Non-Preferred Brand	1	4	110000	1	1	110		01	100		1	31		90				1			90				31		31				94.45	45		45																				45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	024	0	1	04	01	H3916_024_0	9	2	Generic	1	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	15.00		45.00																					37.50																15.00				15.00		0.48						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	024	0	1	04	01	H3916_024_0	9	3	Preferred Brand	1	4	010001	1	2	110		01	100		1	31		90				1			90				31		31	47.00		141.00																					117.50																47.00				47.00		1.52						1.52	Preferred Generic, 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	3.00		9.00																					7.50																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	032	0	1	04	01	H3916_032_0	9	3	Preferred Brand	1	4	010001	1	2	110		01	100		1	31		90				1			90				31		31	47.00		141.00																					117.50																47.00				47.00		1.52						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	032	0	1	04	01	H3916_032_0	9	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	31		90				1			90				31		31	3.00		9.00																					7.50																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	032	0	1	04	01	H3916_032_0	9	2	Generic	1	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	15.00		45.00																					37.50																15.00				15.00		0.48						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	032	0	1	04	01	H3916_032_0	9	4	Non-Preferred Brand	1	4	110000	1	1	110		01	100		1	31		90				1			90				31		31				80.84	45		45																				45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	032	0	1	04	01	H3916_032_0	9	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31				771.77	33																				33																	33			33								Preferred Generic, 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	010		01	010		1	31							31						31		31				1165.87	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	033	0	1	04	01	H3916_033_0	9	4	Non-Preferred Brand	1	4	110000	1	1	110		01	100		1	31		90				1			90				31		31				48.12	45		45																				45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	033	0	1	04	01	H3916_033_0	9	3	Preferred Brand	1	4	010001	1	2	110		01	100		1	31		90				1			90				31		31	47.00		141.00																					117.50																47.00				47.00		1.52						1.52	Preferred Generic, 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	3.00		9.00																					7.50																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3916	033	0	1	04	01	H3916_033_0	9	2	Generic	1	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	15.00		45.00																					37.50																15.00				15.00		0.48						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3923	013	0	1	04	01	H3923_013_0	8	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				30		90	1	30		90				30		31								12.00		36.00					4.00		12.00					4.00		12.00																12.00				12.00			0.40	0.13	0.13			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3923	013	0	1	04	01	H3923_013_0	8	2	Generic	1	4	000100	1	2		110	01	110		1				30		90	1	30		90				30		31								20.00		60.00					15.00		45.00					15.00		45.00																20.00				20.00			0.67	0.50	0.50			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3923	013	0	1	04	01	H3923_013_0	8	3	Preferred Brand	1	4	000101	1	2		110	01	110		1				30		90	1	30		90				30		31								47.00		141.00					39.00		117.00					39.00		117.00																47.00				47.00			1.57	1.30	1.30			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3923	013	0	1	04	01	H3923_013_0	8	4	Non-Preferred Brand	1	4	100100	1	2		110	01	110		1				30		90	1	30		90				30		31								99.00		297.00					89.00		267.00					89.00		267.00																99.00				99.00			3.30	2.97	2.97			3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3923	013	0	1	04	01	H3923_013_0	8	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											625.36	33						625.36	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3923	017	0	1	04	01	H3923_017_0	8	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				30		90	1	30		90				30		31								9.00		27.00					4.00		12.00					4.00		12.00																9.00				9.00			0.30	0.13	0.13			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3923	017	0	1	04	01	H3923_017_0	8	2	Generic	1	4	000100	1	2		110	01	110		1				30		90	1	30		90				30		31								15.00		45.00					10.00		30.00					10.00		30.00																15.00				15.00			0.50	0.33	0.33			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3923	017	0	1	04	01	H3923_017_0	8	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				30		90	1	30		90				30		31								45.00		135.00					38.00		114.00					38.00		114.00																45.00				45.00			1.50	1.27	1.27			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3923	017	0	1	04	01	H3923_017_0	8	4	Non-Preferred Brand	1	4	100100	1	2		110	01	110		1				30		90	1	30		90				30		31								95.00		285.00					89.00		267.00					89.00		267.00																95.00				95.00			3.17	2.97	2.97			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3923	017	0	1	04	01	H3923_017_0	8	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											409.37	33						409.37	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	3	1	04	01	H3924_059_3	6	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	3.00		9.00																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	3	1	04	01	H3924_059_3	6	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	47.00		141.00																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	3	1	04	01	H3924_059_3	6	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	20.00		60.00																					60.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	3	1	04	01	H3924_059_3	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	3	1	04	01	H3924_059_3	6	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31				1622.73	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	3	1	04	01	H3924_059_3	6	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	3.00		9.00																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3924	059	4	1	04	01	H3924_059_4	6	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	47.00		141.00																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	4	1	04	01	H3924_059_4	6	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	3.00		9.00																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	4	1	04	01	H3924_059_4	6	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	20.00		60.00																					60.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	4	1	04	01	H3924_059_4	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	4	1	04	01	H3924_059_4	6	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31				1622.73	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	4	1	04	01	H3924_059_4	6	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	3.00		9.00																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3924	059	6	1	04	01	H3924_059_6	6	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	3.00		9.00																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3924	059	6	1	04	01	H3924_059_6	6	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	47.00		141.00																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	6	1	04	01	H3924_059_6	6	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31				1622.73	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	6	1	04	01	H3924_059_6	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	6	1	04	01	H3924_059_6	6	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	3.00		9.00																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	6	1	04	01	H3924_059_6	6	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	20.00		60.00																					60.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	7	1	04	01	H3924_059_7	6	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	3.00		9.00																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3924	059	7	1	04	01	H3924_059_7	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	7	1	04	01	H3924_059_7	6	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31				1622.73	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	7	1	04	01	H3924_059_7	6	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	47.00		141.00																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	7	1	04	01	H3924_059_7	6	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	20.00		60.00																					60.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	7	1	04	01	H3924_059_7	6	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	3.00		9.00																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	8	1	04	01	H3924_059_8	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	8	1	04	01	H3924_059_8	6	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31				1622.73	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	8	1	04	01	H3924_059_8	6	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	3.00		9.00																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3924	059	8	1	04	01	H3924_059_8	6	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	3.00		9.00																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	8	1	04	01	H3924_059_8	6	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	20.00		60.00																					60.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	8	1	04	01	H3924_059_8	6	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	47.00		141.00																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	9	1	04	01	H3924_059_9	6	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	3.00		9.00																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	9	1	04	01	H3924_059_9	6	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	20.00		60.00																					60.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	9	1	04	01	H3924_059_9	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	9	1	04	01	H3924_059_9	6	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31				1622.73	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	9	1	04	01	H3924_059_9	6	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	3.00		9.00																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3924	059	9	1	04	01	H3924_059_9	6	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	47.00		141.00																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, 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	3.00		9.00																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3924	060	3	1	04	01	H3924_060_3	6	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	20.00		60.00																					60.00																20.00				20.00		0.67						0.65	Preferred Generic, 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	3.00		9.00																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	3	1	04	01	H3924_060_3	6	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31				1566.44	33																																					33			33								Preferred Generic, 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	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, 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	47.00		141.00																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	4	1	04	01	H3924_060_4	6	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	20.00		60.00																					60.00																20.00				20.00		0.67						0.65	Preferred Generic, 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	3.00		9.00																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, 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	47.00		141.00																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, 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	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	4	1	04	01	H3924_060_4	6	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31				1566.44	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	3.00		9.00																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3924	060	6	1	04	01	H3924_060_6	6	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	20.00		60.00																					60.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	6	1	04	01	H3924_060_6	6	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	3.00		9.00																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	6	1	04	01	H3924_060_6	6	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	47.00		141.00																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	6	1	04	01	H3924_060_6	6	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	3.00		9.00																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3924	060	6	1	04	01	H3924_060_6	6	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31				1566.44	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	6	1	04	01	H3924_060_6	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	7	1	04	01	H3924_060_7	6	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	3.00		9.00																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	7	1	04	01	H3924_060_7	6	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	20.00		60.00																					60.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	7	1	04	01	H3924_060_7	6	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	47.00		141.00																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	7	1	04	01	H3924_060_7	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	7	1	04	01	H3924_060_7	6	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31				1566.44	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	7	1	04	01	H3924_060_7	6	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	3.00		9.00																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3924	060	8	1	04	01	H3924_060_8	6	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31				1566.44	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	8	1	04	01	H3924_060_8	6	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	3.00		9.00																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3924	060	8	1	04	01	H3924_060_8	6	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	3.00		9.00																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	8	1	04	01	H3924_060_8	6	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	20.00		60.00																					60.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	8	1	04	01	H3924_060_8	6	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	47.00		141.00																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	8	1	04	01	H3924_060_8	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	9	1	04	01	H3924_060_9	6	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	3.00		9.00																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	9	1	04	01	H3924_060_9	6	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	20.00		60.00																					60.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	9	1	04	01	H3924_060_9	6	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	3.00		9.00																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3924	060	9	1	04	01	H3924_060_9	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	9	1	04	01	H3924_060_9	6	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31				1566.44	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	9	1	04	01	H3924_060_9	6	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	47.00		141.00																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3928	001	0	1	01	01	H3928_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											36.59	50	50	50				31.16	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3928	001	0	1	01	01	H3928_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3928	001	0	1	01	01	H3928_001_0	5	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								5.00	10.00	15.00					0.00	0.00	0.00					5.00	10.00	15.00																	5.00			5.00			0.17	0.00	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3928	001	0	1	01	01	H3928_001_0	5	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					15.00	30.00	45.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.50	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3928	001	0	1	01	01	H3928_001_0	5	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					45.00	90.00	135.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.50	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3928	002	0	1	01	01	H3928_002_0	5	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					0.00	0.00	0.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.00	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3928	002	0	1	01	01	H3928_002_0	5	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					15.00	30.00	45.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.50	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3928	002	0	1	01	01	H3928_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3928	002	0	1	01	01	H3928_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											40.93	50	50	50				34.57	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3928	002	0	1	01	01	H3928_002_0	5	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					45.00	90.00	135.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.50	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	004	0	1	01	01	H3931_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											50.97	50	50	50				48.52	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	004	0	1	01	01	H3931_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	004	0	1	01	01	H3931_004_0	7	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	117.50					47.00	94.00	117.50					47.00	94.00	117.50																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	004	0	1	01	01	H3931_004_0	7	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								17.00	34.00	42.50					12.00	24.00	30.00					17.00	34.00	42.50																	17.00			17.00			0.57	0.40	0.57			0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	004	0	1	01	01	H3931_004_0	7	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								8.00	16.00	20.00					2.00	4.00	5.00					8.00	16.00	20.00																	8.00			8.00			0.27	0.07	0.27			0.26	Preferred Generic, 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								8.00	16.00	20.00					2.00	4.00	5.00					8.00	16.00	20.00																	8.00			8.00			0.27	0.07	0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	064	0	1	01	01	H3931_064_0	4	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								17.00	34.00	42.50					12.00	24.00	30.00					17.00	34.00	42.50																	17.00			17.00			0.57	0.40	0.57			0.55	Preferred Generic, 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								47.00	94.00	117.50					47.00	94.00	117.50					47.00	94.00	117.50																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, 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											47.56	50	50	50				46.09	50	50	50				50	50	50																50		50								Preferred Generic, 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	29						1.00	29						29																		29		29								Preferred Generic, 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								10.00	20.00	25.00					0.00	0.00	0.00					10.00	20.00	25.00																	10.00			10.00			0.33	0.00	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	065	0	1	01	01	H3931_065_0	4	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	50.00					12.00	24.00	30.00					20.00	40.00	50.00																	20.00			20.00			0.67	0.40	0.67			0.65	Preferred Generic, 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								47.00	94.00	117.50					47.00	94.00	117.50					47.00	94.00	117.50																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, 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											50.79	50	50	50				49.46	50	50	50				50	50	50																50		50								Preferred Generic, 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	33						1.00	33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	070	0	1	01	01	H3931_070_0	5	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								17.00	34.00	42.50					2.00	4.00	5.00					17.00	34.00	42.50																	17.00			17.00			0.57	0.07	0.57			0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	070	0	1	01	01	H3931_070_0	5	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	50.00					15.00	30.00	37.50					20.00	40.00	50.00																	20.00			20.00			0.67	0.50	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	070	0	1	01	01	H3931_070_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	070	0	1	01	01	H3931_070_0	5	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											76.53	50	50	50				68.39	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	070	0	1	01	01	H3931_070_0	5	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								46.00	92.00	115.00					46.00	92.00	115.00					46.00	92.00	115.00																	46.00			46.00			1.53	1.53	1.53			1.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	081	0	1	01	01	H3931_081_0	7	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								17.00	34.00	51.00					12.00	24.00	36.00					17.00	34.00	51.00																	17.00			17.00			0.57	0.40	0.57			0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	081	0	1	01	01	H3931_081_0	7	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	081	0	1	01	01	H3931_081_0	7	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	081	0	1	01	01	H3931_081_0	7	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											56.43	50	50	50				54.63	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	081	0	1	01	01	H3931_081_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	083	0	1	01	01	H3931_083_0	5	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	17.50					1.00	2.00	2.50					7.00	14.00	17.50																	7.00			7.00			0.23	0.03	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	083	0	1	01	01	H3931_083_0	5	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								15.00	30.00	37.50					7.00	14.00	17.50					15.00	30.00	37.50																	15.00			15.00			0.50	0.23	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	083	0	1	01	01	H3931_083_0	5	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	117.50					47.00	94.00	117.50					47.00	94.00	117.50																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	083	0	1	01	01	H3931_083_0	5	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											46.09	50	50	50				43.21	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	083	0	1	01	01	H3931_083_0	5	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31											1.00	26						1.00	26						26																		26		26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	084	0	1	01	01	H3931_084_0	6	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	50.00					14.00	28.00	35.00					20.00	40.00	50.00																	20.00			20.00			0.67	0.47	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	084	0	1	01	01	H3931_084_0	6	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	25.00					2.00	4.00	5.00					10.00	20.00	25.00																	10.00			10.00			0.33	0.07	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	084	0	1	01	01	H3931_084_0	6	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	117.50					47.00	94.00	117.50					47.00	94.00	117.50																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	084	0	1	01	01	H3931_084_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	084	0	1	01	01	H3931_084_0	6	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											45.69	50	50	50				42.48	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	087	0	1	01	01	H3931_087_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	087	0	1	01	01	H3931_087_0	5	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											44.79	50	50	50				40.58	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	087	0	1	01	01	H3931_087_0	5	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	087	0	1	01	01	H3931_087_0	5	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								17.00	34.00	51.00					12.00	24.00	36.00					17.00	34.00	51.00																	17.00			17.00			0.57	0.40	0.57			0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	087	0	1	01	01	H3931_087_0	5	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								5.00	10.00	15.00					0.00	0.00	0.00					5.00	10.00	15.00																	5.00			5.00			0.17	0.00	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	088	0	1	01	01	H3931_088_0	6	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											34.88	50	50	50				32.75	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	088	0	1	01	01	H3931_088_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	088	0	1	01	01	H3931_088_0	6	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	117.50					47.00	94.00	117.50					47.00	94.00	117.50																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	088	0	1	01	01	H3931_088_0	6	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								12.00	24.00	30.00					7.00	14.00	17.50					12.00	24.00	30.00																	12.00			12.00			0.40	0.23	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	088	0	1	01	01	H3931_088_0	6	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								6.00	12.00	15.00					0.00	0.00	0.00					6.00	12.00	15.00																	6.00			6.00			0.13	0.00	0.20			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3931	088	0	1	01	01	H3931_088_0	6	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								6.00	12.00	15.00					0.00	0.00	0.00					6.00	12.00	15.00																	6.00			6.00			0.20	0.00	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	090	0	1	01	01	H3931_090_0	4	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	090	0	1	01	01	H3931_090_0	4	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								5.00	10.00	15.00					0.00	0.00	0.00					5.00	10.00	15.00																	5.00			5.00			0.17	0.00	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	090	0	1	01	01	H3931_090_0	4	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								15.00	30.00	45.00					10.00	20.00	30.00					15.00	30.00	45.00																	15.00			15.00			0.50	0.33	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	090	0	1	01	01	H3931_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											46.42	50	50	50				43.11	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	090	0	1	01	01	H3931_090_0	4	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31											1.00	29						1.00	29						29																		29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	091	0	1	01	01	H3931_091_0	7	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											49.59	50	50	50				46.02	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	091	0	1	01	01	H3931_091_0	7	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	25.00					0.00	0.00	0.00					10.00	20.00	25.00																	10.00			10.00			0.33	0.00	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	091	0	1	01	01	H3931_091_0	7	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	50.00					15.00	30.00	37.50					20.00	40.00	50.00																	20.00			20.00			0.67	0.50	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	091	0	1	01	01	H3931_091_0	7	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	117.50					47.00	94.00	117.50					47.00	94.00	117.50																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	091	0	1	01	01	H3931_091_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	092	0	1	01	01	H3931_092_0	9	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								8.00	16.00	24.00					3.00	6.00	6.00					8.00	16.00	24.00																	8.00			8.00			0.27	0.10	0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand												
H3931	092	0	1	01	01	H3931_092_0	9	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								15.00	30.00	45.00					10.00	20.00	20.00					15.00	30.00	45.00																	15.00			15.00			0.50	0.33	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand												
H3931	092	0	1	01	01	H3931_092_0	9	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	94.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand												
H3931	092	0	1	01	01	H3931_092_0	9	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											43.97	42	42	42				41.19	42	42	42				42	42	42																42		42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand												
H3931	093	0	1	01	01	H3931_093_0	9	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								15.00	30.00	45.00					10.00	20.00	20.00					15.00	30.00	45.00																	15.00			15.00			0.50	0.33	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand												
H3931	093	0	1	01	01	H3931_093_0	9	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											69.72	40	40	40				66.89	40	40	40				40	40	40																40		40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand												
H3931	093	0	1	01	01	H3931_093_0	9	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								45.00	90.00	135.00					45.00	90.00	90.00					45.00	90.00	135.00																	45.00			45.00			1.50	1.50	1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand												
H3931	093	0	1	01	01	H3931_093_0	9	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								8.00	16.00	24.00					3.00	6.00	6.00					8.00	16.00	24.00																	8.00			8.00			0.27	0.10	0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand												
H3931	094	0	1	01	01	H3931_094_0	7	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	94.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	094	0	1	01	01	H3931_094_0	7	4	Non-Preferred Brand	1	4	110000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								100.00	200.00	300.00					100.00	200.00	200.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	094	0	1	01	01	H3931_094_0	7	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	094	0	1	01	01	H3931_094_0	7	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								15.00	30.00	45.00					10.00	20.00	20.00					15.00	30.00	45.00																	15.00			15.00			0.50	0.33	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	094	0	1	01	01	H3931_094_0	7	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								8.00	16.00	24.00					3.00	6.00	6.00					8.00	16.00	24.00																	8.00			8.00			0.27	0.10	0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	095	0	1	01	01	H3931_095_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											66.77	50	50	50				67.95	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	095	0	1	01	01	H3931_095_0	4	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31											1.00	29						1.00	29						29																		29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	095	0	1	01	01	H3931_095_0	4	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					12.00	24.00	36.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.40	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	095	0	1	01	01	H3931_095_0	4	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					3.00	6.00	9.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.10	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	095	0	1	01	01	H3931_095_0	4	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								43.00	86.00	129.00					40.00	80.00	120.00					43.00	86.00	129.00																	43.00			43.00			1.43	1.33	1.43			1.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	096	0	1	01	01	H3931_096_0	4	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					4.00	8.00	12.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.13	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	096	0	1	01	01	H3931_096_0	4	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					12.00	24.00	36.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.40	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	096	0	1	01	01	H3931_096_0	4	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31											1.00	29						1.00	29						29																		29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	096	0	1	01	01	H3931_096_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											47.78	50	50	50				43.85	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	096	0	1	01	01	H3931_096_0	4	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								45.00	90.00	135.00					43.00	86.00	129.00					45.00	90.00	135.00																	45.00			45.00			1.50	1.43	1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	097	0	1	01	01	H3931_097_0	5	4	Non-Preferred Brand	1	2	110000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	097	0	1	01	01	H3931_097_0	5	3	Preferred Brand	1	2	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								44.00	88.00	132.00					44.00	88.00	132.00					44.00	88.00	132.00																	44.00			44.00			1.47	1.47	1.47			1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	097	0	1	01	01	H3931_097_0	5	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	097	0	1	01	01	H3931_097_0	5	2	Generic	1	2	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	097	0	1	01	01	H3931_097_0	5	1	Preferred Generic	1	2	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								5.00	10.00	15.00					0.00	0.00	0.00					5.00	10.00	15.00																	5.00			5.00			0.17	0.00	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	098	0	1	01	01	H3931_098_0	5	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					12.00	24.00	36.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.40	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	098	0	1	01	01	H3931_098_0	5	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	098	0	1	01	01	H3931_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											34.44	50	50	50				31.20	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	098	0	1	01	01	H3931_098_0	5	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					4.00	8.00	12.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.13	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	098	0	1	01	01	H3931_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	099	0	1	01	01	H3931_099_0	5	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	099	0	1	01	01	H3931_099_0	5	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											36.34	50	50	50				33.95	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	099	0	1	01	01	H3931_099_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	099	0	1	01	01	H3931_099_0	5	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					4.00	8.00	12.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.13	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	099	0	1	01	01	H3931_099_0	5	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					12.00	24.00	36.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.40	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	100	0	1	01	01	H3931_100_0	6	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	100	0	1	01	01	H3931_100_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	100	0	1	01	01	H3931_100_0	6	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											37.94	50	50	50				34.65	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	100	0	1	01	01	H3931_100_0	6	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					12.00	24.00	36.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.40	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	100	0	1	01	01	H3931_100_0	6	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					4.00	8.00	12.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.13	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	101	0	1	01	01	H3931_101_0	4	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					4.00	8.00	12.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.13	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	101	0	1	01	01	H3931_101_0	4	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					12.00	24.00	36.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.40	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	101	0	1	01	01	H3931_101_0	4	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	101	0	1	01	01	H3931_101_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											41.15	50	50	50				38.65	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	101	0	1	01	01	H3931_101_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	102	0	1	01	01	H3931_102_0	5	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								12.00	24.00	30.00					2.00	4.00	5.00					12.00	24.00	30.00																	12.00			12.00			0.40	0.07	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	102	0	1	01	01	H3931_102_0	5	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								17.00	34.00	42.50					9.00	18.00	22.50					17.00	34.00	42.50																	17.00			17.00			0.57	0.30	0.57			0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	102	0	1	01	01	H3931_102_0	5	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	102	0	1	01	01	H3931_102_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	102	0	1	01	01	H3931_102_0	5	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											39.64	50	50	50				39.45	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	104	0	1	01	01	H3931_104_0	6	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								15.00	30.00	37.50					4.00	8.00	10.00					15.00	30.00	37.50																	15.00			15.00			0.50	0.13	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	104	0	1	01	01	H3931_104_0	6	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	50.00					15.00	30.00	37.50					20.00	40.00	50.00																	20.00			20.00			0.67	0.50	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	104	0	1	01	01	H3931_104_0	6	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	104	0	1	01	01	H3931_104_0	6	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											38.34	50	50	50				35.73	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	104	0	1	01	01	H3931_104_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	105	0	1	01	01	H3931_105_0	7	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											45.54	50	50	50				40.88	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	105	0	1	01	01	H3931_105_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	105	0	1	01	01	H3931_105_0	7	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	117.50					47.00	94.00	117.50					47.00	94.00	117.50																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	105	0	1	01	01	H3931_105_0	7	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								17.00	34.00	42.50					11.00	22.00	27.50					17.00	34.00	42.50																	17.00			17.00			0.57	0.37	0.57			0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	105	0	1	01	01	H3931_105_0	7	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								12.00	24.00	30.00					7.00	14.00	17.50					12.00	24.00	30.00																	12.00			12.00			0.40	0.23	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	106	0	1	01	01	H3931_106_0	5	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								12.00	24.00	36.00					7.00	14.00	21.00					12.00	24.00	36.00																	12.00			12.00			0.40	0.23	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	106	0	1	01	01	H3931_106_0	5	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	106	0	1	01	01	H3931_106_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	106	0	1	01	01	H3931_106_0	5	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											43.48	50	50	50				41.56	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	106	0	1	01	01	H3931_106_0	5	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	107	0	1	01	01	H3931_107_0	6	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								6.00	12.00	18.00					0.00	0.00	0.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.00	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	107	0	1	01	01	H3931_107_0	6	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31											1.00	29						1.00	29						29																		29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	107	0	1	01	01	H3931_107_0	6	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											44.96	50	50	50				40.39	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	107	0	1	01	01	H3931_107_0	6	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	107	0	1	01	01	H3931_107_0	6	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								15.00	30.00	45.00					10.00	20.00	30.00					15.00	30.00	45.00																	15.00			15.00			0.50	0.33	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	108	0	1	01	01	H3931_108_0	4	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					12.00	24.00	36.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.40	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	108	0	1	01	01	H3931_108_0	4	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								11.00	22.00	33.00					0.00	0.00	0.00					11.00	22.00	33.00																	11.00			11.00			0.37	0.00	0.37			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	108	0	1	01	01	H3931_108_0	4	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	108	0	1	01	01	H3931_108_0	4	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31											1.00	27						1.00	27						27																		27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	108	0	1	01	01	H3931_108_0	4	4	Non-Preferred Brand	1	4	110000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	109	0	1	01	01	H3931_109_0	5	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								19.00	38.00	57.00					10.00	20.00	30.00					19.00	38.00	57.00																	19.00			19.00			0.63	0.33	0.63			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	109	0	1	01	01	H3931_109_0	5	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	109	0	1	01	01	H3931_109_0	5	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					0.00	0.00	0.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.00	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	109	0	1	01	01	H3931_109_0	5	4	Non-Preferred Brand	1	4	110000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	109	0	1	01	01	H3931_109_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	110	0	1	01	01	H3931_110_0	4	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								16.00	32.00	48.00					11.00	22.00	33.00					16.00	32.00	48.00																	16.00			16.00			0.53	0.37	0.53			0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	110	0	1	01	01	H3931_110_0	4	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								5.00	10.00	15.00					0.00	0.00	0.00					5.00	10.00	15.00																	5.00			5.00			0.17	0.00	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	110	0	1	01	01	H3931_110_0	4	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	110	0	1	01	01	H3931_110_0	4	4	Non-Preferred Brand	1	4	110000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	110	0	1	01	01	H3931_110_0	4	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31											1.00	27						1.00	27						27																		27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	111	0	1	01	01	H3931_111_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	111	0	1	01	01	H3931_111_0	9	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								6.00	12.00	15.00					0.00	0.00	0.00					6.00	12.00	15.00																	6.00			6.00			0.20	0.00	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	111	0	1	01	01	H3931_111_0	9	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								6.00	12.00	15.00					0.00	0.00	0.00					6.00	12.00	15.00																	6.00			6.00			0.13	0.00	0.20			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3931	111	0	1	01	01	H3931_111_0	9	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	117.50					47.00	94.00	117.50					47.00	94.00	117.50																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	111	0	1	01	01	H3931_111_0	9	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											34.88	50	50	50				32.75	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3931	111	0	1	01	01	H3931_111_0	9	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								12.00	24.00	30.00					6.00	12.00	15.00					12.00	24.00	30.00																	12.00			12.00			0.40	0.20	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3945	003	0	1	02	01	H3945_003_0	4	3	Preferred Brand	1	4	000101	1	2	111		01	110		1	30	60	90				2	30		90				30		31	45.00	90.00	135.00																			45.00		135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3945	003	0	1	02	01	H3945_003_0	4	2	Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	15.00	30.00	45.00																			15.00		45.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3945	003	0	1	02	01	H3945_003_0	4	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31				440.90	33	33	33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3945	003	0	1	02	01	H3945_003_0	4	4	Non-Preferred Brand	1	4	100100	1	1	111		01	110		1	30	60	90				2	30		90				30		31				95.93	38	38	38																		38		38															38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3945	003	0	1	02	01	H3945_003_0	4	1	Preferred Generic	1	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	5.00	10.00	15.00																			5.00		15.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3949	013	0	1	01	01	H3949_013_0	5	2	Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	8.00	16.00	20.00																			8.00		20.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, 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	80.00	160.00	240.00																			80.00		240.00																80.00				80.00		2.67			2.67			2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3949	013	0	1	01	01	H3949_013_0	5	3	Preferred Brand	1	4	000101	1	2	111		01	110		1	30	60	90				2	30		90				30		31	40.00	80.00	120.00																			40.00		120.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, 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				576.80	28	28	28																		28		28															28			28								Preferred Generic, 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	4.00	8.00	10.00																			4.00		10.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3949	024	0	1	01	01	H3949_024_0	4	6	Select Diabetic Drugs	1	4	010010	1	2	111		01	110		1	30	60	90				2	30		90				30		31	5.00	10.00	12.50																			5.00		12.50																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H3949	024	0	1	01	01	H3949_024_0	4	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31				447.62	26	26	26																		26		26															26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H3949	024	0	1	01	01	H3949_024_0	4	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	95.00	190.00	285.00																			95.00		285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H3949	024	0	1	01	01	H3949_024_0	4	2	Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	10.00	20.00	25.00																			10.00		25.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H3949	024	0	1	01	01	H3949_024_0	4	1	Preferred Generic	1	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	4.00	8.00	10.00																			4.00		10.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H3949	024	0	1	01	01	H3949_024_0	4	3	Preferred Brand	1	4	000101	1	2	111		01	110		1	30	60	90				2	30		90				30		31	47.00	94.00	141.00																			47.00		141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, 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	7.00	14.00	17.50																			7.00		17.50																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3949	027	0	1	02	01	H3949_027_0	5	2	Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	10.00	20.00	25.00																			10.00		25.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3949	027	0	1	02	01	H3949_027_0	5	3	Preferred Brand	1	4	000101	1	2	111		01	110		1	30	60	90				2	30		90				30		31	40.00	80.00	120.00																			40.00		120.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, 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	80.00	160.00	240.00																			80.00		240.00																80.00				80.00		2.67			2.67			2.58	Preferred Generic, 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				526.13	26	26	26																		26		26															26			26								Preferred Generic, 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	4.00	8.00	10.00																			4.00		10.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3949	028	0	1	01	01	H3949_028_0	5	2	Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	10.00	20.00	25.00																			10.00		25.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3949	028	0	1	01	01	H3949_028_0	5	3	Preferred Brand	1	4	000101	1	2	111		01	110		1	30	60	90				2	30		90				30		31	47.00	94.00	141.00																			47.00		141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, 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	95.00	190.00	285.00																			95.00		285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, 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				522.19	26	26	26																		26		26															26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3949	030	0	1	01	01	H3949_030_0	4	1	Preferred Generic	1	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	4.00	8.00	10.00																			4.00		10.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3949	030	0	1	01	01	H3949_030_0	4	2	Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	12.00	24.00	30.00																			12.00		30.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3949	030	0	1	01	01	H3949_030_0	4	3	Preferred Brand	1	4	000101	1	2	111		01	110		1	30	60	90				2	30		90				30		31	47.00	94.00	141.00																			47.00		141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3949	030	0	1	01	01	H3949_030_0	4	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	95.00	190.00	285.00																			95.00		285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3949	030	0	1	01	01	H3949_030_0	4	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31				522.19	26	26	26																		26		26															26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3952	020	0	1	01	01	H3952_020_0	4	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3952	020	0	1	01	01	H3952_020_0	4	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	16.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3952	020	0	1	01	01	H3952_020_0	4	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3952	020	0	1	01	01	H3952_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	97.00	194.00	291.00																			97.00	194.00	194.00																97.00				97.00		3.23			3.23			3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3952	020	0	1	01	01	H3952_020_0	4	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3952	045	0	1	01	01	H3952_045_0	4	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3952	045	0	1	01	01	H3952_045_0	4	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	16.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3952	045	0	1	01	01	H3952_045_0	4	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3952	045	0	1	01	01	H3952_045_0	4	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	97.00	194.00	291.00																			97.00	194.00	194.00																97.00				97.00		3.23			3.23			3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3952	045	0	1	01	01	H3952_045_0	4	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3952	049	0	1	01	01	H3952_049_0	4	5	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31				1.00	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3952	049	0	1	01	01	H3952_049_0	4	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3952	049	0	1	01	01	H3952_049_0	4	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3952	049	0	1	01	01	H3952_049_0	4	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3952	049	0	1	01	01	H3952_049_0	4	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, 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				1.00	25	25	25																		25	25	25															25			25								Preferred Generic, 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	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, 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	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3952	051	0	1	01	01	H3952_051_0	4	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, 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	3.00	6.00	9.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3952	053	0	1	01	01	H3952_053_0	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3952	053	0	1	01	01	H3952_053_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3952	053	0	1	01	01	H3952_053_0	5	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3952	053	0	1	01	01	H3952_053_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3952	053	0	1	01	01	H3952_053_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3952	054	0	1	01	01	H3952_054_0	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3952	054	0	1	01	01	H3952_054_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3952	054	0	1	01	01	H3952_054_0	5	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3952	054	0	1	01	01	H3952_054_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3952	054	0	1	01	01	H3952_054_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	146	0	1	01	01	H3954_146_0	6	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31				1433.25	33																																					33			33								Preferred Generic, 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	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, 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	47.00		141.00																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	146	0	1	01	01	H3954_146_0	6	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	20.00		60.00																					60.00																20.00				20.00		0.67						0.65	Preferred Generic, 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	3.00		9.00																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, 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	3.00		9.00																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3954	157	1	1	01	01	H3954_157_1	6	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	3.00		9.00																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	1	1	01	01	H3954_157_1	6	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	20.00		60.00																					60.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	1	1	01	01	H3954_157_1	6	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	47.00		141.00																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	1	1	01	01	H3954_157_1	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	1	1	01	01	H3954_157_1	6	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31				1717.49	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	1	1	01	01	H3954_157_1	6	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	3.00		9.00																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3954	157	2	1	01	01	H3954_157_2	6	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31				1717.49	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	2	1	01	01	H3954_157_2	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	2	1	01	01	H3954_157_2	6	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	47.00		141.00																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	2	1	01	01	H3954_157_2	6	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	20.00		60.00																					60.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	2	1	01	01	H3954_157_2	6	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	3.00		9.00																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	2	1	01	01	H3954_157_2	6	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	3.00		9.00																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3954	157	3	1	01	01	H3954_157_3	6	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	20.00		60.00																					60.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	3	1	01	01	H3954_157_3	6	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	3.00		9.00																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	3	1	01	01	H3954_157_3	6	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	47.00		141.00																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	3	1	01	01	H3954_157_3	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	3	1	01	01	H3954_157_3	6	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31				1717.49	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	3	1	01	01	H3954_157_3	6	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	3.00		9.00																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3954	157	4	1	01	01	H3954_157_4	6	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	20.00		60.00																					60.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	4	1	01	01	H3954_157_4	6	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	3.00		9.00																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	4	1	01	01	H3954_157_4	6	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	47.00		141.00																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	4	1	01	01	H3954_157_4	6	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	3.00		9.00																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3954	157	4	1	01	01	H3954_157_4	6	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31				1717.49	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	4	1	01	01	H3954_157_4	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	5	1	01	01	H3954_157_5	6	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	3.00		9.00																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	5	1	01	01	H3954_157_5	6	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	20.00		60.00																					60.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	5	1	01	01	H3954_157_5	6	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31				1717.49	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	5	1	01	01	H3954_157_5	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	5	1	01	01	H3954_157_5	6	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	47.00		141.00																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	5	1	01	01	H3954_157_5	6	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	3.00		9.00																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3954	157	6	1	01	01	H3954_157_6	6	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	3.00		9.00																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3954	157	6	1	01	01	H3954_157_6	6	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	3.00		9.00																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	6	1	01	01	H3954_157_6	6	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	20.00		60.00																					60.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	6	1	01	01	H3954_157_6	6	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	47.00		141.00																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	6	1	01	01	H3954_157_6	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	6	1	01	01	H3954_157_6	6	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31				1717.49	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	1	1	01	01	H3954_158_1	7	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	3.00		9.00																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	1	1	01	01	H3954_158_1	7	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	20.00		60.00																					60.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	1	1	01	01	H3954_158_1	7	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	47.00		141.00																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	1	1	01	01	H3954_158_1	7	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	1	1	01	01	H3954_158_1	7	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31				1707.61	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	1	1	01	01	H3954_158_1	7	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	3.00		9.00																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3954	158	2	1	01	01	H3954_158_2	7	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31				1707.61	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	2	1	01	01	H3954_158_2	7	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	3.00		9.00																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3954	158	2	1	01	01	H3954_158_2	7	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	2	1	01	01	H3954_158_2	7	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	47.00		141.00																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	2	1	01	01	H3954_158_2	7	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	20.00		60.00																					60.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	2	1	01	01	H3954_158_2	7	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	3.00		9.00																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	3	1	01	01	H3954_158_3	7	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	3.00		9.00																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3954	158	3	1	01	01	H3954_158_3	7	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31				1707.61	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	3	1	01	01	H3954_158_3	7	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	3	1	01	01	H3954_158_3	7	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	47.00		141.00																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	3	1	01	01	H3954_158_3	7	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	20.00		60.00																					60.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	3	1	01	01	H3954_158_3	7	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	3.00		9.00																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	4	1	01	01	H3954_158_4	7	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	3.00		9.00																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3954	158	4	1	01	01	H3954_158_4	7	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31				1707.61	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	4	1	01	01	H3954_158_4	7	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	4	1	01	01	H3954_158_4	7	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	47.00		141.00																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	4	1	01	01	H3954_158_4	7	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	20.00		60.00																					60.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	4	1	01	01	H3954_158_4	7	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	3.00		9.00																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	5	1	01	01	H3954_158_5	7	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31				1707.61	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	5	1	01	01	H3954_158_5	7	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	47.00		141.00																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	5	1	01	01	H3954_158_5	7	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	20.00		60.00																					60.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	5	1	01	01	H3954_158_5	7	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	3.00		9.00																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	5	1	01	01	H3954_158_5	7	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	5	1	01	01	H3954_158_5	7	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	3.00		9.00																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3954	158	6	1	01	01	H3954_158_6	7	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31				1707.61	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	6	1	01	01	H3954_158_6	7	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	3.00		9.00																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3954	158	6	1	01	01	H3954_158_6	7	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	3.00		9.00																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	6	1	01	01	H3954_158_6	7	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	20.00		60.00																					60.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	6	1	01	01	H3954_158_6	7	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	47.00		141.00																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	6	1	01	01	H3954_158_6	7	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	003	0	1	01	01	H3957_003_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	31		90				1			90				31		31	3.00		9.00																					7.50																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	003	0	1	01	01	H3957_003_0	7	2	Generic	1	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	15.00		45.00																					37.50																15.00				15.00		0.48						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	003	0	1	01	01	H3957_003_0	7	3	Preferred Brand	1	4	010001	1	2	110		01	100		1	31		90				1			90				31		31	45.00		135.00																					112.50																45.00				45.00		1.45						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	003	0	1	01	01	H3957_003_0	7	4	Non-Preferred Brand	1	4	110000	1	1	110		01	100		1	31		90				1			90				31		31				95.47	45		45																				45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	003	0	1	01	01	H3957_003_0	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31				914.63	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	006	0	1	01	01	H3957_006_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	31		90				1			90				31		31	3.00		9.00																					7.50																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	006	0	1	01	01	H3957_006_0	7	2	Generic	1	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	15.00		45.00																					37.50																15.00				15.00		0.48						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	006	0	1	01	01	H3957_006_0	7	3	Preferred Brand	1	4	010001	1	2	110		01	100		1	31		90				1			90				31		31	45.00		135.00																					112.50																45.00				45.00		1.45						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	006	0	1	01	01	H3957_006_0	7	4	Non-Preferred Brand	1	4	110000	1	1	110		01	100		1	31		90				1			90				31		31				97.35	45		45																				45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	006	0	1	01	01	H3957_006_0	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31				1063.89	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	3.00		9.00																					7.50																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	020	0	1	01	01	H3957_020_0	7	2	Generic	1	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	15.00		45.00																					37.50																15.00				15.00		0.48						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	020	0	1	01	01	H3957_020_0	7	3	Preferred Brand	1	4	010001	1	2	110		01	100		1	31		90				1			90				31		31	42.00		126.00																					105.00																42.00				42.00		1.35						1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	020	0	1	01	01	H3957_020_0	7	4	Non-Preferred Brand	1	4	110000	1	1	110		01	100		1	31		90				1			90				31		31				91.78	45		45																				45															45			45								Preferred Generic, 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	010		01	010		1	31							31						31		31				968.85	33																				33																	33			33								Preferred Generic, 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	3.00		9.00																					7.50																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3957	020	0	1	01	01	H3957_020_0	7	2	Generic	3	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	15.00		45.00																					37.50																15.00				15.00		0.48						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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	3.00		9.00																					7.50																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	021	0	1	01	01	H3957_021_0	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31				851.20	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	021	0	1	01	01	H3957_021_0	7	3	Preferred Brand	1	4	010001	1	2	110		01	100		1	31		90				1			90				31		31	42.00		126.00																					105.00																42.00				42.00		1.35						1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	021	0	1	01	01	H3957_021_0	7	4	Non-Preferred Brand	1	4	110000	1	1	110		01	100		1	31		90				1			90				31		31				94.30	45		45																				45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	021	0	1	01	01	H3957_021_0	7	2	Generic	1	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	15.00		45.00																					37.50																15.00				15.00		0.48						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	3.00		9.00																					7.50																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3957	021	0	1	01	01	H3957_021_0	7	2	Generic	3	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	15.00		45.00																					37.50																15.00				15.00		0.48						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3957	031	0	1	01	01	H3957_031_0	8	3	Preferred Brand	1	4	010001	1	2	110		01	100		1	31		90				1			90				31		31	47.00		141.00																					117.50																47.00				47.00		1.52						1.52	Preferred Generic, 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	3.00		9.00																					7.50																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	031	0	1	01	01	H3957_031_0	8	2	Generic	1	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	15.00		45.00																					37.50																15.00				15.00		0.48						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	031	0	1	01	01	H3957_031_0	8	4	Non-Preferred Brand	1	4	110000	1	1	110		01	100		1	31		90				1			90				31		31				90.84	45		45																				45															45			45								Preferred Generic, 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	010		01	010		1	31							31						31		31				926.65	33																				33																	33			33								Preferred Generic, 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	010		01	010		1	31							31						31		31				860.98	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	032	0	1	01	01	H3957_032_0	8	4	Non-Preferred Brand	1	4	110000	1	1	110		01	100		1	31		90				1			90				31		31				94.70	45		45																				45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	032	0	1	01	01	H3957_032_0	8	3	Preferred Brand	1	4	010001	1	2	110		01	100		1	31		90				1			90				31		31	47.00		141.00																					117.50																47.00				47.00		1.52						1.52	Preferred Generic, 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	3.00		9.00																					7.50																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	032	0	1	01	01	H3957_032_0	8	2	Generic	1	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	15.00		45.00																					37.50																15.00				15.00		0.48						0.48	Preferred Generic, 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	010		01	010		1	31							31						31		31				919.03	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	038	0	1	01	01	H3957_038_0	8	4	Non-Preferred Brand	1	4	110000	1	1	110		01	100		1	31		90				1			90				31		31				92.92	45		45																				45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	038	0	1	01	01	H3957_038_0	8	3	Preferred Brand	1	4	010001	1	2	110		01	100		1	31		90				1			90				31		31	47.00		141.00																					117.50																47.00				47.00		1.52						1.52	Preferred Generic, 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	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	038	0	1	01	01	H3957_038_0	8	2	Generic	1	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	20.00		60.00																					50.00																20.00				20.00		0.65						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	039	0	1	01	01	H3957_039_0	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31				818.01	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	039	0	1	01	01	H3957_039_0	7	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	31		90				1			90				31		31	3.00		9.00																					7.50																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3957	039	0	1	01	01	H3957_039_0	7	2	Generic	3	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	15.00		45.00																					37.50																15.00				15.00		0.48						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3957	039	0	1	01	01	H3957_039_0	7	3	Preferred Brand	1	4	010001	1	2	110		01	100		1	31		90				1			90				31		31	42.00		126.00																					105.00																42.00				42.00		1.35						1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	039	0	1	01	01	H3957_039_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	31		90				1			90				31		31	3.00		9.00																					7.50																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	039	0	1	01	01	H3957_039_0	7	4	Non-Preferred Brand	1	4	110000	1	1	110		01	100		1	31		90				1			90				31		31				92.27	45		45																				45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	039	0	1	01	01	H3957_039_0	7	2	Generic	1	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	15.00		45.00																					37.50																15.00				15.00		0.48						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	040	0	1	01	01	H3957_040_0	11	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	31		90				1			90				31		31	5.00		15.00																					12.50																5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	040	0	1	01	01	H3957_040_0	11	2	Generic	1	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	20.00		60.00																					50.00																20.00				20.00		0.65						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	040	0	1	01	01	H3957_040_0	11	4	Non-Preferred Brand	1	4	110000	1	1	110		01	100		1	31		90				1			90				31		31				98.13	45		45																				45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	040	0	1	01	01	H3957_040_0	11	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31				844.97	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	040	0	1	01	01	H3957_040_0	11	3	Preferred Brand	1	4	010001	1	2	110		01	100		1	31		90				1			90				31		31	47.00		141.00																					117.50																47.00				47.00		1.52						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	041	0	1	01	01	H3957_041_0	11	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31				779.42	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	041	0	1	01	01	H3957_041_0	11	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	31		90				1			90				31		31	5.00		15.00																					12.50																5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	041	0	1	01	01	H3957_041_0	11	4	Non-Preferred Brand	1	4	110000	1	1	110		01	100		1	31		90				1			90				31		31				92.90	45		45																				45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	041	0	1	01	01	H3957_041_0	11	3	Preferred Brand	1	4	010001	1	2	110		01	100		1	31		90				1			90				31		31	47.00		141.00																					117.50																47.00				47.00		1.52						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	041	0	1	01	01	H3957_041_0	11	2	Generic	1	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	20.00		60.00																					50.00																20.00				20.00		0.65						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	001	0	1	01	01	H3959_001_0	5	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								12.00	24.00	30.00					7.00	14.00	17.50					12.00	24.00	30.00																	12.00			12.00			0.40	0.23	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	001	0	1	01	01	H3959_001_0	5	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								19.00	38.00	47.50					9.00	18.00	22.50					19.00	38.00	47.50																	19.00			19.00			0.63	0.30	0.63			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	001	0	1	01	01	H3959_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	001	0	1	01	01	H3959_001_0	5	4	Non-Preferred Brand	1	4	110000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	001	0	1	01	01	H3959_001_0	5	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								12.00	24.00	30.00					7.00	14.00	17.50					12.00	24.00	30.00																	12.00			12.00			0.33	0.17	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3959	001	0	1	01	01	H3959_001_0	5	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	117.50					47.00	94.00	117.50					47.00	94.00	117.50																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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								12.00	24.00	30.00					7.00	14.00	17.50					12.00	24.00	30.00																	12.00			12.00			0.40	0.23	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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											58.78	50	50	50				49.69	50	50	50				50	50	50																50		50								Preferred Generic, 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								47.00	94.00	117.50					47.00	94.00	117.50					47.00	94.00	117.50																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	002	0	1	01	01	H3959_002_0	4	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								17.00	34.00	42.50					12.00	24.00	30.00					17.00	34.00	42.50																	17.00			17.00			0.57	0.40	0.57			0.55	Preferred Generic, 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								12.00	24.00	30.00					7.00	14.00	17.50					12.00	24.00	30.00																	12.00			12.00			0.40	0.23	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	010	0	1	01	01	H3959_010_0	5	4	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31											1.00	30						1.00	30						30																		30		30								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	010	0	1	01	01	H3959_010_0	5	3	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											42.20	50	50	50				39.12	50	50	50				50	50	50																50		50								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	010	0	1	01	01	H3959_010_0	5	1	Generic	1	4	010010	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	50.00					7.00	14.00	17.50					20.00	40.00	50.00																	20.00			20.00			0.67	0.23	0.67			0.65	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	010	0	1	01	01	H3959_010_0	5	2	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	117.50					47.00	94.00	117.50					47.00	94.00	117.50																	47.00			47.00			1.57	1.57	1.57			1.52	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	011	0	1	01	01	H3959_011_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	011	0	1	01	01	H3959_011_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											52.72	50	50	50				46.70	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	011	0	1	01	01	H3959_011_0	4	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	011	0	1	01	01	H3959_011_0	4	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	50.00					15.00	30.00	37.50					20.00	40.00	50.00																	20.00			20.00			0.67	0.50	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	011	0	1	01	01	H3959_011_0	4	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								19.00	38.00	47.50					10.00	20.00	25.00					19.00	38.00	47.50																	19.00			19.00			0.63	0.33	0.63			0.61	Preferred Generic, 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	29						1.00	29						29																		29		29								Preferred Generic, 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	2		111	10	111		1				30	60	90	1	30	60	90					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, 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								47.00	94.00	117.50					47.00	94.00	117.50					47.00	94.00	117.50																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	031	0	1	01	01	H3959_031_0	3	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	50.00					15.00	30.00	37.50					20.00	40.00	50.00																	20.00			20.00			0.67	0.50	0.67			0.65	Preferred Generic, 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								12.00	24.00	30.00					5.00	10.00	12.50					12.00	24.00	30.00																	12.00			12.00			0.40	0.17	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	032	0	1	01	01	H3959_032_0	3	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												
H3959	032	0	1	01	01	H3959_032_0	3	3	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				39.35	50	50	50				50	50	50																50		50								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	032	0	1	01	01	H3959_032_0	3	1	Generic	1	4	010010	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								15.00	30.00	37.50					10.00	20.00	25.00					15.00	30.00	37.50																	15.00			15.00			0.50	0.33	0.50			0.48	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	032	0	1	01	01	H3959_032_0	3	2	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	117.50					47.00	94.00	117.50					47.00	94.00	117.50																	47.00			47.00			1.57	1.57	1.57			1.52	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											69.14	50	50	50				66.04	50	50	50				50	50	50																50		50								Preferred Generic, 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								12.00	24.00	30.00					7.00	14.00	17.50					12.00	24.00	30.00																	12.00			12.00			0.40	0.23	0.40			0.39	Preferred Generic, 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						1.00	33						33																		33		33								Preferred Generic, 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								47.00	94.00	117.50					47.00	94.00	117.50					47.00	94.00	117.50																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	033	0	1	01	01	H3959_033_0	3	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	50.00					15.00	30.00	37.50					20.00	40.00	50.00																	20.00			20.00			0.67	0.50	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	037	0	1	01	01	H3959_037_0	3	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												
H3959	037	0	1	01	01	H3959_037_0	3	3	Non-Preferred Brand	1	4	110000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	037	0	1	01	01	H3959_037_0	3	2	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	117.50					47.00	94.00	117.50					47.00	94.00	117.50																	47.00			47.00			1.57	1.57	1.57			1.52	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	037	0	1	01	01	H3959_037_0	3	1	Generic	1	4	010010	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								15.00	30.00	37.50					10.00	20.00	25.00					15.00	30.00	37.50																	15.00			15.00			0.50	0.33	0.50			0.48	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, 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								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	039	0	1	01	01	H3959_039_0	3	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	50.00					15.00	30.00	37.50					20.00	40.00	50.00																	20.00			20.00			0.67	0.50	0.67			0.65	Preferred Generic, 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								15.00	30.00	37.50					5.00	10.00	12.50					15.00	30.00	37.50																	15.00			15.00			0.50	0.17	0.50			0.48	Preferred Generic, 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											45.13	50	50	50				41.70	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	043	0	1	01	01	H3959_043_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	043	0	1	01	01	H3959_043_0	7	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											45.13	50	50	50				40.57	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	043	0	1	01	01	H3959_043_0	7	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	043	0	1	01	01	H3959_043_0	7	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	50.00					15.00	30.00	37.50					20.00	40.00	50.00																	20.00			20.00			0.67	0.50	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	043	0	1	01	01	H3959_043_0	7	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								15.00	30.00	37.50					7.00	14.00	17.50					15.00	30.00	37.50																	15.00			15.00			0.50	0.23	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	044	0	1	01	01	H3959_044_0	6	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								14.00	28.00	35.00					8.00	16.00	20.00					14.00	28.00	35.00																	14.00			14.00			0.47	0.27	0.47			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	044	0	1	01	01	H3959_044_0	6	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	50.00					15.00	30.00	37.50					20.00	40.00	50.00																	20.00			20.00			0.67	0.50	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	044	0	1	01	01	H3959_044_0	6	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	044	0	1	01	01	H3959_044_0	6	4	Non-Preferred Brand	1	4	110000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3959	044	0	1	01	01	H3959_044_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3962	001	0	1	01	01	H3962_001_0	8	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				30		90	1	30		90				30		31								8.00		24.00					3.00		9.00					3.00		9.00																8.00				8.00			0.27	0.10	0.10			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3962	001	0	1	01	01	H3962_001_0	8	2	Generic	1	4	000100	1	2		110	01	110		1				30		90	1	30		90				30		31								14.00		42.00					9.00		27.00					9.00		27.00																14.00				14.00			0.47	0.30	0.30			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3962	001	0	1	01	01	H3962_001_0	8	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				30		90	1	30		90				30		31								45.00		135.00					38.00		114.00					38.00		114.00																45.00				45.00			1.50	1.27	1.27			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3962	001	0	1	01	01	H3962_001_0	8	4	Non-Preferred Brand	1	4	100100	1	2		110	01	110		1				30		90	1	30		90				30		31								95.00		285.00					89.00		267.00					89.00		267.00																95.00				95.00			3.17	2.97	2.97			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3962	001	0	1	01	01	H3962_001_0	8	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											285.42	33						285.42	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3962	001	0	1	01	01	H3962_001_0	8	1	Preferred Generic	3	4	001000	1	2		110	01	110		1				30		90	1	30		90				30		31								8.00		24.00					3.00		9.00					3.00		9.00																8.00				8.00			0.27	0.10	0.10			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3962	001	0	1	01	01	H3962_001_0	8	2	Generic	3	4	000100	1	2		110	01	110		1				30		90	1	30		90				30		31								14.00		42.00					9.00		27.00					9.00		27.00																14.00				14.00			0.47	0.30	0.30			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3962	004	0	1	01	01	H3962_004_0	7	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				30		90	1	30		90				30		31								9.00		27.00					4.00		12.00					4.00		12.00																9.00				9.00			0.30	0.13	0.13			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3962	004	0	1	01	01	H3962_004_0	7	2	Generic	1	4	000100	1	2		110	01	110		1				30		90	1	30		90				30		31								17.00		51.00					12.00		36.00					12.00		36.00																17.00				17.00			.57	.40	.40			.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3962	004	0	1	01	01	H3962_004_0	7	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											456.53	33						456.53	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3962	004	0	1	01	01	H3962_004_0	7	4	Non-Preferred Brand	1	4	100100	1	2		110	01	110		1				30		90	1	30		90				30		31								95.00		285.00					89.00		267.00					89.00		267.00																95.00				95.00			3.17	2.97	2.97			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3962	004	0	1	01	01	H3962_004_0	7	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				30		90	1	30		90				30		31								45.00		135.00					38.00		114.00					38.00		114.00																45.00				45.00			1.50	1.27	1.27			1.45	Preferred Generic, 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				30		90	1	30		90				30		31								10.00		30.00					4.00		12.00					4.00		12.00																10.00				10.00			0.33	0.13	0.13			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3962	007	0	1	01	01	H3962_007_0	7	4	Non-Preferred Brand	1	4	100100	1	2		110	01	110		1				30		90	1	30		90				30		31								95.00		285.00					89.00		267.00					89.00		267.00																95.00				95.00			3.17	2.97	2.97			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3962	007	0	1	01	01	H3962_007_0	7	3	Preferred Brand	1	4	000101	1	2		110	01	110		1				30		90	1	30		90				30		31								45.00		135.00					38.00		114.00					38.00		114.00																45.00				45.00			1.50	1.27	1.27			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3962	007	0	1	01	01	H3962_007_0	7	2	Generic	1	4	000100	1	2		110	01	110		1				30		90	1	30		90				30		31								20.00		60.00					12.00		36.00					12.00		36.00																20.00				20.00			0.67	0.40	0.40			0.65	Preferred Generic, 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				30				30						30		31											442.42	33						442.42	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3979	001	0	1	01	01	H3979_001_0	6	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3979	001	0	1	01	01	H3979_001_0	6	2	Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								11.00		33.00					6.00		18.00							33.00																11.00				11.00			0.37	0.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3979	001	0	1	01	01	H3979_001_0	6	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31								44.00		132.00					39.00		117.00							132.00																44.00				44.00			1.47	1.30				1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3979	001	0	1	01	01	H3979_001_0	6	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					85.00		255.00							285.00																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3979	001	0	1	01	01	H3979_001_0	6	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31											1330.00	33		33				1330.00	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3979	001	0	1	01	01	H3979_001_0	6	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			.16	.00				.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3979	001	0	1	01	01	H3979_001_0	6	2	Generic	3	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								11.00		33.00					6.00		18.00							33.00																11.00				11.00			.36	.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3979	002	0	1	02	01	H3979_002_0	6	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3979	002	0	1	02	01	H3979_002_0	6	2	Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								11.00		33.00					6.00		18.00							33.00																11.00				11.00			0.37	0.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3979	002	0	1	02	01	H3979_002_0	6	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31								44.00		132.00					39.00		117.00							132.00																44.00				44.00			1.47	1.30				1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3979	002	0	1	02	01	H3979_002_0	6	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					85.00		255.00							285.00																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3979	002	0	1	02	01	H3979_002_0	6	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31											1330.00	33		33				1330.00	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3979	002	0	1	02	01	H3979_002_0	6	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			.16	.00				.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3979	002	0	1	02	01	H3979_002_0	6	2	Generic	3	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								11.00		33.00					6.00		18.00							33.00																11.00				11.00			.36	.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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	3.00		9.00																					6.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	009	0	1	01	01	H4003_009_0	8	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				2			90				30		31				2648.00	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	009	0	1	01	01	H4003_009_0	8	3	Preferred Brand	1	4	000101	1	2	110		01	100		1	30		90				2			90				30		31	35.00		105.00																					70.00																35.00				35.00		1.17						1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	009	0	1	01	01	H4003_009_0	8	4	Non-Preferred Brand	1	4	100100	1	2	110		01	100		1	30		90				2			90				30		31	45.00		135.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	009	0	1	01	01	H4003_009_0	8	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	7.00		21.00																					14.00																7.00				7.00		0.23						0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	009	0	1	01	01	H4003_009_0	8	4	Non-Preferred Brand	3	4	100100	1	2	110		01	100		1	30		90				2			90				30		31	45.00		135.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4003	009	0	1	01	01	H4003_009_0	8	3	Preferred Brand	3	4	000101	1	2	110		01	100		1	30		90				2			90				30		31	35.00		105.00																					70.00																35.00				35.00		1.17						1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4003	009	0	1	01	01	H4003_009_0	8	2	Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	7.00		21.00																					14.00																7.00				7.00		.23						.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H4003	009	0	1	01	01	H4003_009_0	8	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	3.00		9.00																					6.00																3.00				3.00		.10						.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
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	4.00		12.00																					8.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H4003	015	0	1	01	01	H4003_015_0	8	2	Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	14.00		42.00																					28.00																14.00				14.00		0.47						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H4003	015	0	1	01	01	H4003_015_0	8	3	Preferred Brand	3	4	000101	1	2	110		01	100		1	30		90				2			90				30		31	25.00		75.00																					50.00																25.00				25.00		0.83						0.81	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4003	015	0	1	01	01	H4003_015_0	8	4	Non-Preferred Brand	3	4	100100	1	2	110		01	100		1	30		90				2			90				30		31	60.00		180.00																					120.00																60.00				60.00		2.00						1.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	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	4.00		12.00																					8.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	015	0	1	01	01	H4003_015_0	8	4	Non-Preferred Brand	1	4	100100	1	2	110		01	100		1	30		90				2			90				30		31	60.00		180.00																					120.00																60.00				60.00		2.00						1.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	015	0	1	01	01	H4003_015_0	8	3	Preferred Brand	1	4	000101	1	2	110		01	100		1	30		90				2			90				30		31	25.00		75.00																					50.00																25.00				25.00		0.83						0.81	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	015	0	1	01	01	H4003_015_0	8	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	14.00		42.00																					28.00																14.00				14.00		0.47						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	015	0	1	01	01	H4003_015_0	8	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				2			90				30		31				2487.00	31		31																				31															31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	019	0	1	01	01	H4003_019_0	7	4	Non-Preferred Brand	1	4	100100	1	2	110		01	100		1	30		90				2			90				30		31	40.00		120.00																					80.00																40.00				40.00		1.33						1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	019	0	1	01	01	H4003_019_0	7	3	Preferred Brand	1	4	000101	1	2	110		01	100		1	30		90				2			90				30		31	20.00		60.00																					40.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	019	0	1	01	01	H4003_019_0	7	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	6.00		18.00																					12.00																6.00				6.00		0.20						0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	019	0	1	01	01	H4003_019_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	019	0	1	01	01	H4003_019_0	7	3	Preferred Brand	3	4	000101	1	2	110		01	100		1	30		90				2			90				30		31	20.00		60.00																					40.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4003	019	0	1	01	01	H4003_019_0	7	4	Non-Preferred Brand	3	4	100100	1	2	110		01	100		1	30		90				2			90				30		31	40.00		120.00																					80.00																40.00				40.00		1.33						1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4003	019	0	1	01	01	H4003_019_0	7	2	Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	6.00		18.00																					12.00																6.00				6.00		0.20						0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H4003	019	0	1	01	01	H4003_019_0	7	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H4003	019	0	1	01	01	H4003_019_0	7	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				2			90				30		31				2648.00	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	027	0	1	02	01	H4003_027_0	9	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				2			90				30		31				2648.00	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	027	0	1	02	01	H4003_027_0	9	2	Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	18.00		54.00																					36.00																18.00				18.00		0.60						0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H4003	027	0	1	02	01	H4003_027_0	9	3	Preferred Brand	3	4	000101	1	2	110		01	100		1	30		90				2			90				30		31	35.00		105.00																					70.00																35.00				35.00		1.17						1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4003	027	0	1	02	01	H4003_027_0	9	4	Non-Preferred Brand	3	4	100100	1	2	110		01	100		1	30		90				2			90				30		31	65.00		195.00																					130.00																65.00				65.00		2.17						2.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	7.50		22.50																					15.00																7.50				7.50		0.25						0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	027	0	1	02	01	H4003_027_0	9	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	18.00		54.00																					36.00																18.00				18.00		0.60						0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	027	0	1	02	01	H4003_027_0	9	3	Preferred Brand	1	4	000101	1	2	110		01	100		1	30		90				2			90				30		31	35.00		105.00																					70.00																35.00				35.00		1.17						1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	027	0	1	02	01	H4003_027_0	9	4	Non-Preferred Brand	1	4	100100	1	2	110		01	100		1	30		90				2			90				30		31	65.00		195.00																					130.00																65.00				65.00		2.17						2.10	Preferred Generic, Generic, Preferred Brand, Non-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	7.50		22.50																					15.00																7.50				7.50		0.25						0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H4003	034	0	1	02	01	H4003_034_0	11	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	4.00		12.00																					8.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	034	0	1	02	01	H4003_034_0	11	4	Non-Preferred Brand	3	4	100100	1	2	110		01	100		1	30		90				2			90				30		31	30.00		90.00																					60.00																30.00				30.00		1.00						0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4003	034	0	1	02	01	H4003_034_0	11	3	Preferred Brand	3	4	000101	1	2	110		01	100		1	30		90				2			90				30		31	20.00		60.00																					40.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4003	034	0	1	02	01	H4003_034_0	11	2	Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	10.00		30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H4003	034	0	1	02	01	H4003_034_0	11	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	10.00		30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	034	0	1	02	01	H4003_034_0	11	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				2			90				30		31				2648.00	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	034	0	1	02	01	H4003_034_0	11	4	Non-Preferred Brand	1	4	100100	1	2	110		01	100		1	30		90				2			90				30		31	30.00		90.00																					60.00																30.00				30.00		1.00						0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	034	0	1	02	01	H4003_034_0	11	3	Preferred Brand	1	4	000101	1	2	110		01	100		1	30		90				2			90				30		31	20.00		60.00																					40.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	034	0	1	02	01	H4003_034_0	11	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	4.00		12.00																					8.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H4004	053	0	1	02	01	H4004_053_0	8	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	5.00		15.00																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4004	053	0	1	02	01	H4004_053_0	8	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	16.00		48.00																					32.00																16.00				16.00		0.53						0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4004	053	0	1	02	01	H4004_053_0	8	3	Preferred Brand	1	4	000101	1	2	110		01	100		1	30		90				2			90				30		31	30.00		90.00																					60.00																30.00				30.00		1.00						0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4004	053	0	1	02	01	H4004_053_0	8	4	Non-Preferred Brand	1	4	100100	1	2	110		01	100		1	30		90				2			90				30		31	45.00		135.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4004	053	0	1	02	01	H4004_053_0	8	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				2			90				30		31				2568.00	32		32																				32															32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4004	053	0	1	02	01	H4004_053_0	8	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	5.00		15.00																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H4004	053	0	1	02	01	H4004_053_0	8	2	Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	16.00		48.00																					32.00																16.00				16.00		0.53						0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H4004	053	0	1	02	01	H4004_053_0	8	3	Preferred Brand	3	4	000101	1	2	110		01	100		1	30		90				2			90				30		31	30.00		90.00																					60.00																30.00				30.00		1.00						0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4004	053	0	1	02	01	H4004_053_0	8	4	Non-Preferred Brand	3	4	100100	1	2	110		01	100		1	30		90				2			90				30		31	45.00		135.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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								45.00		90.00					25.00		50.00							50.00																45.00				25.00			1.50	0.83				0.81	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4005	004	0	1	04	01	H4005_004_0	10	2	Generic	1	4	000100	3	2		110	01	100		1				30		90	1			90				30		31								20.00		40.00					10.00		20.00							20.00																20.00				10.00			0.67	0.33				0.32	Preferred Generic, 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								10.00		20.00					5.00		10.00							10.00																10.00				5.00			0.33	0.17				0.16	Preferred Generic, 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								75.00		150.00					40.00		80.00							80.00																75.00				40.00			2.50	1.33				1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, 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								10.00		20.00					5.00		10.00							10.00																10.00				5.00			.33	.16				.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H4005	004	0	1	04	01	H4005_004_0	10	2	Generic	3	4	000100	3	2		110	01	100		1				30		90	1			90				30		31								20.00		40.00					10.00		20.00							20.00																20.00				10.00			0.67	.33				.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H4005	006	0	1	04	01	H4005_006_0	9	3	Preferred Brand	1	4	000001	3	2		110	01	100		1				30		90	1			90				30		31								45.00		90.00					25.00		50.00							50.00																45.00				25.00			1.50	0.83				0.81	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4005	006	0	1	04	01	H4005_006_0	9	2	Generic	1	4	000100	3	2		110	01	100		1				30		90	1			90				30		31								20.00		40.00					10.00		20.00							20.00																20.00				10.00			0.67	0.33				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4005	006	0	1	04	01	H4005_006_0	9	1	Preferred Generic	1	4	001000	3	2		110	01	100		1				30		90	1			90				30		31								10.00		20.00					5.00		10.00							10.00																10.00				5.00			0.33	0.17				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4005	006	0	1	04	01	H4005_006_0	9	4	Non-Preferred Brand	1	4	100000	3	2		110	01	100		1				30		90	1			90				30		31								75.00		150.00					40.00		80.00							80.00																75.00				40.00			2.50	1.33				1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4005	006	0	1	04	01	H4005_006_0	9	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4007	012	0	1	01	01	H4007_012_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	1.00		3.00																									1.00		3.00				1.00		0.00				1.00				1.00		0.03				0.03	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4007	012	0	1	01	01	H4007_012_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	8.00		24.00																									8.00		24.00				8.00		0.00				8.00				8.00		0.26				0.26	0.26	0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4007	012	0	1	01	01	H4007_012_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	35.00		105.00																									35.00		105.00				35.00		95.00				35.00				35.00		1.16				1.16	1.16	1.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4007	012	0	1	01	01	H4007_012_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	80.00		240.00																									80.00		240.00				80.00		230.00				80.00				80.00		2.66				2.66	2.66	2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4007	012	0	1	01	01	H4007_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4007	012	0	1	01	01	H4007_012_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	1.00		3.00																									1.00		3.00				1.00		0.00				1.00				1.00		0.03				0.03	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4007	012	0	1	01	01	H4007_012_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	8.00		24.00																									8.00		24.00				8.00		0.00				8.00				8.00		0.26				0.26	0.26	0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4007	012	0	1	01	01	H4007_012_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	35.00		105.00																									35.00		105.00				35.00		95.00				35.00				35.00		1.16				1.16	1.16	1.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4007	012	0	1	01	01	H4007_012_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	80.00		240.00																									80.00		240.00				80.00		230.00				80.00				80.00		2.66				2.66	2.66	2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4007	012	0	1	01	01	H4007_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4007	013	0	1	01	01	H4007_013_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	1.00		3.00																									1.00		3.00				1.00		0.00				1.00				1.00		0.03				0.03	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4007	013	0	1	01	01	H4007_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4007	013	0	1	01	01	H4007_013_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	40.00		120.00																									40.00		120.00				40.00		110.00				40.00				40.00		1.33				1.33	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4007	013	0	1	01	01	H4007_013_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	35.00		105.00																									35.00		105.00				35.00		95.00				35.00				35.00		1.16				1.16	1.16	1.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4007	013	0	1	01	01	H4007_013_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4007	013	0	1	01	01	H4007_013_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	1.00		3.00																									1.00		3.00				1.00		0.00				1.00				1.00		0.03				0.03	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4007	013	0	1	01	01	H4007_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4007	013	0	1	01	01	H4007_013_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	40.00		120.00																									40.00		120.00				40.00		110.00				40.00				40.00		1.33				1.33	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4007	013	0	1	01	01	H4007_013_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	35.00		105.00																									35.00		105.00				35.00		95.00				35.00				35.00		1.16				1.16	1.16	1.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4007	013	0	1	01	01	H4007_013_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4007	016	0	1	01	01	H4007_016_0	5	1	Generic	1	3	001010	1	1	110		01	110		1	30		90				2	30		90				30		31				4.00	25		25																		25		25															25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4007	016	0	1	01	01	H4007_016_0	5	4	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		31					25																				25																	25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4007	016	0	1	01	01	H4007_016_0	5	3	Non-Preferred Brand	1	3	100100	1	1	110		01	110		1	30		90				2	30		90				30		31				15.00	25		25																		25		25															25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4007	016	0	1	01	01	H4007_016_0	5	2	Preferred Brand	1	3	010001	1	1	110		01	110		1	30		90				2	30		90				30		31				94.00	25		25																		25		25															25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4007	017	0	1	01	01	H4007_017_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4007	017	0	1	01	01	H4007_017_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	80.00		240.00																									80.00		240.00				80.00		230.00				80.00				80.00		2.66				2.66	2.66	2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4007	017	0	1	01	01	H4007_017_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	35.00		105.00																									35.00		105.00				35.00		95.00				35.00				35.00		1.16				1.16	1.16	1.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4007	017	0	1	01	01	H4007_017_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	8.00		24.00																									8.00		24.00				8.00		0.00				8.00				8.00		0.26				0.26	0.26	0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4007	017	0	1	01	01	H4007_017_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	1.00		3.00																									1.00		3.00				1.00		0.00				1.00				1.00		0.03				0.03	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4007	017	0	1	01	01	H4007_017_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	1.00		3.00																									1.00		3.00				1.00		0.00				1.00				1.00		0.03				0.03	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4007	017	0	1	01	01	H4007_017_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4007	017	0	1	01	01	H4007_017_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	35.00		105.00																									35.00		105.00				35.00		95.00				35.00				35.00		1.16				1.16	1.16	1.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4007	017	0	1	01	01	H4007_017_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	80.00		240.00																									80.00		240.00				80.00		230.00				80.00				80.00		2.66				2.66	2.66	2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4007	017	0	1	01	01	H4007_017_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	8.00		24.00																									8.00		24.00				8.00		0.00				8.00				8.00		0.26				0.26	0.26	0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4011	010	0	1	04	01	H4011_010_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	6.00		18.00																					12.00																6.00				6.00		.20						.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4011	010	0	1	04	01	H4011_010_0	6	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	14.00		42.00																					28.00																14.00				14.00		.47						.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4011	010	0	1	04	01	H4011_010_0	6	3	Preferred Brand	1	4	000101	1	2	110		01	100		1	30		90				2			90				30		31	40.00		120.00																					80.00																40.00				40.00		1.33						1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4011	010	0	1	04	01	H4011_010_0	6	4	Non-Preferred Brand	1	4	100100	1	2	110		01	100		1	30		90				2			90				30		31	65.00		195.00																					130.00																65.00				65.00		2.17						2.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4011	010	0	1	04	01	H4011_010_0	6	4	Non-Preferred Brand	3	4	100100	1	2	110		01	100		1	30		90				2			90				30		31	65.00		195.00																					130.00																65.00				65.00		2.17						2.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4011	010	0	1	04	01	H4011_010_0	6	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	6.00		18.00																					12.00																6.00				6.00		.20						.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H4011	010	0	1	04	01	H4011_010_0	6	2	Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	14.00		42.00																					28.00																14.00				14.00		.47						.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H4011	010	0	1	04	01	H4011_010_0	6	3	Preferred Brand	3	4	000101	1	2	110		01	100		1	30		90				2			90				30		31	40.00		120.00																					80.00																40.00				40.00		1.33						1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4011	010	0	1	04	01	H4011_010_0	6	5	Specialty Tier	1	4	010010	1	1	110		01			1	30		90				2							30		31				2648.00	33		33																																			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4036	008	0	1	04	01	H4036_008_0	10	5	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34											1395.01	32						1395.01	32						32																	32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4036	008	0	1	04	01	H4036_008_0	10	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								98.00	196.00	294.00					93.00	186.00	279.00					93.00	279.00	279.00																98.00				98.00			3.27	3.10	3.10			2.88	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4036	008	0	1	04	01	H4036_008_0	10	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4036	008	0	1	04	01	H4036_008_0	10	2	Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4036	008	0	1	04	01	H4036_008_0	10	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	15.00	15.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4036	008	0	1	04	01	H4036_008_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4036	009	0	1	04	01	H4036_009_0	10	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4036	009	0	1	04	01	H4036_009_0	10	2	Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4036	009	0	1	04	01	H4036_009_0	10	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4036	009	0	1	04	01	H4036_009_0	10	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4036	009	0	1	04	01	H4036_009_0	10	5	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34											1432.31	31						1432.31	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4036	009	0	1	04	01	H4036_009_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4036	010	1	1	04	01	H4036_010_1	10	5	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34											1705.28	31						1705.28	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4036	010	1	1	04	01	H4036_010_1	10	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4036	010	1	1	04	01	H4036_010_1	10	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4036	010	1	1	04	01	H4036_010_1	10	2	Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4036	010	1	1	04	01	H4036_010_1	10	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4036	010	1	1	04	01	H4036_010_1	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4036	010	2	1	04	01	H4036_010_2	10	2	Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4036	010	2	1	04	01	H4036_010_2	10	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4036	010	2	1	04	01	H4036_010_2	10	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4036	010	2	1	04	01	H4036_010_2	10	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4036	010	2	1	04	01	H4036_010_2	10	5	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34											1705.28	31						1705.28	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4036	010	2	1	04	01	H4036_010_2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4036	012	1	1	04	01	H4036_012_1	10	2	Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4036	012	1	1	04	01	H4036_012_1	10	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4036	012	1	1	04	01	H4036_012_1	10	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4036	012	1	1	04	01	H4036_012_1	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4036	012	1	1	04	01	H4036_012_1	10	5	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34											1474.22	32						1474.22	32						32																	32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4036	012	1	1	04	01	H4036_012_1	10	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4036	012	2	1	04	01	H4036_012_2	10	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4036	012	2	1	04	01	H4036_012_2	10	2	Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4036	012	2	1	04	01	H4036_012_2	10	5	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34											1474.22	32						1474.22	32						32																	32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4036	012	2	1	04	01	H4036_012_2	10	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4036	012	2	1	04	01	H4036_012_2	10	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4036	012	2	1	04	01	H4036_012_2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4141	001	0	1	01	01	H4141_001_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	001	0	1	01	01	H4141_001_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	001	0	1	01	01	H4141_001_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	001	0	1	01	01	H4141_001_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	001	0	1	01	01	H4141_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4141	001	0	1	01	01	H4141_001_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4141	001	0	1	01	01	H4141_001_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4141	001	0	1	01	01	H4141_001_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4141	001	0	1	01	01	H4141_001_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4141	001	0	1	01	01	H4141_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, 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					26																										26						26					26			26								Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	003	0	1	01	01	H4141_003_0	5	2	Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	004	0	1	01	01	H4141_004_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4141	004	0	1	01	01	H4141_004_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4141	004	0	1	01	01	H4141_004_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4141	004	0	1	01	01	H4141_004_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4141	004	0	1	01	01	H4141_004_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4141	004	0	1	01	01	H4141_004_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	004	0	1	01	01	H4141_004_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	004	0	1	01	01	H4141_004_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	004	0	1	01	01	H4141_004_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	004	0	1	01	01	H4141_004_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	008	0	1	01	01	H4141_008_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	008	0	1	01	01	H4141_008_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4141	008	0	1	01	01	H4141_008_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4141	008	0	1	01	01	H4141_008_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4141	008	0	1	01	01	H4141_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4141	008	0	1	01	01	H4141_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	008	0	1	01	01	H4141_008_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	008	0	1	01	01	H4141_008_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	008	0	1	01	01	H4141_008_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	008	0	1	01	01	H4141_008_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4141	009	0	1	01	01	H4141_009_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H4141	009	0	1	01	01	H4141_009_0	6	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4141	009	0	1	01	01	H4141_009_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4141	009	0	1	01	01	H4141_009_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4141	009	0	1	01	01	H4141_009_0	6	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4141	009	0	1	01	01	H4141_009_0	6	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4141	009	0	1	01	01	H4141_009_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4141	009	0	1	01	01	H4141_009_0	6	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H4141	009	0	1	01	01	H4141_009_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H4141	009	0	1	01	01	H4141_009_0	6	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H4141	009	0	1	01	01	H4141_009_0	6	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H4141	010	0	1	01	01	H4141_010_0	5	2	Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	010	0	1	01	01	H4141_010_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	010	0	1	01	01	H4141_010_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	010	0	1	01	01	H4141_010_0	5	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	010	0	1	01	01	H4141_010_0	5	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	015	0	1	01	01	H4141_015_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4141	015	0	1	01	01	H4141_015_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4141	015	0	1	01	01	H4141_015_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	015	0	1	01	01	H4141_015_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	015	0	1	01	01	H4141_015_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	015	0	1	01	01	H4141_015_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	015	0	1	01	01	H4141_015_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4141	015	0	1	01	01	H4141_015_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4141	015	0	1	01	01	H4141_015_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4141	015	0	1	01	01	H4141_015_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4145	001	0	1	01	01	H4145_001_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	11.00		33.00																									11.00		33.00				11.00		0.00				11.00				11.00		0.36				0.36	0.36	0.35	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4145	001	0	1	01	01	H4145_001_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	11.00		33.00																									11.00		33.00				11.00		0.00				11.00				11.00		0.36				0.36	0.36	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4145	002	0	1	01	01	H4145_002_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	11.00		33.00																									11.00		33.00				11.00		0.00				11.00				11.00		0.36				0.36	0.36	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, 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, 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	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4145	002	0	1	01	01	H4145_002_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	11.00		33.00																									11.00		33.00				11.00		0.00				11.00				11.00		0.36				0.36	0.36	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4152	005	0	1	01	01	H4152_005_0	14	3	Preferred Brand	1	4	000101	1	2	111		01	100		1	30	60	90				1			90				30		31	47.00	94.00	141.00																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	005	0	1	01	01	H4152_005_0	14	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	005	0	1	01	01	H4152_005_0	14	4	Non-Preferred Brand	1	4	100100	1	2	111		01	100		1	30	60	90				1			90				30		31	100.00	200.00	300.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	005	0	1	01	01	H4152_005_0	14	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	30	60	90				1			90				30		31	3.00	6.00	9.00																					3.00																3.00				3.00		.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	005	0	1	01	01	H4152_005_0	14	2	Generic	1	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	6.00	12.00	18.00																					6.00																6.00				6.00		.20						.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	007	0	1	02	01	H4152_007_0	14	1	Preferred Generic	3	4	001000	1	2	111		01	100		1	30	60	90				1			90				30		31	3.00	6.00	9.00																					3.00																3.00				3.00		.10						.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4152	007	0	1	02	01	H4152_007_0	14	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	007	0	1	02	01	H4152_007_0	14	4	Non-Preferred Brand	1	4	100100	1	2	111		01	100		1	30	60	90				1			90				30		31	100.00	200.00	300.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	007	0	1	02	01	H4152_007_0	14	3	Preferred Brand	1	4	000101	1	2	111		01	100		1	30	60	90				1			90				30		31	47.00	94.00	141.00																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	007	0	1	02	01	H4152_007_0	14	2	Generic	1	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	6.00	12.00	18.00																					6.00																6.00				6.00		.20						.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	007	0	1	02	01	H4152_007_0	14	2	Generic	3	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	6.00	12.00	18.00																					6.00																6.00				6.00		0.20						0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4152	007	0	1	02	01	H4152_007_0	14	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	30	60	90				1			90				30		31	3.00	6.00	9.00																					3.00																3.00				3.00		.10						.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	013	0	1	01	01	H4152_013_0	12	3	Preferred Brand	1	4	000101	1	2	111		01	100		1	30	60	90				1			90				30		31	47.00	94.00	141.00																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	013	0	1	01	01	H4152_013_0	12	2	Generic	1	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	12.00	24.00	36.00																					12.00																12.00				12.00		.40						.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	013	0	1	01	01	H4152_013_0	12	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	30	60	90				1			90				30		31	7.00	14.00	21.00																					7.00																7.00				7.00		.23						0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	013	0	1	01	01	H4152_013_0	12	4	Non-Preferred Brand	1	4	100100	1	2	111		01	100		1	30	60	90				1			90				30		31	100.00	200.00	300.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	013	0	1	01	01	H4152_013_0	12	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	016	0	1	02	01	H4152_016_0	14	2	Generic	1	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	10.00	20.00	30.00																					10.00																10.00				10.00		.33						.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	016	0	1	02	01	H4152_016_0	14	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	30	60	90				1			90				30		31	2.00	4.00	6.00																					2.00																2.00				2.00		.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	016	0	1	02	01	H4152_016_0	14	3	Preferred Brand	1	4	000101	1	2	111		01	100		1	30	60	90				1			90				30		31	47.00	94.00	141.00																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	016	0	1	02	01	H4152_016_0	14	4	Non-Preferred Brand	1	4	100100	1	2	111		01	100		1	30	60	90				1			90				30		31	100.00	200.00	300.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	016	0	1	02	01	H4152_016_0	14	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	017	0	1	01	01	H4152_017_0	15	2	Generic	1	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	10.00	20.00	30.00																					10.00																10.00				10.00		.33						.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	017	0	1	01	01	H4152_017_0	15	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	30	60	90				1			90				30		31	2.00	4.00	6.00																					2.00																2.00				2.00		.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	017	0	1	01	01	H4152_017_0	15	3	Preferred Brand	1	4	000101	1	2	111		01	100		1	30	60	90				1			90				30		31	47.00	94.00	141.00																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	017	0	1	01	01	H4152_017_0	15	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	017	0	1	01	01	H4152_017_0	15	4	Non-Preferred Brand	1	4	100100	1	2	111		01	100		1	30	60	90				1			90				30		31	100.00	200.00	300.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	018	0	1	02	01	H4152_018_0	13	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	30	60	90				1			90				30		31	4.00	8.00	12.00																					4.00																4.00				4.00		.13						.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	018	0	1	02	01	H4152_018_0	13	2	Generic	1	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	8.00	16.00	24.00																					8.00																8.00				8.00		.27						.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	018	0	1	02	01	H4152_018_0	13	4	Non-Preferred Brand	1	4	100100	1	2	111		01	100		1	30	60	90				1			90				30		31	100.00	200.00	300.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	018	0	1	02	01	H4152_018_0	13	3	Preferred Brand	1	4	000101	1	2	111		01	100		1	30	60	90				1			90				30		31	47.00	94.00	141.00																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	018	0	1	02	01	H4152_018_0	13	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4198	003	0	1	01	01	H4198_003_0	4	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H4198	003	0	1	01	01	H4198_003_0	4	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H4198	003	0	1	01	01	H4198_003_0	4	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	40.00	80.00	120.00																			40.00	80.00	80.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H4198	003	0	1	01	01	H4198_003_0	4	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H4198	003	0	1	01	01	H4198_003_0	4	5	Specialty Tier	1	4	100000	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H4198	003	0	1	01	01	H4198_003_0	4	6	Injectable Drugs	1	4	100000	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31				83.81	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H4198	005	0	1	01	01	H4198_005_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H4198	005	0	1	01	01	H4198_005_0	5	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	13.00	26.00	39.00																			13.00	26.00	26.00																13.00				13.00		0.43			0.43			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H4198	005	0	1	01	01	H4198_005_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	40.00	80.00	120.00																			40.00	80.00	80.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H4198	005	0	1	01	01	H4198_005_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	90.00	180.00	270.00																			90.00	180.00	180.00																90.00				90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H4198	005	0	1	01	01	H4198_005_0	5	5	Specialty Tier	1	4	100000	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H4198	005	0	1	01	01	H4198_005_0	5	6	Injectable Drugs	1	4	100000	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31				87.43	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs												
H4213	017	1	1	09	04	H4213_017_1	7	1	Preferred Generic	1	3	001000	1	2		110	01	110		1				30		90	1	30		90				30		31								10.00		25.00					3.00		7.50					3.00		7.50																10.00				3.00			0.33	0.10	0.10			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4213	017	1	1	09	04	H4213_017_1	7	2	Generic	1	3	000100	1	2		110	01	110		1				30		90	1	30		90				30		31								20.00		50.00					13.00		32.50					13.00		32.50																20.00				13.00			0.66	0.43	0.43			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4213	017	1	1	09	04	H4213_017_1	7	3	Preferred Brand	1	3	000001	1	2		110	01	110		1				30		90	1	30		90				30		31								47.00		117.50					42.00		105.00					42.00		105.00																47.00				42.00			1.56	1.40	1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4213	017	1	1	09	04	H4213_017_1	7	4	Non-Preferred Brand	1	3	110000	1	2		110	01	110		1				30		90	1	30		90				30		31								100.00		250.00					95.00		237.50					95.00		237.50																100.00				95.00			3.33	3.16	3.16			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4213	017	1	1	09	04	H4213_017_1	7	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4213	017	2	1	09	04	H4213_017_2	8	2	Generic	1	3	000100	1	2		110	01	110		1				30		90	1	30		90				30		31								20.00		50.00					13.00		32.50					13.00		32.50																20.00				13.00			0.66	0.43	0.43			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4213	017	2	1	09	04	H4213_017_2	8	1	Preferred Generic	1	3	001000	1	2		110	01	110		1				30		90	1	30		90				30		31								10.00		25.00					3.00		7.50					3.00		7.50																10.00				3.00			0.33	0.10	0.10			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4213	017	2	1	09	04	H4213_017_2	8	3	Preferred Brand	1	3	000001	1	2		110	01	110		1				30		90	1	30		90				30		31								47.00		117.50					42.00		105.00					42.00		105.00																47.00				42.00			1.56	1.40	1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4213	017	2	1	09	04	H4213_017_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4213	017	2	1	09	04	H4213_017_2	8	4	Non-Preferred Brand	1	3	110000	1	2		110	01	110		1				30		90	1	30		90				30		31								100.00		250.00					95.00		237.50					95.00		237.50																100.00				95.00			3.33	3.16	3.16			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4213	017	5	1	09	04	H4213_017_5	7	1	Preferred Generic	1	3	001000	1	2		110	01	110		1				30		90	1	30		90				30		31								10.00		25.00					3.00		7.50					3.00		7.50																10.00				3.00			0.33	0.10	0.10			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4213	017	5	1	09	04	H4213_017_5	7	2	Generic	1	3	000100	1	2		110	01	110		1				30		90	1	30		90				30		31								20.00		50.00					13.00		32.50					13.00		32.50																20.00				13.00			0.66	0.43	0.43			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4213	017	5	1	09	04	H4213_017_5	7	4	Non-Preferred Brand	1	3	110000	1	2		110	01	110		1				30		90	1	30		90				30		31								100.00		250.00					95.00		237.50					95.00		237.50																100.00				95.00			3.33	3.16	3.16			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4213	017	5	1	09	04	H4213_017_5	7	3	Preferred Brand	1	3	000001	1	2		110	01	110		1				30		90	1	30		90				30		31								47.00		117.50					42.00		105.00					42.00		105.00																47.00				42.00			1.56	1.40	1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4213	017	5	1	09	04	H4213_017_5	7	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4213	017	6	1	09	04	H4213_017_6	8	2	Generic	1	3	000100	1	2		110	01	110		1				30		90	1	30		90				30		31								20.00		50.00					13.00		32.50					13.00		32.50																20.00				13.00			0.66	0.43	0.43			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4213	017	6	1	09	04	H4213_017_6	8	1	Preferred Generic	1	3	001000	1	2		110	01	110		1				30		90	1	30		90				30		31								10.00		25.00					3.00		7.50					3.00		7.50																10.00				3.00			0.33	0.10	0.10			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4213	017	6	1	09	04	H4213_017_6	8	3	Preferred Brand	1	3	000001	1	2		110	01	110		1				30		90	1	30		90				30		31								47.00		117.50					42.00		105.00					42.00		105.00																47.00				42.00			1.56	1.40	1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4213	017	6	1	09	04	H4213_017_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4213	017	6	1	09	04	H4213_017_6	8	4	Non-Preferred Brand	1	3	110000	1	2		110	01	110		1				30		90	1	30		90				30		31								100.00		250.00					95.00		237.50					95.00		237.50																100.00				95.00			3.33	3.16	3.16			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4227	001	0	1	01	01	H4227_001_0	16	1	Preferred Generic	1	2	001000	1	2	111		01	100		1	30	60	90				1			90				30		31	4.00	8.00	12.00																					12.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4227	001	0	1	01	01	H4227_001_0	16	2	Generic	1	2	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	13.00	26.00	39.00																					39.00																13.00				13.00		0.43						0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4227	001	0	1	01	01	H4227_001_0	16	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4227	001	0	1	01	01	H4227_001_0	16	4	Non-Preferred Brand	1	2	100000	1	2	111		01	100		1	30	60	90				1			90				30		31	100.00	200.00	300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4227	001	0	1	01	01	H4227_001_0	16	3	Preferred Brand	1	2	000001	1	2	111		01	100		1	30	60	90				1			90				30		31	47.00	94.00	141.00																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4227	002	0	1	01	01	H4227_002_0	15	3	Preferred Brand	1	2	000001	1	2	111		01	100		1	30	60	90				1			90				30		31	47.00	94.00	141.00																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4227	002	0	1	01	01	H4227_002_0	15	4	Non-Preferred Brand	1	2	100000	1	2	111		01	100		1	30	60	90				1			90				30		31	100.00	200.00	300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4227	002	0	1	01	01	H4227_002_0	15	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4227	002	0	1	01	01	H4227_002_0	15	1	Preferred Generic	1	2	001000	1	2	111		01	100		1	30	60	90				1			90				30		31	4.00	8.00	12.00																					12.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4227	002	0	1	01	01	H4227_002_0	15	2	Generic	1	2	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	14.00	28.00	42.00																					42.00																14.00				14.00		0.47						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4279	001	0	1	01	01	H4279_001_0	9	2	Preferred Brand	1	2	010001	1	2	110		01	100		1	30		90				1			90				30		31	30.00		90.00																					90.00																30.00				30.00		1.00						.97	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4279	001	0	1	01	01	H4279_001_0	9	1	Generic	1	2	010000	1	2	110		01	100		1	30		90				1			90				30		31	3.00		9.00																					9.00																3.00				3.00		0.10						0.10	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4279	001	0	1	01	01	H4279_001_0	9	3	Non-Preferred Brand	1	2	110000	1	1	110		01	100		1	30		90				1			90				30		31				61.89	46		46																				46															46			46								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4279	001	0	1	01	01	H4279_001_0	9	4	Specialty Tier	1	2	010010	1	1	010		01	010		1	30							30						30		31				409.52	25																				25																	25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4279	001	0	1	01	01	H4279_001_0	9	5	Select Care Drugs	1	2	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												
H4346	001	0	1	01	01	H4346_001_0	5	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4346	001	0	1	01	01	H4346_001_0	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	001	0	1	01	01	H4346_001_0	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H4346	001	0	1	01	01	H4346_001_0	5	2	Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			.40	.24				.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4346	001	0	1	01	01	H4346_001_0	5	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	001	0	1	01	01	H4346_001_0	5	2	Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			.40	.24				.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	001	0	1	01	01	H4346_001_0	5	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31								45.00		135.00					40.00		120.00							100.00																45.00				45.00			1.45	1.29				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	001	0	1	01	01	H4346_001_0	5	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					85.00		255.00							212.50																95.00				95.00			3.06	2.74				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	001	0	1	01	01	H4346_001_0	5	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											584.00	33						584.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	005	0	1	01	01	H4346_005_0	5	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	005	0	1	01	01	H4346_005_0	5	2	Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			.40	.24				.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4346	005	0	1	01	01	H4346_005_0	5	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4346	005	0	1	01	01	H4346_005_0	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	005	0	1	01	01	H4346_005_0	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H4346	005	0	1	01	01	H4346_005_0	5	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					85.00		255.00							212.50																95.00				95.00			3.06	2.74				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	005	0	1	01	01	H4346_005_0	5	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31								45.00		135.00					40.00		120.00							100.00																45.00				45.00			1.45	1.29				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	005	0	1	01	01	H4346_005_0	5	2	Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			.40	.24				.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	005	0	1	01	01	H4346_005_0	5	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											584.00	33						584.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	006	0	1	01	01	H4346_006_0	5	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4346	006	0	1	01	01	H4346_006_0	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	006	0	1	01	01	H4346_006_0	5	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											584.00	33						584.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	006	0	1	01	01	H4346_006_0	5	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					85.00		255.00							212.50																95.00				95.00			3.06	2.74				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	006	0	1	01	01	H4346_006_0	5	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31								45.00		135.00					40.00		120.00							100.00																45.00				45.00			1.45	1.29				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	006	0	1	01	01	H4346_006_0	5	2	Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			.40	.24				.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	006	0	1	01	01	H4346_006_0	5	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	006	0	1	01	01	H4346_006_0	5	2	Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			.40	.24				.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4346	006	0	1	01	01	H4346_006_0	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H4346	008	0	1	01	01	H4346_008_0	5	2	Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			.40	.24				.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	008	0	1	01	01	H4346_008_0	5	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	008	0	1	01	01	H4346_008_0	5	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31								45.00		135.00					40.00		120.00							100.00																45.00				45.00			1.45	1.29				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	008	0	1	01	01	H4346_008_0	5	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					85.00		255.00							212.50																95.00				95.00			3.06	2.74				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	008	0	1	01	01	H4346_008_0	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H4346	008	0	1	01	01	H4346_008_0	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	008	0	1	01	01	H4346_008_0	5	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4346	008	0	1	01	01	H4346_008_0	5	2	Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			.40	.24				.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4346	008	0	1	01	01	H4346_008_0	5	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											584.00	33						584.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	009	0	1	01	01	H4346_009_0	5	2	Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								15.50		46.50					10.50		31.50							26.25																15.50				15.50			.50	.33				.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	009	0	1	01	01	H4346_009_0	5	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								10.00		30.00					5.00		15.00							12.50																10.00				10.00			0.32	0.16				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	009	0	1	01	01	H4346_009_0	5	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31								45.00		135.00					40.00		120.00							100.00																45.00				45.00			1.45	1.29				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	009	0	1	01	01	H4346_009_0	5	6	Select Care Drugs	1	4	010010	1	2		110	01	100		1				30		90	1			90				30		31								10.00		30.00					10.00		30.00							25.00																10.00				10.00			0.32	0.32				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	009	0	1	01	01	H4346_009_0	5	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											584.00	33						584.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	009	0	1	01	01	H4346_009_0	5	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					90.00		270.00							225.00																95.00				95.00			3.06	2.90				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	010	0	1	01	01	H4346_010_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	010	0	1	01	01	H4346_010_0	5	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	7.50		22.50																					18.75																7.50				7.50		.24						.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	010	0	1	01	01	H4346_010_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	40.00		120.00																					100.00																40.00				40.00		1.29						1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	010	0	1	01	01	H4346_010_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	85.00		255.00																					212.50																85.00				85.00		2.74						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	010	0	1	01	01	H4346_010_0	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H4346	010	0	1	01	01	H4346_010_0	5	2	Generic	3	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	7.50		22.50																					18.75																7.50				7.50		.24						.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4346	010	0	1	01	01	H4346_010_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4346	010	0	1	01	01	H4346_010_0	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4346	010	0	1	01	01	H4346_010_0	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				584.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4407	025	1	1	01	01	H4407_025_1	6	1	Preferred Generic	1	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	1.00	2.00	2.00																			1.00		2.00																1.00				1.00		0.03			0.03			0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4407	025	1	1	01	01	H4407_025_1	6	2	Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	15.00	30.00	37.00																			15.00		37.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4407	025	1	1	01	01	H4407_025_1	6	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31				462.88	26	26	26																		26		26															26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4407	025	1	1	01	01	H4407_025_1	6	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	95.00	190.00	237.00																			95.00		237.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4407	025	1	1	01	01	H4407_025_1	6	3	Preferred Brand	1	4	000101	1	2	111		01	110		1	30	60	90				2	30		90				30		31	47.00	94.00	117.00																			47.00		117.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4407	025	2	1	01	01	H4407_025_2	6	2	Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	15.00	30.00	37.00																			15.00		37.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4407	025	2	1	01	01	H4407_025_2	6	3	Preferred Brand	1	4	000101	1	2	111		01	110		1	30	60	90				2	30		90				30		31	47.00	94.00	117.00																			47.00		117.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4407	025	2	1	01	01	H4407_025_2	6	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	95.00	190.00	237.00																			95.00		237.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4407	025	2	1	01	01	H4407_025_2	6	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31				462.88	26	26	26																		26		26															26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4407	025	2	1	01	01	H4407_025_2	6	1	Preferred Generic	1	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	1.00	2.00	2.00																			1.00		2.00																1.00				1.00		0.03			0.03			0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4454	030	0	1	02	01	H4454_030_0	5	1	Preferred Generic	3	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	3.00	6.00	9.00																			3.00		9.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4454	030	0	1	02	01	H4454_030_0	5	2	Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	17.00	34.00	51.00																			17.00		51.00																17.00				17.00		0.57			0.57			0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4454	030	0	1	02	01	H4454_030_0	5	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	100.00	200.00	300.00																			100.00		300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4454	030	0	1	02	01	H4454_030_0	5	3	Preferred Brand	1	4	000101	1	2	111		01	110		1	30	60	90				2	30		90				30		31	47.00	94.00	141.00																			47.00		141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4454	030	0	1	02	01	H4454_030_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31				503.91	33	33	33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4454	030	0	1	02	01	H4454_030_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	3.00	6.00	9.00																			3.00		9.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, 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				547.00	28	28	28																		28		28															28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4454	031	0	1	01	01	H4454_031_0	4	1	Preferred Generic	1	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	5.00	10.00	15.00																			5.00		15.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4454	031	0	1	01	01	H4454_031_0	4	2	Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	20.00	40.00	60.00																			20.00		60.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4454	031	0	1	01	01	H4454_031_0	4	3	Preferred Brand	1	4	000101	1	2	111		01	110		1	30	60	90				2	30		90				30		31	47.00	94.00	141.00																			47.00		141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, 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	100.00	200.00	300.00																			100.00		300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, 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	5.00	10.00	15.00																			5.00		15.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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	3.00	6.00	9.00																			3.00		9.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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				519.87	33	33	33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	3.00	6.00	9.00																			3.00		9.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4454	033	0	1	01	01	H4454_033_0	4	2	Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	20.00	40.00	60.00																			20.00		60.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4454	033	0	1	01	01	H4454_033_0	4	3	Preferred Brand	1	4	000101	1	2	111		01	110		1	30	60	90				2	30		90				30		31	47.00	94.00	141.00																			47.00		141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, 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	100.00	200.00	300.00																			100.00		300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4454	036	0	1	02	01	H4454_036_0	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4454	036	0	1	02	01	H4454_036_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31				503.91	33	33	33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4454	036	0	1	02	01	H4454_036_0	5	2	Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	12.00	24.00	36.00																			12.00		36.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4454	036	0	1	02	01	H4454_036_0	5	3	Preferred Brand	1	4	000101	1	2	111		01	110		1	30	60	90				2	30		90				30		31	45.00	90.00	135.00																			45.00		135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4454	036	0	1	02	01	H4454_036_0	5	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	100.00	200.00	300.00																			100.00		300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4454	036	0	1	02	01	H4454_036_0	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4454	037	1	1	01	01	H4454_037_1	4	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31				519.87	33	33	33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4454	037	1	1	01	01	H4454_037_1	4	1	Preferred Generic	1	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	3.00	6.00	9.00																			3.00		9.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4454	037	1	1	01	01	H4454_037_1	4	2	Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	17.00	34.00	51.00																			17.00		51.00																17.00				17.00		0.57			0.57			0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4454	037	1	1	01	01	H4454_037_1	4	3	Preferred Brand	1	4	000101	1	2	111		01	110		1	30	60	90				2	30		90				30		31	47.00	94.00	141.00																			47.00		141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4454	037	1	1	01	01	H4454_037_1	4	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	100.00	200.00	300.00																			100.00		300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4454	037	1	1	01	01	H4454_037_1	4	1	Preferred Generic	3	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	3.00	6.00	9.00																			3.00		9.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4454	037	2	1	01	01	H4454_037_2	4	1	Preferred Generic	3	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	3.00	6.00	9.00																			3.00		9.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4454	037	2	1	01	01	H4454_037_2	4	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31				519.87	33	33	33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4454	037	2	1	01	01	H4454_037_2	4	1	Preferred Generic	1	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	3.00	6.00	9.00																			3.00		9.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4454	037	2	1	01	01	H4454_037_2	4	2	Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	17.00	34.00	51.00																			17.00		51.00																17.00				17.00		0.57			0.57			0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4454	037	2	1	01	01	H4454_037_2	4	3	Preferred Brand	1	4	000101	1	2	111		01	110		1	30	60	90				2	30		90				30		31	47.00	94.00	141.00																			47.00		141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4454	037	2	1	01	01	H4454_037_2	4	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	100.00	200.00	300.00																			100.00		300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	022	0	1	01	01	H4461_022_0	4	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	022	0	1	01	01	H4461_022_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	022	0	1	01	01	H4461_022_0	4	2	Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00		9.00																									3.00		9.00				3.00		0.00				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	022	0	1	01	01	H4461_022_0	4	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	022	0	1	01	01	H4461_022_0	4	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	025	0	1	01	01	H4461_025_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	025	0	1	01	01	H4461_025_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, 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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	029	0	1	01	01	H4461_029_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4461	029	0	1	01	01	H4461_029_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4461	029	0	1	01	01	H4461_029_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4461	029	0	1	01	01	H4461_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	029	0	1	01	01	H4461_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4461	029	0	1	01	01	H4461_029_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	029	0	1	01	01	H4461_029_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	029	0	1	01	01	H4461_029_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	029	0	1	01	01	H4461_029_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4461	029	0	1	01	01	H4461_029_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4461	030	1	1	01	01	H4461_030_1	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		0.00				12.00				12.00		0.40				0.40	0.40	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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, 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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	030	1	1	01	01	H4461_030_1	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		0.00				12.00				12.00		0.40				0.40	0.40	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4461	030	2	1	01	01	H4461_030_2	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		0.00				12.00				12.00		0.40				0.40	0.40	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	030	2	1	01	01	H4461_030_2	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		0.00				12.00				12.00		0.40				0.40	0.40	0.38	Preferred Generic, 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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	030	3	1	01	01	H4461_030_3	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		0.00				12.00				12.00		0.40				0.40	0.40	0.38	Preferred Generic, 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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, 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, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4461	030	3	1	01	01	H4461_030_3	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		0.00				12.00				12.00		0.40				0.40	0.40	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	031	1	1	01	01	H4461_031_1	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, 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, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H4461	031	1	1	01	01	H4461_031_1	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, 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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4461	031	2	1	01	01	H4461_031_2	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	031	2	1	01	01	H4461_031_2	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4461	031	3	1	01	01	H4461_031_3	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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, 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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H4461	031	3	1	01	01	H4461_031_3	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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																																														0.00			0.00			0.00	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																																														0.00			0.00			0.00	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																																														0.00			0.00			0.00	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																																														0.00			0.00			0.00	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			
H4488	001	0	1	01	01	H4488_001_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	2.00	4.00	5.00																			2.00	4.00	6.00																2.00				2.00		0.06			0.06			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4488	001	0	1	01	01	H4488_001_0	5	2	Generic	1	4	000100	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	7.00	14.00	17.50																			7.00	14.00	21.00																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4488	001	0	1	01	01	H4488_001_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	47.00	94.00	117.50																			47.00	94.00	141.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4488	001	0	1	01	01	H4488_001_0	5	4	Non-Preferred Brand	1	4	100000	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31				93.20	35	35	35																		35	35	35															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4488	001	0	1	01	01	H4488_001_0	5	5	Specialty Tier	1	4	000010	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4497	001	1	1	04	01	H4497_001_1	10	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	100.00	150.00	200.00																			100.00	150.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4497	001	1	1	04	01	H4497_001_1	10	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	71.00	94.00																			47.00	71.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4497	001	1	1	04	01	H4497_001_1	10	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	17.00	26.00	34.00																			17.00	26.00	34.00																17.00				17.00		0.57			0.57			0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4497	001	1	1	04	01	H4497_001_1	10	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	4.00	6.00	8.00																			4.00	6.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4497	001	1	1	04	01	H4497_001_1	10	5	Specialty Tier	1	4	100101	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31				198.00	29	29	29																		29	29	29															29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4497	001	1	1	04	01	H4497_001_1	10	2	Generic	3	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	17.00	26.00	34.00																			17.00	26.00	34.00																17.00				17.00		0.57			0.57			0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4497	001	1	1	04	01	H4497_001_1	10	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	4.00	6.00	8.00																			4.00	6.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4497	001	2	1	04	01	H4497_001_2	8	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	4.00	6.00	8.00																			4.00	6.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4497	001	2	1	04	01	H4497_001_2	8	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	17.00	26.00	34.00																			17.00	26.00	34.00																17.00				17.00		0.57			0.57			0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4497	001	2	1	04	01	H4497_001_2	8	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	71.00	94.00																			47.00	71.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4497	001	2	1	04	01	H4497_001_2	8	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	100.00	150.00	200.00																			100.00	150.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4497	001	2	1	04	01	H4497_001_2	8	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	4.00	6.00	8.00																			4.00	6.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4497	001	2	1	04	01	H4497_001_2	8	5	Specialty Tier	1	4	100101	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31				198.00	29	29	29																		29	29	29															29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4497	001	2	1	04	01	H4497_001_2	8	2	Generic	3	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	17.00	26.00	34.00																			17.00	26.00	34.00																17.00				17.00		0.57			0.57			0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4497	002	1	1	04	01	H4497_002_1	11	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	100.00	150.00	200.00																			100.00	150.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4497	002	1	1	04	01	H4497_002_1	11	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	71.00	94.00																			47.00	71.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4497	002	1	1	04	01	H4497_002_1	11	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	12.00	18.00	24.00																			12.00	18.00	24.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4497	002	1	1	04	01	H4497_002_1	11	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4497	002	1	1	04	01	H4497_002_1	11	5	Specialty Tier	1	4	100101	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31				198.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4497	002	1	1	04	01	H4497_002_1	11	2	Generic	3	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	12.00	18.00	24.00																			12.00	18.00	24.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4497	002	1	1	04	01	H4497_002_1	11	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4497	002	2	1	04	01	H4497_002_2	11	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	71.00	94.00																			47.00	71.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4497	002	2	1	04	01	H4497_002_2	11	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	12.00	18.00	24.00																			12.00	18.00	24.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4497	002	2	1	04	01	H4497_002_2	11	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4497	002	2	1	04	01	H4497_002_2	11	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	100.00	150.00	200.00																			100.00	150.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4497	002	2	1	04	01	H4497_002_2	11	5	Specialty Tier	1	4	100101	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31				198.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4497	002	2	1	04	01	H4497_002_2	11	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4497	002	2	1	04	01	H4497_002_2	11	2	Generic	3	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	12.00	18.00	24.00																			12.00	18.00	24.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4497	003	1	1	04	01	H4497_003_1	9	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	71.00	94.00																			47.00	71.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4497	003	1	1	04	01	H4497_003_1	9	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	12.00	18.00	24.00																			12.00	18.00	24.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4497	003	1	1	04	01	H4497_003_1	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4497	003	1	1	04	01	H4497_003_1	9	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	100.00	150.00	200.00																			100.00	150.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4497	003	1	1	04	01	H4497_003_1	9	2	Generic	3	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	12.00	18.00	24.00																			12.00	18.00	24.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4497	003	1	1	04	01	H4497_003_1	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4497	003	1	1	04	01	H4497_003_1	9	5	Specialty Tier	1	4	100101	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31				198.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4497	003	2	1	04	01	H4497_003_2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4497	003	2	1	04	01	H4497_003_2	9	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	12.00	18.00	24.00																			12.00	18.00	24.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4497	003	2	1	04	01	H4497_003_2	9	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	71.00	94.00																			47.00	71.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4497	003	2	1	04	01	H4497_003_2	9	5	Specialty Tier	1	4	100101	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31				198.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4497	003	2	1	04	01	H4497_003_2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4497	003	2	1	04	01	H4497_003_2	9	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	100.00	150.00	200.00																			100.00	150.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4497	003	2	1	04	01	H4497_003_2	9	2	Generic	3	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	12.00	18.00	24.00																			12.00	18.00	24.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4506	003	0	1	01	01	H4506_003_0	8	1	Preferred Generic	3	4	001000	1	2	110		01		110	1	30		90				2				30		90	30		34	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4506	003	0	1	01	01	H4506_003_0	8	3	Preferred Brand	3	4	000001	1	2	110		01		110	1	30		90				2				30		90	30		34	40.00		100.00																									40.00		100.00				40.00		80.00				40.00				40.00		1.33				1.33	1.33	1.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H4506	003	0	1	01	01	H4506_003_0	8	2	Generic	3	4	000100	1	2	110		01		110	1	30		90				2				30		90	30		34	5.00		12.50																									5.00		12.50				5.00		5.00				5.00				5.00		0.16				0.16	0.16	0.14	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4506	003	0	1	01	01	H4506_003_0	8	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		34				1.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4506	003	0	1	01	01	H4506_003_0	8	4	Non-Preferred Brand	1	4	100000	1	2	110		01		110	1	30		90				2				30		90	30		34	80.00		200.00																									80.00		200.00				80.00		160.00				80.00				80.00		2.66				2.66	2.66	2.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4506	003	0	1	01	01	H4506_003_0	8	3	Preferred Brand	1	4	000001	1	2	110		01		110	1	30		90				2				30		90	30		34	40.00		100.00																									40.00		100.00				40.00		80.00				40.00				40.00		1.33				1.33	1.33	1.17	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4506	003	0	1	01	01	H4506_003_0	8	1	Preferred Generic	1	4	001000	1	2	110		01		110	1	30		90				2				30		90	30		34	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4506	003	0	1	01	01	H4506_003_0	8	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				2				30		90	30		34	5.00		12.50																									5.00		12.50				5.00		5.00				5.00				5.00		0.16				0.16	0.16	0.14	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4506	029	0	1	02	01	H4506_029_0	6	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				2				30		90	30		34	5.00		12.50																									5.00		12.50				5.00		5.00				5.00				5.00		0.16				0.16	0.16	0.14	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4506	029	0	1	02	01	H4506_029_0	6	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4506	029	0	1	02	01	H4506_029_0	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01		110	1	30		90				2				30		90	30		34	80.00		200.00																									80.00		200.00				80.00		160.00				80.00				80.00		2.67				2.67	2.67	2.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4506	029	0	1	02	01	H4506_029_0	6	3	Preferred Brand	1	4	000001	1	2	110		01		110	1	30		90				2				30		90	30		34	40.00		100.00																									40.00		100.00				40.00		80.00				40.00				40.00		1.33				1.33	1.33	1.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4506	029	0	1	02	01	H4506_029_0	6	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		34				1.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4506	029	0	1	02	01	H4506_029_0	6	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4513	025	0	1	01	01	H4513_025_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4513	025	0	1	01	01	H4513_025_0	4	2	Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	4.00	8.00	10.00																			4.00		10.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4513	025	0	1	01	01	H4513_025_0	4	3	Preferred Brand	1	4	000101	1	2	111		01	110		1	30	60	90				2	30		90				30		31	40.00	80.00	120.00																			40.00		120.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4513	025	0	1	01	01	H4513_025_0	4	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	80.00	160.00	240.00																			80.00		240.00																80.00				80.00		2.67			2.67			2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4513	025	0	1	01	01	H4513_025_0	4	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31				551.63	33	33	33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4513	025	0	1	01	01	H4513_025_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4513	025	0	1	01	01	H4513_025_0	4	2	Generic	3	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	4.00	8.00	10.00																			4.00		10.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4514	007	0	1	01	01	H4514_007_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4514	007	0	1	01	01	H4514_007_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4514	007	0	1	01	01	H4514_007_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4514	007	0	1	01	01	H4514_007_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4514	007	0	1	01	01	H4514_007_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				596.00	26		26																										26						26			26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4523	001	0	1	01	01	H4523_001_0	10	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					0.00	0.00	0.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.00	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4523	001	0	1	01	01	H4523_001_0	10	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					10.00	20.00	30.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.33	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4523	001	0	1	01	01	H4523_001_0	10	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					42.00	84.00	126.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.40	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4523	001	0	1	01	01	H4523_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4523	001	0	1	01	01	H4523_001_0	10	4	Non-Preferred Brand	1	4	110000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4523	005	0	1	01	01	H4523_005_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4523	005	0	1	01	01	H4523_005_0	8	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					10.00	20.00	30.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.33	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4523	005	0	1	01	01	H4523_005_0	8	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					42.00	84.00	126.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.40	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4523	005	0	1	01	01	H4523_005_0	8	4	Non-Preferred Brand	1	4	110000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4523	005	0	1	01	01	H4523_005_0	8	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					0.00	0.00	0.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.00	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4523	015	0	1	01	01	H4523_015_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4523	015	0	1	01	01	H4523_015_0	8	4	Non-Preferred Brand	1	4	110000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4523	015	0	1	01	01	H4523_015_0	8	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					42.00	84.00	126.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.40	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4523	015	0	1	01	01	H4523_015_0	8	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					0.00	0.00	0.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.00	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4523	015	0	1	01	01	H4523_015_0	8	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					10.00	20.00	30.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.33	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4523	020	0	1	01	01	H4523_020_0	6	1	Generic	3	4	010010	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					0.00	0.00	0.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.00	0.33			0.32	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4523	020	0	1	01	01	H4523_020_0	6	1	Generic	1	4	010010	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					0.00	0.00	0.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.00	0.33			0.32	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4523	020	0	1	01	01	H4523_020_0	6	3	Non-Preferred Brand	1	4	110000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								85.00	170.00	255.00					65.00	130.00	195.00					85.00	170.00	255.00																	85.00			85.00			2.83	2.17	2.83			2.74	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4523	020	0	1	01	01	H4523_020_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												
H4523	020	0	1	01	01	H4523_020_0	6	2	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								30.00	60.00	90.00					10.00	20.00	30.00					30.00	60.00	90.00																	30.00			30.00			1.00	0.33	1.00			0.97	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4523	021	0	1	01	01	H4523_021_0	6	1	Generic	3	4	010010	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					0.00	0.00	0.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.00	0.33			0.32	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4523	021	0	1	01	01	H4523_021_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												
H4523	021	0	1	01	01	H4523_021_0	6	3	Non-Preferred Brand	1	4	110000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								85.00	170.00	255.00					65.00	130.00	195.00					85.00	170.00	255.00																	85.00			85.00			2.83	2.17	2.83			2.74	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4523	021	0	1	01	01	H4523_021_0	6	1	Generic	1	4	010010	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					0.00	0.00	0.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.00	0.33			0.32	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4523	021	0	1	01	01	H4523_021_0	6	2	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								30.00	60.00	90.00					10.00	20.00	30.00					30.00	60.00	90.00																	30.00			30.00			1.00	0.33	1.00			0.97	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4523	024	0	1	01	01	H4523_024_0	5	1	Generic	3	4	010010	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					0.00	0.00	0.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.00	0.33			0.32	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4523	024	0	1	01	01	H4523_024_0	5	1	Generic	1	4	010010	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					0.00	0.00	0.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.00	0.33			0.32	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4523	024	0	1	01	01	H4523_024_0	5	3	Non-Preferred Brand	1	4	110000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								85.00	170.00	255.00					65.00	130.00	195.00					85.00	170.00	255.00																	85.00			85.00			2.83	2.17	2.83			2.74	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4523	024	0	1	01	01	H4523_024_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												
H4523	024	0	1	01	01	H4523_024_0	5	2	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								30.00	60.00	90.00					10.00	20.00	30.00					30.00	60.00	90.00																	30.00			30.00			1.00	0.33	1.00			0.97	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4525	001	0	1	01	01	H4525_001_0	7	5	Specialty Tier	1	4	010010	1	1	111		10	111		1	31	62	90				2	31	62	90					10	31				1683.00	33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4525	001	0	1	01	01	H4525_001_0	7	4	Non-Preferred Brand	1	4	100000	1	2	111		10	111		1	31	62	90				2	31	62	90					10	31	95.00	190.00	285.00																			95.00	190.00	237.50																	95.00			95.00		3.06			3.06			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4525	001	0	1	01	01	H4525_001_0	7	3	Preferred Brand	1	4	000001	1	2	111		10	111		1	31	62	90				2	31	62	90					10	31	47.00	94.00	141.00																			47.00	94.00	117.50																	47.00			47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4525	001	0	1	01	01	H4525_001_0	7	1	Preferred Generic	1	4	001000	1	2	111		10	111		1	31	62	90				2	31	62	90					10	31	3.00	6.00	9.00																			3.00	6.00	7.50																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4525	001	0	1	01	01	H4525_001_0	7	2	Generic	1	4	000100	1	2	111		10	111		1	31	62	90				2	31	62	90					10	31	14.00	28.00	42.00																			14.00	28.00	35.00																	14.00			14.00		.45			.45			.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4525	002	0	1	01	01	H4525_002_0	7	5	Specialty Tier	1	4	010010	1	1	111		10	111		1	31	62	90				2	31	62	90					10	31				1683.00	33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4525	002	0	1	01	01	H4525_002_0	7	1	Preferred Generic	1	4	001000	1	2	111		10	111		1	31	62	90				2	31	62	90					10	31	3.00	6.00	9.00																			3.00	6.00	7.50																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4525	002	0	1	01	01	H4525_002_0	7	3	Preferred Brand	1	4	000001	1	2	111		10	111		1	31	62	90				2	31	62	90					10	31	47.00	94.00	141.00																			47.00	94.00	117.50																	47.00			47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4525	002	0	1	01	01	H4525_002_0	7	4	Non-Preferred Brand	1	4	100000	1	2	111		10	111		1	31	62	90				2	31	62	90					10	31	95.00	190.00	285.00																			95.00	190.00	237.50																	95.00			95.00		3.06			3.06			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4525	002	0	1	01	01	H4525_002_0	7	2	Generic	1	4	000100	1	2	111		10	111		1	31	62	90				2	31	62	90					10	31	14.00	28.00	42.00																			14.00	28.00	35.00																	14.00			14.00		.45			.45			.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4525	010	0	1	01	01	H4525_010_0	7	3	Preferred Brand	1	4	000001	1	2	111		10	111		1	31	62	90				2	31	62	90					10	31	47.00	94.00	141.00																			47.00	94.00	117.50																	47.00			47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4525	010	0	1	01	01	H4525_010_0	7	2	Generic	1	4	000100	1	2	111		10	111		1	31	62	90				2	31	62	90					10	31	14.00	28.00	42.00																			14.00	28.00	35.00																	14.00			14.00		.45			.45			.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4525	010	0	1	01	01	H4525_010_0	7	1	Preferred Generic	1	4	001000	1	2	111		10	111		1	31	62	90				2	31	62	90					10	31	3.00	6.00	9.00																			3.00	6.00	7.50																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4525	010	0	1	01	01	H4525_010_0	7	4	Non-Preferred Brand	1	4	100000	1	2	111		10	111		1	31	62	90				2	31	62	90					10	31	95.00	190.00	285.00																			95.00	190.00	237.50																	95.00			95.00		3.06			3.06			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4525	010	0	1	01	01	H4525_010_0	7	5	Specialty Tier	1	4	010010	1	1	111		10	111		1	31	62	90				2	31	62	90					10	31				1683.00	33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4525	012	0	1	01	01	H4525_012_0	7	1	Preferred Generic	1	4	001000	1	2	111		10	111		1	31	62	90				2	31	62	90					10	31	3.00	6.00	9.00																			3.00	6.00	7.50																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4525	012	0	1	01	01	H4525_012_0	7	2	Generic	1	4	000100	1	2	111		10	111		1	31	62	90				2	31	62	90					10	31	14.00	28.00	42.00																			14.00	28.00	35.00																	14.00			14.00		.45			.45			.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4525	012	0	1	01	01	H4525_012_0	7	3	Preferred Brand	1	4	000001	1	2	111		10	111		1	31	62	90				2	31	62	90					10	31	47.00	94.00	141.00																			47.00	94.00	117.50																	47.00			47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4525	012	0	1	01	01	H4525_012_0	7	4	Non-Preferred Brand	1	4	100000	1	2	111		10	111		1	31	62	90				2	31	62	90					10	31	95.00	190.00	285.00																			95.00	190.00	237.50																	95.00			95.00		3.06			3.06			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4525	012	0	1	01	01	H4525_012_0	7	5	Specialty Tier	1	4	010010	1	1	111		10	111		1	31	62	90				2	31	62	90					10	31				1683.00	33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4525	014	0	1	01	01	H4525_014_0	8	1	Preferred Generic	1	4	001000	1	2	111		10	111		1	31	62	90				2	31	62	90					10	31	3.00	6.00	9.00																			3.00	6.00	7.50																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4525	014	0	1	01	01	H4525_014_0	8	2	Generic	1	4	000100	1	2	111		10	111		1	31	62	90				2	31	62	90					10	31	14.00	28.00	42.00																			14.00	28.00	35.00																	14.00			14.00		.45			.45			.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4525	014	0	1	01	01	H4525_014_0	8	3	Preferred Brand	1	4	000001	1	2	111		10	111		1	31	62	90				2	31	62	90					10	31	47.00	94.00	141.00																			47.00	94.00	117.50																	47.00			47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4525	014	0	1	01	01	H4525_014_0	8	4	Non-Preferred Brand	1	4	100000	1	2	111		10	111		1	31	62	90				2	31	62	90					10	31	95.00	190.00	285.00																			95.00	190.00	237.50																	95.00			95.00		3.06			3.06			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4525	014	0	1	01	01	H4525_014_0	8	5	Specialty Tier	1	4	010010	1	1	111		10	111		1	31	62	90				2	31	62	90					10	31				1683.00	33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4527	001	0	1	01	01	H4527_001_0	2	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4527	001	0	1	01	01	H4527_001_0	2	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4527	001	0	1	01	01	H4527_001_0	2	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4527	001	0	1	01	01	H4527_001_0	2	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				630.00	25		25																										25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4527	001	0	1	01	01	H4527_001_0	2	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4527	002	0	1	01	01	H4527_002_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4527	002	0	1	01	01	H4527_002_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4527	002	0	1	01	01	H4527_002_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4527	002	0	1	01	01	H4527_002_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4527	002	0	1	01	01	H4527_002_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				769.00	25		25																										25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4527	005	0	1	01	01	H4527_005_0	2	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4527	005	0	1	01	01	H4527_005_0	2	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4527	005	0	1	01	01	H4527_005_0	2	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4527	005	0	1	01	01	H4527_005_0	2	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				783.00	25		25																										25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4527	005	0	1	01	01	H4527_005_0	2	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4527	006	0	1	01	01	H4527_006_0	3	2	Generic	1	4	000100	1	1	110		01	100		1	30		90				1			90				30		31					25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4527	006	0	1	01	01	H4527_006_0	3	1	Preferred Generic	1	4	001000	1	1	110		01	100		1	30		90				1			90				30		31					25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4527	006	0	1	01	01	H4527_006_0	3	3	Preferred Brand	1	4	010001	1	1	110		01	100		1	30		90				1			90				30		31					25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4527	006	0	1	01	01	H4527_006_0	3	4	Non-Preferred Brand	1	4	110000	1	1	110		01	100		1	30		90				1			90				30		31					25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4527	006	0	1	01	01	H4527_006_0	3	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31					25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4527	013	0	1	01	01	H4527_013_0	2	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4527	013	0	1	01	01	H4527_013_0	2	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4527	013	0	1	01	01	H4527_013_0	2	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4527	013	0	1	01	01	H4527_013_0	2	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				990.00	25		25																										25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4527	013	0	1	01	01	H4527_013_0	2	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4528	001	0	1	01	01	H4528_001_0	4	1	Preferred Generic	1	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	3.00	6.00	7.50																			3.00		7.50																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4528	001	0	1	01	01	H4528_001_0	4	2	Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	8.00	16.00	20.00																			8.00		20.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4528	001	0	1	01	01	H4528_001_0	4	3	Preferred Brand	1	4	000101	1	2	111		01	110		1	30	60	90				2	30		90				30		31	35.00	70.00	105.00																			35.00		105.00																35.00				35.00		1.17			1.17			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4528	001	0	1	01	01	H4528_001_0	4	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	70.00	140.00	210.00																			70.00		210.00																70.00				70.00		2.33			2.33			2.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4528	001	0	1	01	01	H4528_001_0	4	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31				568.59	33	33	33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	001	0	1	18	06	H4564_001_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		.13			.13			.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	001	0	1	18	06	H4564_001_0	5	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		.50			.50			.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	001	0	1	18	06	H4564_001_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	001	0	1	18	06	H4564_001_0	5	4	Non-Preferred Brand	1	4	100100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	001	0	1	18	06	H4564_001_0	5	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	002	0	1	18	06	H4564_002_0	10	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		.50			.50			.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	002	0	1	18	06	H4564_002_0	10	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		.13			.13			.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	002	0	1	18	06	H4564_002_0	10	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	002	0	1	18	06	H4564_002_0	10	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	002	0	1	18	06	H4564_002_0	10	4	Non-Preferred Brand	1	4	100100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	004	0	1	18	06	H4564_004_0	3	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	004	0	1	18	06	H4564_004_0	3	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		.33			.33			.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	004	0	1	18	06	H4564_004_0	3	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	004	0	1	18	06	H4564_004_0	3	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	004	0	1	18	06	H4564_004_0	3	4	Non-Preferred Brand	1	4	100100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	85.00	170.00	255.00																			85.00	170.00	170.00																85.00				85.00		2.83			2.83			2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	004	0	1	18	06	H4564_004_0	3	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4564	005	0	1	18	06	H4564_005_0	6	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		.33			.33			.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	005	0	1	18	06	H4564_005_0	6	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	005	0	1	18	06	H4564_005_0	6	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	005	0	1	18	06	H4564_005_0	6	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4564	005	0	1	18	06	H4564_005_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	005	0	1	18	06	H4564_005_0	6	4	Non-Preferred Brand	1	4	100100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	85.00	170.00	255.00																			85.00	170.00	170.00																85.00				85.00		2.83			2.83			2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	015	0	1	18	06	H4564_015_0	11	2	Generic	1	3	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	40.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	015	0	1	18	06	H4564_015_0	11	1	Preferred Generic	1	3	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	015	0	1	18	06	H4564_015_0	11	3	Preferred Brand	1	3	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	015	0	1	18	06	H4564_015_0	11	4	Non-Preferred Brand	1	3	100100	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31				100.00	37	37	37																		37	37	37															37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	015	0	1	18	06	H4564_015_0	11	5	Specialty Tier	1	3	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					27	27	27																		27	27	27															27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	017	0	1	18	06	H4564_017_0	7	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		.50			.50			.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	017	0	1	18	06	H4564_017_0	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		.13			.13			.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	017	0	1	18	06	H4564_017_0	7	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	017	0	1	18	06	H4564_017_0	7	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	017	0	1	18	06	H4564_017_0	7	4	Non-Preferred Brand	1	4	100100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	018	0	1	18	06	H4564_018_0	6	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	018	0	1	18	06	H4564_018_0	6	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		.33			.33			.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	018	0	1	18	06	H4564_018_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	018	0	1	18	06	H4564_018_0	6	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	018	0	1	18	06	H4564_018_0	6	4	Non-Preferred Brand	1	4	100100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	85.00	170.00	255.00																			85.00	170.00	170.00																85.00				85.00		2.83			2.83			2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4564	018	0	1	18	06	H4564_018_0	6	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4590	010	0	1	01	01	H4590_010_0	7	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4590	010	0	1	01	01	H4590_010_0	7	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						75.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4590	010	0	1	01	01	H4590_010_0	7	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4590	010	0	1	01	01	H4590_010_0	7	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4590	010	0	1	01	01	H4590_010_0	7	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				701.00	25		25																										25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4590	010	0	1	01	01	H4590_010_0	7	1	Preferred Generic	3	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4590	010	0	1	01	01	H4590_010_0	7	2	Generic	3	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4590	012	0	1	01	01	H4590_012_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4590	012	0	1	01	01	H4590_012_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4590	012	0	1	01	01	H4590_012_0	4	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4590	012	0	1	01	01	H4590_012_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4590	012	0	1	01	01	H4590_012_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				697.00	26		26																										26						26			26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4590	025	0	1	01	01	H4590_025_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4590	025	0	1	01	01	H4590_025_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				412.00	25		25																										25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4590	025	0	1	01	01	H4590_025_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4590	025	0	1	01	01	H4590_025_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4590	025	0	1	01	01	H4590_025_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4590	037	0	1	01	01	H4590_037_0	4	1	Preferred Generic	3	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4590	037	0	1	01	01	H4590_037_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				775.00	25		25																										25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4590	037	0	1	01	01	H4590_037_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4590	037	0	1	01	01	H4590_037_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						75.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4590	037	0	1	01	01	H4590_037_0	4	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4590	037	0	1	01	01	H4590_037_0	4	2	Generic	3	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4590	037	0	1	01	01	H4590_037_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4604	003	0	1	01	01	H4604_003_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				449.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4604	003	0	1	01	01	H4604_003_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4604	003	0	1	01	01	H4604_003_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4604	003	0	1	01	01	H4604_003_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4604	003	0	1	01	01	H4604_003_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4604	011	0	1	01	01	H4604_011_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4604	011	0	1	01	01	H4604_011_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4604	011	0	1	01	01	H4604_011_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4604	011	0	1	01	01	H4604_011_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				453.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4604	011	0	1	01	01	H4604_011_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4605	002	0	1	04	01	H4605_002_0	7	6	Select Care Drugs	1	3	010000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4605	002	0	1	04	01	H4605_002_0	7	3	Preferred Brand	1	3	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	94.00	117.50																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4605	002	0	1	04	01	H4605_002_0	7	4	Non-Preferred Brand	1	3	110000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	100.00	200.00	250.00																			100.00	200.00	250.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4605	002	0	1	04	01	H4605_002_0	7	5	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4605	002	0	1	04	01	H4605_002_0	7	2	Generic	1	3	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	18.00	36.00	36.00																			18.00	36.00	36.00																18.00				18.00		0.60			0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4605	002	0	1	04	01	H4605_002_0	7	1	Preferred Generic	1	3	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	10.00	20.00	20.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4605	004	0	1	04	01	H4605_004_0	7	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	94.00	117.50																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4605	004	0	1	04	01	H4605_004_0	7	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	12.00	24.00	24.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4605	004	0	1	04	01	H4605_004_0	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	5.00	10.00	10.00																			5.00	10.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4605	004	0	1	04	01	H4605_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	100.00	200.00	250.00																			100.00	200.00	250.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4605	004	0	1	04	01	H4605_004_0	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4605	004	0	1	04	01	H4605_004_0	7	6	Select Care Drugs	1	4	010000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4738	002	0	1	04	01	H4738_002_0	3	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	45.00		135.00																			45.00		112.50																45.00				45.00		1.50			1.50			1.45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4738	002	0	1	04	01	H4738_002_0	3	1	Generic	1	4	001000	3	2	110		01	110		1	30		90				1	30		90				30		31	6.00		18.00																			6.00		15.00																6.00				6.00		0.20			0.20			0.19	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4738	002	0	1	04	01	H4738_002_0	3	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31				761.33	33		33																		33		33															33			33								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4738	002	0	1	04	01	H4738_002_0	3	3	Non-Preferred Brand	1	4	100100	3	2	110		01	110		1	30		90				1	30		90				30		31	90.00		270.00																			90.00		225.00																90.00				90.00		3.00			3.00			2.90	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4754	004	0	1	04	01	H4754_004_0	11	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4754	004	0	1	04	01	H4754_004_0	11	6	Select Care Drugs	1	4	010000	1	2		110	01		110	1				30		90	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4754	004	0	1	04	01	H4754_004_0	11	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	2				30		90	30		31								100.00		300.00					90.00		270.00											100.00		300.00				90.00		270.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4754	004	0	1	04	01	H4754_004_0	11	3	Preferred Brand	1	4	000001	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					37.00		111.00											47.00		141.00				37.00		111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4754	004	0	1	04	01	H4754_004_0	11	2	Generic	1	4	000100	1	2		110	01		110	1				30		90	2				30		90	30		31								17.00		51.00					12.00		36.00											17.00		51.00				12.00		36.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4754	004	0	1	04	01	H4754_004_0	11	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	2				30		90	30		31								7.00		21.00					2.00		6.00											7.00		21.00				2.00		6.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4754	004	0	1	04	01	H4754_004_0	11	3	Preferred Brand	3	4	000001	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					37.00		111.00											47.00		141.00				37.00		111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H4754	004	0	1	04	01	H4754_004_0	11	6	Select Care Drugs	3	4	010000	1	2		110	01		110	1				30		90	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4754	004	0	1	04	01	H4754_004_0	11	4	Non-Preferred Brand	3	4	100000	1	2		110	01		110	1				30		90	2				30		90	30		31								100.00		300.00					90.00		270.00											100.00		300.00				90.00		270.00				100.00				100.00			3.33	3.00		3.33	3.00	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H4754	007	0	1	04	01	H4754_007_0	9	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	2				30		90	30		31								7.00		21.00					2.00		6.00											7.00		21.00				2.00		6.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4754	007	0	1	04	01	H4754_007_0	9	2	Generic	1	4	000100	1	2		110	01		110	1				30		90	2				30		90	30		31								17.00		51.00					12.00		36.00											17.00		51.00				12.00		36.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4754	007	0	1	04	01	H4754_007_0	9	3	Preferred Brand	1	4	000001	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					37.00		111.00											47.00		141.00				37.00		111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4754	007	0	1	04	01	H4754_007_0	9	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	2				30		90	30		31								100.00		300.00					90.00		270.00											100.00		300.00				90.00		270.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4754	007	0	1	04	01	H4754_007_0	9	6	Select Care Drugs	3	4	010000	1	2		110	01		110	1				30		90	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4754	007	0	1	04	01	H4754_007_0	9	6	Select Care Drugs	1	4	010000	1	2		110	01		110	1				30		90	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4754	007	0	1	04	01	H4754_007_0	9	4	Non-Preferred Brand	3	4	100000	1	2		110	01		110	1				30		90	2				30		90	30		31								100.00		300.00					90.00		270.00											100.00		300.00				90.00		270.00				100.00				100.00			3.33	3.00		3.33	3.00	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H4754	007	0	1	04	01	H4754_007_0	9	3	Preferred Brand	3	4	000001	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					37.00		111.00											47.00		141.00				37.00		111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H4754	007	0	1	04	01	H4754_007_0	9	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4754	009	0	1	04	01	H4754_009_0	9	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	2				30		90	30		31								7.00		21.00					2.00		6.00											7.00		21.00				2.00		6.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4754	009	0	1	04	01	H4754_009_0	9	2	Generic	1	4	000100	1	2		110	01		110	1				30		90	2				30		90	30		31								17.00		51.00					12.00		36.00											17.00		51.00				12.00		36.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4754	009	0	1	04	01	H4754_009_0	9	3	Preferred Brand	1	4	000001	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					37.00		111.00											47.00		141.00				37.00		111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4754	009	0	1	04	01	H4754_009_0	9	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	2				30		90	30		31								100.00		300.00					90.00		270.00											100.00		300.00				90.00		270.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4754	009	0	1	04	01	H4754_009_0	9	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4754	009	0	1	04	01	H4754_009_0	9	6	Select Care Drugs	1	4	010000	1	2		110	01		110	1				30		90	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4754	009	0	1	04	01	H4754_009_0	9	3	Preferred Brand	3	4	000001	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					37.00		111.00											47.00		141.00				37.00		111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H4754	009	0	1	04	01	H4754_009_0	9	4	Non-Preferred Brand	3	4	100000	1	2		110	01		110	1				30		90	2				30		90	30		31								100.00		300.00					90.00		270.00											100.00		300.00				90.00		270.00				100.00				100.00			3.33	3.00		3.33	3.00	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H4754	009	0	1	04	01	H4754_009_0	9	6	Select Care Drugs	3	4	010000	1	2		110	01		110	1				30		90	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4754	011	0	1	04	01	H4754_011_0	8	6	Select Care Drugs	3	4	010000	1	2		110	01		110	1				30		90	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4754	011	0	1	04	01	H4754_011_0	8	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	2				30		90	30		31								7.00		21.00					2.00		6.00											7.00		21.00				2.00		6.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4754	011	0	1	04	01	H4754_011_0	8	2	Generic	1	4	000100	1	2		110	01		110	1				30		90	2				30		90	30		31								17.00		51.00					12.00		36.00											17.00		51.00				12.00		36.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4754	011	0	1	04	01	H4754_011_0	8	3	Preferred Brand	1	4	000001	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					37.00		111.00											47.00		141.00				37.00		111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4754	011	0	1	04	01	H4754_011_0	8	4	Non-Preferred Brand	1	4	100000	1	2		110	01		110	1				30		90	2				30		90	30		31								100.00		300.00					90.00		270.00											100.00		300.00				90.00		270.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4754	011	0	1	04	01	H4754_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4754	011	0	1	04	01	H4754_011_0	8	6	Select Care Drugs	1	4	010000	1	2		110	01		110	1				30		90	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4754	011	0	1	04	01	H4754_011_0	8	3	Preferred Brand	3	4	000001	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					37.00		111.00											47.00		141.00				37.00		111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H4754	011	0	1	04	01	H4754_011_0	8	4	Non-Preferred Brand	3	4	100000	1	2		110	01		110	1				30		90	2				30		90	30		31								100.00		300.00					90.00		270.00											100.00		300.00				90.00		270.00				100.00				100.00			3.33	3.00		3.33	3.00	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2		
H4866	003	0	1	01	01	H4866_003_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	35.00		105.00																					52.50																35.00				35.00		1.17						1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4866	003	0	1	01	01	H4866_003_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	75.00		225.00																					112.50																75.00				75.00		2.50						2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4866	003	0	1	01	01	H4866_003_0	5	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	8.00		24.00																					12.00																8.00				8.00		0.27						.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4866	003	0	1	01	01	H4866_003_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	4.00		12.00																					6.00																4.00				4.00		.13						.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4866	003	0	1	01	01	H4866_003_0	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	016	1	1	04	01	H4875_016_1	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	0.00																4.00				4.00		0.13			0.13			.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	016	1	1	04	01	H4875_016_1	5	2	Generic	1	4	000110	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	12.00	24.00	36.00																			12.00	24.00	0.00																12.00				12.00		0.40			0.40			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	016	1	1	04	01	H4875_016_1	5	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	016	1	1	04	01	H4875_016_1	5	4	Non-Preferred Brand	1	4	110000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	237.50																95.00				95.00		3.16			3.16			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	016	1	1	04	01	H4875_016_1	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					31																				31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	016	2	1	04	01	H4875_016_2	5	2	Generic	1	4	000110	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	12.00	24.00	36.00																			12.00	24.00	0.00																12.00				12.00		0.40			0.40			0.38	Preferred Generic, 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	4.00	8.00	12.00																			4.00	8.00	0.00																4.00				4.00		0.13			0.13			.12	Preferred Generic, 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	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, 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					31																				31																	31			31								Preferred Generic, 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	95.00	190.00	285.00																			95.00	190.00	237.50																95.00				95.00		3.16			3.16			3.06	Preferred Generic, 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	4.00	8.00	12.00																			4.00	8.00	0.00																4.00				4.00		0.13			0.13			.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	016	3	1	04	01	H4875_016_3	5	2	Generic	1	4	000110	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	12.00	24.00	36.00																			12.00	24.00	0.00																12.00				12.00		0.40			0.40			0.38	Preferred Generic, 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	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, 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	95.00	190.00	285.00																			95.00	190.00	237.50																95.00				95.00		3.16			3.16			3.06	Preferred Generic, 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					31																				31																	31			31								Preferred Generic, 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	4.00	8.00	12.00																			4.00	8.00	0.00																4.00				4.00		0.13			0.13			.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	016	4	1	04	01	H4875_016_4	5	2	Generic	1	4	000110	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	12.00	24.00	36.00																			12.00	24.00	0.00																12.00				12.00		0.40			0.40			0.38	Preferred Generic, 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	95.00	190.00	285.00																			95.00	190.00	237.50																95.00				95.00		3.16			3.16			3.06	Preferred Generic, 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	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, 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					31																				31																	31			31								Preferred Generic, 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	95.00	190.00	285.00																			95.00	190.00	237.50																95.00				95.00		3.16			3.16			3.06	Preferred Generic, 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	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	016	5	1	04	01	H4875_016_5	5	2	Generic	1	4	000110	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	12.00	24.00	36.00																			12.00	24.00	0.00																12.00				12.00		0.40			0.40			0.38	Preferred Generic, 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	4.00	8.00	12.00																			4.00	8.00	0.00																4.00				4.00		0.13			0.13			.12	Preferred Generic, 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					31																				31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	017	1	1	04	01	H4875_017_1	5	4	Non-Preferred Brand	1	4	110000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	85.00	170.00	255.00																			85.00	170.00	212.50																85.00				85.00		2.83			2.83			2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	017	1	1	04	01	H4875_017_1	5	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	40.00	80.00	120.00																			40.00	80.00	100.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	017	1	1	04	01	H4875_017_1	5	2	Generic	1	4	000110	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	9.00	18.00	27.00																			9.00	18.00	0.00																9.00				9.00		0.30			0.30			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	017	1	1	04	01	H4875_017_1	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	0.00																4.00				4.00		0.13			0.13			0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	017	1	1	04	01	H4875_017_1	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					33																				33																	33			33								Preferred Generic, 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	4.00	8.00	12.00																			4.00	8.00	0.00																4.00				4.00		0.13			0.13			0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	017	2	1	04	01	H4875_017_2	5	2	Generic	1	4	000110	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	9.00	18.00	27.00																			9.00	18.00	0.00																9.00				9.00		0.30			0.30			0.29	Preferred Generic, 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	40.00	80.00	120.00																			40.00	80.00	100.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, 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	85.00	170.00	255.00																			85.00	170.00	212.50																85.00				85.00		2.83			2.83			2.74	Preferred Generic, 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					33																				33																	33			33								Preferred Generic, 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	85.00	170.00	255.00																			85.00	170.00	212.50																85.00				85.00		2.83			2.83			2.74	Preferred Generic, 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	40.00	80.00	120.00																			40.00	80.00	100.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	017	3	1	04	01	H4875_017_3	5	2	Generic	1	4	000110	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	9.00	18.00	27.00																			9.00	18.00	0.00																9.00				9.00		0.30			0.30			0.29	Preferred Generic, 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	4.00	8.00	12.00																			4.00	8.00	0.00																4.00				4.00		0.13			0.13			0.12	Preferred Generic, 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					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	017	4	1	04	01	H4875_017_4	5	2	Generic	1	4	000110	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	9.00	18.00	27.00																			9.00	18.00	0.00																9.00				9.00		0.30			0.30			0.29	Preferred Generic, 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	4.00	8.00	12.00																			4.00	8.00	0.00																4.00				4.00		0.13			0.13			0.12	Preferred Generic, 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	40.00	80.00	120.00																			40.00	80.00	100.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, 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	85.00	170.00	255.00																			85.00	170.00	212.50																85.00				85.00		2.83			2.83			2.74	Preferred Generic, 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					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4875	017	5	1	04	01	H4875_017_5	5	2	Generic	1	4	000110	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	9.00	18.00	27.00																			9.00	18.00	0.00																9.00				9.00		0.30			0.30			0.29	Preferred Generic, 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	4.00	8.00	12.00																			4.00	8.00	0.00																4.00				4.00		0.13			0.13			0.12	Preferred Generic, 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	40.00	80.00	120.00																			40.00	80.00	100.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, 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					33																				33																	33			33								Preferred Generic, 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	85.00	170.00	255.00																			85.00	170.00	212.50																85.00				85.00		2.83			2.83			2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4876	001	0	1	04	01	H4876_001_0	7	1	Generic	1	4	010000	1	2	111		01	100		1	30	60	90				1			90				30		31	5.00	10.00	15.00																					15.00																5.00				5.00		0.17						0.16	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4876	001	0	1	04	01	H4876_001_0	7	2	Preferred Brand	1	4	000001	1	2	111		01	100		1	30	60	90				1			90				30		31	25.00	50.00	75.00																					75.00																25.00				25.00		0.83						0.81	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4876	001	0	1	04	01	H4876_001_0	7	4	Specialty Tier	1	4	010010	1	1	111		01	100		1	30	60	90				1			90				30		31				1540.11	33	33	33																				33															33			33								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4876	001	0	1	04	01	H4876_001_0	7	3	Non-Preferred Brand	1	4	100000	3	2	111		01	100		1	30	60	90				1			90				30		31	45.00	90.00	135.00																					135.00																45.00				45.00		1.50						1.45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4876	001	0	1	04	01	H4876_001_0	7	1	Generic	3	4	010000	1	2	111		01	100		1	30	60	90				1			90				30		31	5.00	10.00	15.00																					15.00																5.00				5.00		0.16						0.16	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4909	014	0	1	04	01	H4909_014_0	10	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4909	014	0	1	04	01	H4909_014_0	10	2	Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4909	014	0	1	04	01	H4909_014_0	10	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4909	014	0	1	04	01	H4909_014_0	10	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4909	014	0	1	04	01	H4909_014_0	10	5	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34											1655.70	30						1655.70	30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4909	014	0	1	04	01	H4909_014_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
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	5.00	10.00	15.00																					12.50																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4922	001	0	1	01	01	H4922_001_0	7	2	Generic	1	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	15.00	30.00	45.00																					37.50																15.00				15.00		0.50						0.48	Preferred Generic, 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	45.00	90.00	135.00																					112.50																45.00				45.00		1.50						1.45	Preferred Generic, 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	95.00	190.00	285.00																					237.50																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, 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	5.00	10.00	15.00																					12.50																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5008	007	0	1	01	01	H5008_007_0	3	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31				444.00	30		30																										30						30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5008	007	0	1	01	01	H5008_007_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5008	007	0	1	01	01	H5008_007_0	3	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5008	007	0	1	01	01	H5008_007_0	3	2	Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5008	007	0	1	01	01	H5008_007_0	3	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5009	002	0	1	04	01	H5009_002_0	5	5	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5009	002	0	1	04	01	H5009_002_0	5	4	Non-Preferred Brand	1	3	110000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	100.00	200.00	250.00																			100.00	200.00	250.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5009	002	0	1	04	01	H5009_002_0	5	3	Preferred Brand	1	3	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	94.00	117.50																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5009	002	0	1	04	01	H5009_002_0	5	2	Generic	1	3	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	20.00	40.00	40.00																			20.00	40.00	40.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5009	002	0	1	04	01	H5009_002_0	5	6	Select Care Drugs	1	3	010000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5009	002	0	1	04	01	H5009_002_0	5	1	Preferred Generic	1	3	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	10.00	20.00	20.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5010	002	0	1	04	01	H5010_002_0	6	1	Preferred Generic	1	3	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	10.00	20.00	20.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5010	002	0	1	04	01	H5010_002_0	6	6	Select Care Drugs	1	3	010000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5010	002	0	1	04	01	H5010_002_0	6	5	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5010	002	0	1	04	01	H5010_002_0	6	4	Non-Preferred Brand	1	3	110000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	100.00	200.00	250.00																			100.00	200.00	250.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5010	002	0	1	04	01	H5010_002_0	6	3	Preferred Brand	1	3	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	94.00	117.50																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5010	002	0	1	04	01	H5010_002_0	6	2	Generic	1	3	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	17.00	34.00	34.00																			17.00	34.00	34.00																17.00				17.00		0.57			0.57			0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5010	004	0	1	04	01	H5010_004_0	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5010	004	0	1	04	01	H5010_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	100.00	200.00	250.00																			100.00	200.00	250.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5010	004	0	1	04	01	H5010_004_0	7	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	94.00	117.50																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5010	004	0	1	04	01	H5010_004_0	7	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	12.00	24.00	24.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5010	004	0	1	04	01	H5010_004_0	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	5.00	10.00	10.00																			5.00	10.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5010	004	0	1	04	01	H5010_004_0	7	6	Select Care Drugs	1	4	010000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5050	004	0	1	01	01	H5050_004_0	7	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.42			1.42			1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	004	0	1	01	01	H5050_004_0	7	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.48			0.48			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	004	0	1	01	01	H5050_004_0	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	12.00																4.00				4.00		0.11			0.11			0.11	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	004	0	1	01	01	H5050_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	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		1.54			1.54			1.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	004	0	1	01	01	H5050_004_0	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				1146.27	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	009	0	1	01	01	H5050_009_0	7	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.48			0.48			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	009	0	1	01	01	H5050_009_0	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	12.00																4.00				4.00		0.11			0.11			0.11	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	009	0	1	01	01	H5050_009_0	7	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.42			1.42			1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	009	0	1	01	01	H5050_009_0	7	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		1.38			1.38			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	009	0	1	01	01	H5050_009_0	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				1419.36	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	013	0	1	01	01	H5050_013_0	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	12.00																4.00				4.00		0.11			0.11			0.11	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	013	0	1	01	01	H5050_013_0	7	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.44			0.44			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	013	0	1	01	01	H5050_013_0	7	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.44			1.44			1.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	013	0	1	01	01	H5050_013_0	7	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		1.69			1.69			1.69	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	013	0	1	01	01	H5050_013_0	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				1398.69	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	017	0	1	01	01	H5050_017_0	7	2	Generic	1	3	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.46			0.46			0.46	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	017	0	1	01	01	H5050_017_0	7	1	Preferred Generic	1	3	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	15.00																5.00				5.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	017	0	1	01	01	H5050_017_0	7	3	Preferred Brand	1	3	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.51			1.51			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	017	0	1	01	01	H5050_017_0	7	5	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		31				1424.93	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	017	0	1	01	01	H5050_017_0	7	4	Non-Preferred Brand	1	3	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	97.00	194.00	291.00																			97.00	194.00	291.00																97.00				97.00		2.52			2.52			2.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	018	0	1	01	01	H5050_018_0	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	12.00																4.00				4.00		0.11			0.11			0.11	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	018	0	1	01	01	H5050_018_0	7	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.44			0.44			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	018	0	1	01	01	H5050_018_0	7	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.42			1.42			1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	018	0	1	01	01	H5050_018_0	7	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		2.22			2.22			2.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	018	0	1	01	01	H5050_018_0	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				1801.93	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	019	0	1	01	01	H5050_019_0	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	9.00																3.00				3.00		0.09			0.09			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	019	0	1	01	01	H5050_019_0	7	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	30.00																10.00				10.00		0.25			0.25			0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	019	0	1	01	01	H5050_019_0	7	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	90.00	180.00	270.00																			90.00	180.00	270.00																90.00				90.00		1.50			1.50			1.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	019	0	1	01	01	H5050_019_0	7	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	40.00	80.00	120.00																			40.00	80.00	120.00																40.00				40.00		1.28			1.28			1.28	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	019	0	1	01	01	H5050_019_0	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				1537.76	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	021	0	1	01	01	H5050_021_0	8	1	Preferred Generic	1	3	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	6.00	12.00	18.00																			6.00	12.00	18.00																6.00				6.00		0.15			0.15			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	021	0	1	01	01	H5050_021_0	8	2	Generic	1	3	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.46			0.46			0.46	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	021	0	1	01	01	H5050_021_0	8	3	Preferred Brand	1	3	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.44			1.44			1.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	021	0	1	01	01	H5050_021_0	8	4	Non-Preferred Brand	1	3	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		2.11			2.11			2.11	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	021	0	1	01	01	H5050_021_0	8	5	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		31				1441.18	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	001	0	1	01	01	H5087_001_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	001	0	1	01	01	H5087_001_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	001	0	1	01	01	H5087_001_0	5	2	Generic	1	4	000100	3	2	110		01		110	1	30		90				1				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	001	0	1	01	01	H5087_001_0	5	4	Non-Preferred Brand	1	4	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				69.10	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	001	0	1	01	01	H5087_001_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	002	0	1	01	01	H5087_002_0	5	3	Preferred Brand	1	4	010001	3	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	002	0	1	01	01	H5087_002_0	5	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	002	0	1	01	01	H5087_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	002	0	1	01	01	H5087_002_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	002	0	1	01	01	H5087_002_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				1				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		247.50				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	005	0	1	01	01	H5087_005_0	5	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				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5087	005	0	1	01	01	H5087_005_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	005	0	1	01	01	H5087_005_0	5	3	Preferred Brand	1	4	010001	3	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	005	0	1	01	01	H5087_005_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				1				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		247.50				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	005	0	1	01	01	H5087_005_0	5	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		37.50				15.00				15.00		0.50				0.50	0.50	.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	005	0	1	01	01	H5087_005_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	010	0	1	01	01	H5087_010_0	6	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		37.50				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	010	0	1	01	01	H5087_010_0	6	1	Preferred Generic	1	4	001000	1	2	110		01		110	1	30		90				1				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	010	0	1	01	01	H5087_010_0	6	1	Preferred Generic	3	4	001000	1	2	110		01		110	1	30		90				1				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5087	010	0	1	01	01	H5087_010_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	010	0	1	01	01	H5087_010_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				1				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		247.50				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	010	0	1	01	01	H5087_010_0	6	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	011	0	1	01	01	H5087_011_0	6	1	Preferred Generic	3	4	001000	1	2	110		01		110	1	30		90				1				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5087	011	0	1	01	01	H5087_011_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	011	0	1	01	01	H5087_011_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				1				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		247.50				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	011	0	1	01	01	H5087_011_0	6	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	011	0	1	01	01	H5087_011_0	6	1	Preferred Generic	1	4	001000	1	2	110		01		110	1	30		90				1				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				.20	.20	.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	011	0	1	01	01	H5087_011_0	6	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		37.50				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	012	0	1	01	01	H5087_012_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	012	0	1	01	01	H5087_012_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				1				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		247.50				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	012	0	1	01	01	H5087_012_0	6	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	012	0	1	01	01	H5087_012_0	6	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		37.50				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	012	0	1	01	01	H5087_012_0	6	1	Preferred Generic	1	4	001000	1	2	110		01		110	1	30		90				1				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	012	0	1	01	01	H5087_012_0	6	1	Preferred Generic	3	4	001000	1	2	110		01		110	1	30		90				1				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5087	014	0	1	01	01	H5087_014_0	6	1	Preferred Generic	3	4	001000	1	2	110		01		110	1	30		90				1				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5087	014	0	1	01	01	H5087_014_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	014	0	1	01	01	H5087_014_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				1				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		247.50				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	014	0	1	01	01	H5087_014_0	6	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	014	0	1	01	01	H5087_014_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	014	0	1	01	01	H5087_014_0	6	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		37.50				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	016	0	1	01	01	H5087_016_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	016	0	1	01	01	H5087_016_0	6	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				1				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		247.50				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	016	0	1	01	01	H5087_016_0	6	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	016	0	1	01	01	H5087_016_0	6	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		37.50				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	016	0	1	01	01	H5087_016_0	6	1	Preferred Generic	3	4	001000	1	2	110		01		110	1	30		90				1				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5087	016	0	1	01	01	H5087_016_0	6	1	Preferred Generic	1	4	001000	1	2	110		01		110	1	30		90				1				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	017	0	1	01	01	H5087_017_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	017	0	1	01	01	H5087_017_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				1				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		247.50				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	017	0	1	01	01	H5087_017_0	4	3	Preferred Brand	1	4	010001	3	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	017	0	1	01	01	H5087_017_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	017	0	1	01	01	H5087_017_0	4	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	020	0	1	01	01	H5087_020_0	4	4	Non-Preferred Brand	1	4	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				67.40	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	020	0	1	01	01	H5087_020_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	020	0	1	01	01	H5087_020_0	4	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	020	0	1	01	01	H5087_020_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	020	0	1	01	01	H5087_020_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5106	013	0	1	04	01	H5106_013_0	9	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31				1053.48	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5106	013	0	1	04	01	H5106_013_0	9	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	31		90				1			90				31		31	3.00		9.00																					7.50																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5106	013	0	1	04	01	H5106_013_0	9	2	Generic	1	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	15.00		45.00																					37.50																15.00				15.00		0.48						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5106	013	0	1	04	01	H5106_013_0	9	3	Preferred Brand	1	4	010001	1	2	110		01	100		1	31		90				1			90				31		31	44.00		132.00																					110.00																44.00				44.00		1.42						1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5106	013	0	1	04	01	H5106_013_0	9	4	Non-Preferred Brand	1	4	110000	1	1	110		01	100		1	31		90				1			90				31		31				88.18	45		45																				45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5106	027	0	1	04	01	H5106_027_0	10	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	31		90				1			90				31		31	3.00		9.00																					7.50																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5106	027	0	1	04	01	H5106_027_0	10	2	Generic	1	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	15.00		45.00																					37.50																15.00				15.00		0.48						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5106	027	0	1	04	01	H5106_027_0	10	3	Preferred Brand	1	4	010001	1	2	110		01	100		1	31		90				1			90				31		31	47.00		141.00																					117.50																47.00				47.00		1.52						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5106	027	0	1	04	01	H5106_027_0	10	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31				964.60	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5106	027	0	1	04	01	H5106_027_0	10	4	Non-Preferred Brand	1	4	110000	1	1	110		01	100		1	31		90				1			90				31		31				99.90	45		45																				45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5141	001	0	1	04	01	H5141_001_0	18	5	Specialty Tier	1	4	010010	1	1		111	01	100		1				30	60	90	1			90				30		31											400.00	25	25	25				400.00	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5141	001	0	1	04	01	H5141_001_0	18	3	Preferred Brand	1	4	000101	1	2		111	01	100		1				30	60	90	1			90				30		31								45.00	90.00	135.00					35.00	70.00	105.00							70.00																45.00				45.00			1.50	1.17				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5141	001	0	1	04	01	H5141_001_0	18	4	Non-Preferred Brand	1	4	100100	1	2		111	01	100		1				30	60	90	1			90				30		31								95.00	190.00	285.00					85.00	170.00	255.00							170.00																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5141	001	0	1	04	01	H5141_001_0	18	2	Generic	1	4	000100	1	2		111	01	100		1				30	60	90	1			90				30		31								15.00	30.00	45.00					10.00	20.00	30.00							20.00																15.00				15.00			0.50	0.33				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5141	001	0	1	04	01	H5141_001_0	18	1	Preferred Generic	1	4	001000	1	2		111	01	100		1				30	60	90	1			90				30		31								4.00	8.00	12.00					0.00	0.00	0.00							0.00																4.00				4.00			0.13	0.00				0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5141	004	0	1	04	01	H5141_004_0	16	5	Specialty Tier	1	4	010010	1	1		111	01	100		1				30	60	90	1			90				30		31											400.00	25	25	25				400.00	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5141	004	0	1	04	01	H5141_004_0	16	4	Non-Preferred Brand	1	4	100100	1	2		111	01	100		1				30	60	90	1			90				30		31								95.00	190.00	285.00					85.00	170.00	255.00							170.00																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5141	004	0	1	04	01	H5141_004_0	16	3	Preferred Brand	1	4	000101	1	2		111	01	100		1				30	60	90	1			90				30		31								45.00	90.00	135.00					35.00	70.00	105.00							70.00																45.00				45.00			1.50	1.17				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5141	004	0	1	04	01	H5141_004_0	16	2	Generic	1	4	000100	1	2		111	01	100		1				30	60	90	1			90				30		31								15.00	30.00	45.00					10.00	20.00	30.00							20.00																15.00				15.00			0.50	0.33				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5141	004	0	1	04	01	H5141_004_0	16	1	Preferred Generic	1	4	001000	1	2		111	01	100		1				30	60	90	1			90				30		31								4.00	8.00	12.00					0.00	0.00	0.00							0.00																4.00				4.00			0.13	0.00				0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5141	006	0	1	04	01	H5141_006_0	13	2	Generic	1	4	000100	1	2		111	01	100		1				30	60	90	1			90				30		31								12.00	24.00	36.00					7.00	14.00	21.00							14.00																12.00				12.00			0.40	0.23				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5141	006	0	1	04	01	H5141_006_0	13	1	Preferred Generic	1	4	001000	1	2		111	01	100		1				30	60	90	1			90				30		31								4.00	8.00	12.00					0.00	0.00	0.00							0.00																4.00				4.00			0.13	0.00				0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5141	006	0	1	04	01	H5141_006_0	13	2	Generic	3	4	000100	1	2		111	01	100		1				30	60	90	1			90				30		31								12.00	24.00	36.00					7.00	14.00	21.00							14.00																12.00				12.00			0.40	0.23				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5141	006	0	1	04	01	H5141_006_0	13	1	Preferred Generic	3	4	001000	1	2		111	01	100		1				30	60	90	1			90				30		31								4.00	8.00	12.00					0.00	0.00	0.00							0.00																4.00				4.00			0.13	0.00				0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5141	006	0	1	04	01	H5141_006_0	13	5	Specialty Tier	1	4	010010	1	1		111	01	100		1				30	60	90	1			90				30		31											400.00	25	25	25				400.00	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5141	006	0	1	04	01	H5141_006_0	13	4	Non-Preferred Brand	1	4	100000	1	2		111	01	100		1				30	60	90	1			90				30		31								90.00	180.00	270.00					80.00	160.00	240.00							160.00																90.00				90.00			3.00	2.67				2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5141	006	0	1	04	01	H5141_006_0	13	3	Preferred Brand	1	4	000001	1	2		111	01	100		1				30	60	90	1			90				30		31								47.00	94.00	141.00					40.00	80.00	120.00							80.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5141	007	0	1	04	01	H5141_007_0	15	1	Preferred Generic	1	3	001000	1	2		111	01	100		1				30	60	90	1			90				30		31								3.00	6.00	9.00					0.00	0.00	0.00							0.00																3.00				3.00			0.10	0.00				0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5141	007	0	1	04	01	H5141_007_0	15	4	Non-Preferred Brand	1	3	100000	1	2		111	01	100		1				30	60	90	1			90				30		31								90.00	180.00	270.00					80.00	160.00	240.00							180.00																90.00				90.00			3.00	2.67				2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5141	007	0	1	04	01	H5141_007_0	15	3	Preferred Brand	1	3	000001	1	2		111	01	100		1				30	60	90	1			90				30		31								40.00	80.00	120.00					30.00	60.00	90.00							80.00																40.00				40.00			1.33	1.00				1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5141	007	0	1	04	01	H5141_007_0	15	2	Generic	1	3	000100	1	2		111	01	100		1				30	60	90	1			90				30		31								10.00	20.00	30.00					7.00	14.00	21.00							14.00																10.00				10.00			0.33	0.23				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5141	007	0	1	04	01	H5141_007_0	15	5	Specialty Tier	1	3	010010	1	1		111	01	100		1				30	60	90	1			90				30		31											400.00	25	25	25				400.00	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5172	002	0	1	48	05	H5172_002_0	3	4	Non-Medicare OTC Drugs	1	4	010010			110		01	110		1	31		93				1	31		93				31		31																																														0.00			0.00			0.00	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	3	3	Non-Medicare Rx Drugs	1	4	010010			110		01	110		1	31		93				1	31		93				31		31																																														0.00			0.00			0.00	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	3	1	Generic Drugs	1	4	010000			110		01	110		1	31		93				2	31		93				31		31																																														0.00			0.00			0.00	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			
H5172	002	0	1	48	05	H5172_002_0	3	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	7.40	0.00	7.40	0.00	7.40	0.00	7.40			
H5190	001	0	1	01	01	H5190_001_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5190	001	0	1	01	01	H5190_001_0	6	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	20.00		20.00																					20.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5190	001	0	1	01	01	H5190_001_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	47.00		47.00																					47.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5190	001	0	1	01	01	H5190_001_0	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	100.00		100.00																					100.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5190	001	0	1	01	01	H5190_001_0	6	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				2			90				30		31					25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5190	002	0	1	01	01	H5190_002_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5190	002	0	1	01	01	H5190_002_0	7	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	20.00		20.00																					20.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5190	002	0	1	01	01	H5190_002_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	47.00		47.00																					47.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5190	002	0	1	01	01	H5190_002_0	7	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	100.00		100.00																					100.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5190	002	0	1	01	01	H5190_002_0	7	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				2			90				30		31					25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5190	003	0	1	01	01	H5190_003_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5190	003	0	1	01	01	H5190_003_0	6	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				2			90				30		31					25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5190	003	0	1	01	01	H5190_003_0	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	100.00		100.00																					100.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5190	003	0	1	01	01	H5190_003_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	47.00		47.00																					47.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5190	003	0	1	01	01	H5190_003_0	6	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	20.00		20.00																					20.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5190	004	0	1	01	01	H5190_004_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5190	004	0	1	01	01	H5190_004_0	6	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				2			90				30		31					25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5190	004	0	1	01	01	H5190_004_0	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	100.00		100.00																					100.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5190	004	0	1	01	01	H5190_004_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	47.00		47.00																					47.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5190	004	0	1	01	01	H5190_004_0	6	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	20.00		20.00																					20.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5190	004	0	1	01	01	H5190_004_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5211	002	0	1	02	01	H5211_002_0	14	2	Generic	1	3	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	19.00	38.00	57.00																			19.00	38.00	57.00																19.00				19.00		.63			0.63			0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5211	002	0	1	02	01	H5211_002_0	14	1	Preferred Generic	1	3	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	5.00	10.00	15.00																			5.00	10.00	15.00																5.00				5.00		0.16			0.16			0.14	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5211	002	0	1	02	01	H5211_002_0	14	3	Preferred Brand	1	3	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.56			1.56			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5211	002	0	1	02	01	H5211_002_0	14	4	Non-Preferred Brand	1	3	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5211	002	0	1	02	01	H5211_002_0	14	5	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		34				1764.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5211	002	0	1	02	01	H5211_002_0	14	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5211	004	0	1	02	01	H5211_004_0	9	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	19.00	38.00	57.00																			19.00	38.00	57.00																19.00				19.00		0.63			0.63			0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5211	004	0	1	02	01	H5211_004_0	9	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	6.00	12.00	18.00																			6.00	12.00	18.00																6.00				6.00		0.20			0.20			0.17	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5211	004	0	1	02	01	H5211_004_0	9	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.56			1.56			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5211	004	0	1	02	01	H5211_004_0	9	6	Vaccines	1	4	000010	1	2	010		01			1	30													30		34	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5211	004	0	1	02	01	H5211_004_0	9	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		34				2588.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5211	004	0	1	02	01	H5211_004_0	9	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		34	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5211	007	0	1	02	01	H5211_007_0	10	1	Preferred Generic	1	3	001000	1	2	111		01	010		1	30	60	90				1	30						30		34	3.00	6.00	9.00																			3.00																		3.00				3.00		0.10			0.10			0.08	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5211	007	0	1	02	01	H5211_007_0	10	2	Generic	1	3	000100	1	2	111		01	010		1	30	60	90				1	30						30		34	7.00	14.00	21.00																			7.00																		7.00				7.00		0.23			0.23			0.20	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5211	007	0	1	02	01	H5211_007_0	10	5	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		34				1764.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5211	007	0	1	02	01	H5211_007_0	10	4	Non-Preferred Brand	1	3	100000	1	2	111		01	010		1	30	60	90				1	30						30		34	97.00	194.00	291.00																			97.00																		97.00				97.00		3.23			3.23			2.85	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5211	007	0	1	02	01	H5211_007_0	10	3	Preferred Brand	1	3	000001	1	2	111		01	010		1	30	60	90				1	30						30		34	47.00	94.00	141.00																			47.00																		47.00				47.00		1.56			1.56			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5211	007	0	1	02	01	H5211_007_0	10	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5215	002	0	1	04	01	H5215_002_0	8	2	Generic	1	4	001100	1	2		110	01	110		1				30		90	1	30		90				30		31								13.00		33.00					8.00		20.00					8.00		20.00																8.00				8.00			.43	.26	.26			.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	002	0	1	04	01	H5215_002_0	8	3	Preferred Brand	1	4	000101	1	2		110	01	110		1				30		90	1	30		90				30		31								45.00		109.00					42.00		100.00					42.00		100.00																42.00				42.00			1.50	1.40	1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	002	0	1	04	01	H5215_002_0	8	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				30		90	1	30		90				30		31								90.00		215.00					85.00		200.00					85.00		200.00																85.00				85.00			3.00	2.83	2.83			2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	002	0	1	04	01	H5215_002_0	8	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											762.24	28						302.19	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	002	0	1	04	01	H5215_002_0	8	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				30		90	1	30		90				30		31								4.00		10.00					2.00		4.00					2.00		4.00																2.00				2.00			.13	.06	.06			.06	Preferred Generic, 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				30		90	1	30		90				30		31								4.00		10.00					2.00		4.00					2.00		4.00																2.00				2.00			.13	.06	.06			.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	005	0	1	04	01	H5215_005_0	7	2	Generic	1	4	001100	1	2		110	01	110		1				30		90	1	30		90				30		31								13.00		33.00					8.00		20.00					8.00		20.00																8.00				8.00			.43	.26	.26			.25	Preferred Generic, 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				30		90	1	30		90				30		31								45.00		109.00					42.00		100.00					42.00		100.00																42.00				42.00			1.50	1.40	1.40			1.35	Preferred Generic, 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				30		90	1	30		90				30		31								90.00		215.00					85.00		200.00					85.00		200.00																85.00				85.00			3.00	2.83	2.83			2.74	Preferred Generic, 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				30				30						30		31											1144.62	33						416.13	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	007	0	1	04	01	H5215_007_0	9	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				30		90	1	30		90				30		31								86.00		225.00					80.00		212.00					80.00		212.00																80.00				80.00			2.86	2.66	2.66			2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	007	0	1	04	01	H5215_007_0	9	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											690.60	30						328.12	30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	007	0	1	04	01	H5215_007_0	9	3	Preferred Brand	1	4	000101	1	2		110	01	110		1				30		90	1	30		90				30		31								45.00		130.00					42.00		120.00					42.00		120.00																42.00				42.00			1.50	1.40	1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	007	0	1	04	01	H5215_007_0	9	2	Generic	1	4	001100	1	2		110	01	110		1				30		90	1	30		90				30		31								18.00		35.00					13.00		30.00					13.00		30.00																13.00				13.00			0.60	0.43	0.43			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	007	0	1	04	01	H5215_007_0	9	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				30		90	1	30		90				30		31								3.00		8.00					1.00		3.00					1.00		3.00																1.00				1.00			0.10	0.03	0.03			0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	008	0	1	04	01	H5215_008_0	10	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				30		90	1	30		90				30		31								4.00		10.00					2.00		4.00					2.00		4.00																2.00				2.00			.13	.06	.06			.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	008	0	1	04	01	H5215_008_0	10	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											1059.28	28						278.46	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	008	0	1	04	01	H5215_008_0	10	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				30		90	1	30		90				30		31								90.00		215.00					85.00		200.00					85.00		200.00																85.00				85.00			3.00	2.83	2.83			2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	008	0	1	04	01	H5215_008_0	10	3	Preferred Brand	1	4	000101	1	2		110	01	110		1				30		90	1	30		90				30		31								45.00		109.00					42.00		100.00					42.00		100.00																42.00				42.00			1.50	1.40	1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	008	0	1	04	01	H5215_008_0	10	2	Generic	1	4	001100	1	2		110	01	110		1				30		90	1	30		90				30		31								13.00		33.00					8.00		20.00					8.00		20.00																8.00				8.00			.43	.26	.26			.25	Preferred Generic, 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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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, 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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5216	001	0	1	04	01	H5216_001_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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, 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	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5216	001	0	1	04	01	H5216_001_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, 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	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5216	003	0	1	04	01	H5216_003_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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, 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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5216	003	0	1	04	01	H5216_003_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5216	006	0	1	04	01	H5216_006_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5216	006	0	1	04	01	H5216_006_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, 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	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5216	009	0	1	04	01	H5216_009_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5216	009	0	1	04	01	H5216_009_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5216	010	0	1	04	01	H5216_010_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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, 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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5216	010	0	1	04	01	H5216_010_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5253	004	0	1	01	01	H5253_004_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	004	0	1	01	01	H5253_004_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	9.00		27.00																											27.00						0.00				9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	004	0	1	01	01	H5253_004_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	004	0	1	01	01	H5253_004_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	004	0	1	01	01	H5253_004_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				439.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	011	0	1	01	01	H5253_011_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				374.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	011	0	1	01	01	H5253_011_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	011	0	1	01	01	H5253_011_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	011	0	1	01	01	H5253_011_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	11.00		33.00																											33.00						0.00				11.00				11.00		0.36						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	011	0	1	01	01	H5253_011_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	030	0	1	01	01	H5253_030_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	030	0	1	01	01	H5253_030_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	030	0	1	01	01	H5253_030_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				372.00	26		26																										26						26			26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	030	0	1	01	01	H5253_030_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	030	0	1	01	01	H5253_030_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	033	0	1	01	01	H5253_033_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	033	0	1	01	01	H5253_033_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				428.00	26		26																										26						26			26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	033	0	1	01	01	H5253_033_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	033	0	1	01	01	H5253_033_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	033	0	1	01	01	H5253_033_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	034	0	1	01	01	H5253_034_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	034	0	1	01	01	H5253_034_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	034	0	1	01	01	H5253_034_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	034	0	1	01	01	H5253_034_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	034	0	1	01	01	H5253_034_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				348.00	25		25																										25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	035	0	1	02	01	H5253_035_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	035	0	1	02	01	H5253_035_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	035	0	1	02	01	H5253_035_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	035	0	1	02	01	H5253_035_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	035	0	1	02	01	H5253_035_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				500.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	036	0	1	01	01	H5253_036_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	036	0	1	01	01	H5253_036_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	036	0	1	01	01	H5253_036_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	036	0	1	01	01	H5253_036_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	036	0	1	01	01	H5253_036_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				517.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	037	0	1	01	01	H5253_037_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	037	0	1	01	01	H5253_037_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	037	0	1	01	01	H5253_037_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	037	0	1	01	01	H5253_037_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	037	0	1	01	01	H5253_037_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				539.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	038	0	1	01	01	H5253_038_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	038	0	1	01	01	H5253_038_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	038	0	1	01	01	H5253_038_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	038	0	1	01	01	H5253_038_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	038	0	1	01	01	H5253_038_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				550.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	039	0	1	01	01	H5253_039_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	039	0	1	01	01	H5253_039_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	039	0	1	01	01	H5253_039_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	039	0	1	01	01	H5253_039_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	039	0	1	01	01	H5253_039_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				542.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	043	0	1	02	01	H5253_043_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		100	1	30		90				1						90	30		31	98.00		294.00																											294.00						284.00				98.00				98.00		3.26						3.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	043	0	1	02	01	H5253_043_0	3	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	043	0	1	02	01	H5253_043_0	3	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	043	0	1	02	01	H5253_043_0	3	2	Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	043	0	1	02	01	H5253_043_0	3	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31				453.00	31		31																										31						31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	044	0	1	01	01	H5253_044_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	044	0	1	01	01	H5253_044_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	044	0	1	01	01	H5253_044_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	044	0	1	01	01	H5253_044_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	044	0	1	01	01	H5253_044_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				388.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	045	0	1	01	01	H5253_045_0	3	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	045	0	1	01	01	H5253_045_0	3	2	Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	045	0	1	01	01	H5253_045_0	3	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	045	0	1	01	01	H5253_045_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	045	0	1	01	01	H5253_045_0	3	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31				370.00	26		26																										26						26			26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	046	0	1	01	01	H5253_046_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	046	0	1	01	01	H5253_046_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	046	0	1	01	01	H5253_046_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	046	0	1	01	01	H5253_046_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	046	0	1	01	01	H5253_046_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				483.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	047	0	1	01	01	H5253_047_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				513.00	31		31																										31						31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	047	0	1	01	01	H5253_047_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	047	0	1	01	01	H5253_047_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	047	0	1	01	01	H5253_047_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	047	0	1	01	01	H5253_047_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	048	0	1	01	01	H5253_048_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	048	0	1	01	01	H5253_048_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				517.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	048	0	1	01	01	H5253_048_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	048	0	1	01	01	H5253_048_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	048	0	1	01	01	H5253_048_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	049	0	1	01	01	H5253_049_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	049	0	1	01	01	H5253_049_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				461.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	049	0	1	01	01	H5253_049_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	049	0	1	01	01	H5253_049_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	049	0	1	01	01	H5253_049_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	050	0	1	01	01	H5253_050_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	050	0	1	01	01	H5253_050_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	050	0	1	01	01	H5253_050_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	050	0	1	01	01	H5253_050_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	050	0	1	01	01	H5253_050_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				483.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	051	0	1	01	01	H5253_051_0	4	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	051	0	1	01	01	H5253_051_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	051	0	1	01	01	H5253_051_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	051	0	1	01	01	H5253_051_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				538.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	051	0	1	01	01	H5253_051_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	052	0	1	01	01	H5253_052_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	052	0	1	01	01	H5253_052_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	052	0	1	01	01	H5253_052_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	052	0	1	01	01	H5253_052_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	052	0	1	01	01	H5253_052_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				503.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	053	0	1	01	01	H5253_053_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	053	0	1	01	01	H5253_053_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	053	0	1	01	01	H5253_053_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	053	0	1	01	01	H5253_053_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	053	0	1	01	01	H5253_053_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				518.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	054	0	1	01	01	H5253_054_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	054	0	1	01	01	H5253_054_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	054	0	1	01	01	H5253_054_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	054	0	1	01	01	H5253_054_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	054	0	1	01	01	H5253_054_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				573.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	055	0	1	01	01	H5253_055_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	055	0	1	01	01	H5253_055_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	055	0	1	01	01	H5253_055_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	055	0	1	01	01	H5253_055_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	055	0	1	01	01	H5253_055_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				538.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	056	0	1	01	01	H5253_056_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	056	0	1	01	01	H5253_056_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	056	0	1	01	01	H5253_056_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	056	0	1	01	01	H5253_056_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	056	0	1	01	01	H5253_056_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				474.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	057	0	1	01	01	H5253_057_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	057	0	1	01	01	H5253_057_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	057	0	1	01	01	H5253_057_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	057	0	1	01	01	H5253_057_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	057	0	1	01	01	H5253_057_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				461.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	061	0	1	02	01	H5253_061_0	3	2	Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	061	0	1	02	01	H5253_061_0	3	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	061	0	1	02	01	H5253_061_0	3	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	46.00		138.00																											138.00						128.00				46.00				46.00		1.53						1.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	061	0	1	02	01	H5253_061_0	3	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31				451.00	31		31																										31						31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	061	0	1	02	01	H5253_061_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		100	1	30		90				1						90	30		31	97.00		291.00																											291.00						281.00				97.00				97.00		3.23						3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	062	0	1	01	01	H5253_062_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				490.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	062	0	1	01	01	H5253_062_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	062	0	1	01	01	H5253_062_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	062	0	1	01	01	H5253_062_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	062	0	1	01	01	H5253_062_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	063	0	1	01	01	H5253_063_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				573.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	063	0	1	01	01	H5253_063_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	063	0	1	01	01	H5253_063_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	063	0	1	01	01	H5253_063_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	063	0	1	01	01	H5253_063_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	064	0	1	02	01	H5253_064_0	3	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	064	0	1	02	01	H5253_064_0	3	2	Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	064	0	1	02	01	H5253_064_0	3	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	064	0	1	02	01	H5253_064_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5253	064	0	1	02	01	H5253_064_0	3	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31				448.00	31		31																										31						31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5262	001	0	1	01	01	H5262_001_0	4	1	Preferred Generic	1	3	001000	1	2	111		01			1	30	60	90				1							30		31	8.50	17.00	25.50																																					8.50				8.50		0.28						0.27	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5262	001	0	1	01	01	H5262_001_0	4	2	Generic	1	3	000100	1	2	111		01			1	30	60	90				1							30		31	20.00	40.00	60.00																																					20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5262	001	0	1	01	01	H5262_001_0	4	3	Preferred Brand	1	3	010001	1	2	111		01			1	30	60	90				1							30		31	47.00	94.00	141.00																																					47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5262	001	0	1	01	01	H5262_001_0	4	4	Non-Preferred Brand	1	3	100100	1	2	111		01			1	30	60	90				1							30		31	100.00	200.00	300.00																																					100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5262	001	0	1	01	01	H5262_001_0	4	5	Specialty Tier	1	3	010010	1	1	010		01			1	30													30		31					25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5262	003	0	1	01	01	H5262_003_0	4	1	Preferred Generic	1	3	001000	1	2	111		01			1	30	60	90				1							30		31	11.00	22.00	33.00																																					11.00				11.00		0.37						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5262	003	0	1	01	01	H5262_003_0	4	2	Generic	1	3	000100	1	2	111		01			1	30	60	90				1							30		31	20.00	40.00	60.00																																					20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5262	003	0	1	01	01	H5262_003_0	4	3	Preferred Brand	1	3	010001	1	2	111		01			1	30	60	90				1							30		31	47.00	94.00	141.00																																					47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5262	003	0	1	01	01	H5262_003_0	4	4	Non-Preferred Brand	1	3	100100	1	2	111		01			1	30	60	90				1							30		31	100.00	200.00	300.00																																					100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5262	003	0	1	01	01	H5262_003_0	4	5	Specialty Tier	1	3	010010	1	1	010		01			1	30													30		31					25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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			
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	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	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5294	001	0	1	01	01	H5294_001_0	7	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	20.00		20.00																					20.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5294	001	0	1	01	01	H5294_001_0	7	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				2			90				30		31					25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5294	001	0	1	01	01	H5294_001_0	7	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	100.00		100.00																					100.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5294	001	0	1	01	01	H5294_001_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	47.00		47.00																					47.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5302	011	0	1	02	01	H5302_011_0	8	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					15.00	30.00	45.00					20.00	40.00	60.00																	20.00			20.00			.67	.50	.67			.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5302	011	0	1	02	01	H5302_011_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5302	011	0	1	02	01	H5302_011_0	8	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											38.91	50	50	50				35.41	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5302	011	0	1	02	01	H5302_011_0	8	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					45.00	90.00	135.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.50	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5302	011	0	1	02	01	H5302_011_0	8	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								5.00	10.00	15.00					0.00	0.00	0.00					5.00	10.00	15.00																	5.00			5.00			0.17	0.00	0.17			.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5322	024	0	1	01	01	H5322_024_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5322	024	0	1	01	01	H5322_024_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5322	024	0	1	01	01	H5322_024_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				505.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5322	024	0	1	01	01	H5322_024_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5322	024	0	1	01	01	H5322_024_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5355	001	0	1	48	05	H5355_001_0	4	3	Non-Medicare Rx/OTC Drugs	1	4	010010			110		01	110		1	30		90				2	30		90				30		31																																														0.00			0.00			0.00	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	4	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	2.95	0.00	2.95	0.00	2.95	0.00	2.95			
H5355	001	0	1	48	05	H5355_001_0	4	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	7.40	0.00	7.40	0.00	7.40	0.00	7.40			
H5386	001	0	1	01	01	H5386_001_0	2	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	30	60	90				1			90				30		34	4.00	8.00	12.00																					12.00																4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5386	001	0	1	01	01	H5386_001_0	2	2	Generic	1	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		34	8.00	16.00	24.00																					24.00																8.00				8.00		0.27						0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5386	001	0	1	01	01	H5386_001_0	2	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	30	60	90				1			90				30		34	45.00	90.00	135.00																					135.00																45.00				45.00		1.50						1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5386	001	0	1	01	01	H5386_001_0	2	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	30	60	90				1			90				30		34	95.00	190.00	285.00																					285.00																95.00				95.00		3.17						2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5386	001	0	1	01	01	H5386_001_0	2	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		34					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5410	001	0	1	01	01	H5410_001_0	5	1	Generic	1	4	010010	3	2		110	01			1				30		90	2							30		31								5.00		15.00					0.00		0.00																							5.00				5.00			0.17	0.00				0.16	Generic, Brand, Specialty Tier												
H5410	001	0	1	01	01	H5410_001_0	5	1	Generic	3	4	010010	3	2		110	01			1				30		90	2							30		31								5.00		15.00					0.00		0.00																							5.00				5.00			0.17	0.00				0.16	Generic, Brand, Specialty Tier										1		3
H5410	001	0	1	01	01	H5410_001_0	5	3	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31											640.90	33						640.90	33																							33			33								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								10.00		30.00					0.00		0.00																							10.00				10.00			0.33	0.00				0.32	Generic, Brand, Specialty Tier												
H5410	018	0	1	02	01	H5410_018_0	6	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31				564.52	30	30	30																		30		30															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5410	018	0	1	02	01	H5410_018_0	6	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	95.00	190.00	190.00																			95.00		190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5410	018	0	1	02	01	H5410_018_0	6	3	Preferred Brand	1	4	000101	1	2	111		01	110		1	30	60	90				2	30		90				30		31	47.00	94.00	94.00																			47.00		94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5410	018	0	1	02	01	H5410_018_0	6	2	Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	15.00	30.00	30.00																			15.00		30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5410	018	0	1	02	01	H5410_018_0	6	1	Preferred Generic	3	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	1.00	2.00	2.00																			1.00		2.00																1.00				1.00		0.03			0.03			0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5410	018	0	1	02	01	H5410_018_0	6	1	Preferred Generic	1	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	1.00	2.00	2.00																			1.00		2.00																1.00				1.00		0.03			0.03			0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5414	019	0	1	01	01	H5414_019_0	10	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					0.00	0.00	0.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.00	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5414	019	0	1	01	01	H5414_019_0	10	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					10.00	20.00	30.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.33	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5414	019	0	1	01	01	H5414_019_0	10	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					45.00	90.00	135.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.50	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5414	019	0	1	01	01	H5414_019_0	10	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											41.76	50	50	50				39.67	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5414	019	0	1	01	01	H5414_019_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5414	019	0	1	01	01	H5414_019_0	10	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					3.00	6.00	9.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.10	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5414	023	0	1	01	01	H5414_023_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5414	023	0	1	01	01	H5414_023_0	9	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					3.00	6.00	9.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.10	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5414	023	0	1	01	01	H5414_023_0	9	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					45.00	90.00	135.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.50	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5414	023	0	1	01	01	H5414_023_0	9	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											36.02	50	50	50				31.14	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5414	023	0	1	01	01	H5414_023_0	9	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					0.00	0.00	0.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.00	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5414	023	0	1	01	01	H5414_023_0	9	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					10.00	20.00	30.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.33	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5414	024	0	1	01	01	H5414_024_0	7	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					3.00	6.00	9.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.10	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5414	024	0	1	01	01	H5414_024_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5414	024	0	1	01	01	H5414_024_0	7	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					45.00	90.00	135.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.50	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5414	024	0	1	01	01	H5414_024_0	7	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											35.56	50	50	50				32.22	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5414	024	0	1	01	01	H5414_024_0	7	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					10.00	20.00	30.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.33	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5414	024	0	1	01	01	H5414_024_0	7	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					0.00	0.00	0.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.00	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5414	025	0	1	01	01	H5414_025_0	6	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								12.00	24.00	30.00					7.00	14.00	17.50					12.00	24.00	30.00																	12.00			12.00			.40	0.23	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5414	025	0	1	01	01	H5414_025_0	6	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								6.00	12.00	15.00					0.00	0.00	0.00					6.00	12.00	15.00																	6.00			6.00			0.20	0.00	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5414	025	0	1	01	01	H5414_025_0	6	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								6.00	12.00	15.00					0.00	0.00	0.00					6.00	12.00	15.00																	6.00			6.00			0.20	0.00	0.20			0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5414	025	0	1	01	01	H5414_025_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5414	025	0	1	01	01	H5414_025_0	6	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	117.50					47.00	94.00	117.50					47.00	94.00	117.50																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5414	025	0	1	01	01	H5414_025_0	6	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											36.05	50	50	50				33.50	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5414	026	0	1	01	01	H5414_026_0	8	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31											1.00	29						1.00	29						29																		29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5414	026	0	1	01	01	H5414_026_0	8	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											52.47	50	50	50				51.04	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5414	026	0	1	01	01	H5414_026_0	8	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					45.00	90.00	135.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.50	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5414	026	0	1	01	01	H5414_026_0	8	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								8.00	16.00	24.00					3.00	6.00	9.00					8.00	16.00	24.00																	8.00			8.00			0.27	0.10	0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5414	026	0	1	01	01	H5414_026_0	8	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								14.00	28.00	42.00					8.00	16.00	24.00					14.00	28.00	42.00																	14.00			14.00			0.47	0.27	0.47			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5414	027	0	1	01	01	H5414_027_0	7	1	Generic	3	4	010010	3	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	20.00					5.00	10.00	10.00					10.00	20.00	20.00																	10.00			10.00			0.33	0.17	0.33			0.32	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5414	027	0	1	01	01	H5414_027_0	7	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												
H5414	027	0	1	01	01	H5414_027_0	7	3	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											39.21	50	50	50				38.58	50	50	50				50	50	50																50		50								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5414	027	0	1	01	01	H5414_027_0	7	1	Generic	1	4	010010	3	2		111	10	111		1				30	60	90	1	30	60	90					10	31								5.00	10.00	10.00					0.00	0.00	0.00					5.00	10.00	10.00																	5.00			5.00			0.17	0.00	0.17			0.16	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5414	027	0	1	01	01	H5414_027_0	7	2	Preferred Brand	1	4	010001	3	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	40.00					10.00	20.00	20.00					20.00	40.00	40.00																	20.00			20.00			0.67	0.33	0.67			0.65	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5414	028	0	1	01	01	H5414_028_0	7	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												
H5414	028	0	1	01	01	H5414_028_0	7	1	Generic	1	4	010010	3	2		111	10	111		1				30	60	90	1	30	60	90					10	31								5.00	10.00	10.00					0.00	0.00	0.00					5.00	10.00	10.00																	5.00			5.00			0.17	0.00	0.17			0.16	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5414	028	0	1	01	01	H5414_028_0	7	2	Preferred Brand	1	4	010001	3	2		111	10	111		1				30	60	90	1	30	60	90					10	31								40.00	80.00	80.00					30.00	60.00	60.00					40.00	80.00	80.00																	40.00			40.00			1.33	1.00	1.33			1.29	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5414	028	0	1	01	01	H5414_028_0	7	3	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											28.82	50	50	50				27.65	50	50	50				50	50	50																50		50								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5414	029	0	1	01	01	H5414_029_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												
H5414	029	0	1	01	01	H5414_029_0	7	3	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								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5414	029	0	1	01	01	H5414_029_0	7	2	Preferred Brand	1	4	010001	3	2	111		10	111		1	30	60	90				1	30	60	90					10	31	47.00	94.00	94.00																			47.00	94.00	94.00																	47.00			47.00		1.57			1.57			1.52	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5414	029	0	1	01	01	H5414_029_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												
H5414	030	0	1	01	01	H5414_030_0	7	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
H5414	030	0	1	01	01	H5414_030_0	7	2	Preferred Brand	1	4	010001	3	2	111		10	111		1	30	60	90				1	30	60	90					10	31	47.00	94.00	94.00																			47.00	94.00	94.00																	47.00			47.00		1.57			1.57			1.52	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5414	030	0	1	01	01	H5414_030_0	7	3	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								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5414	030	0	1	01	01	H5414_030_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												
H5414	030	0	1	01	01	H5414_030_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												
H5414	031	0	1	01	01	H5414_031_0	7	1	Generic	1	4	010010	3	2		111	10	111		1				30	60	90	1	30	60	90					10	31								5.00	10.00	10.00					0.00	0.00	0.00					5.00	10.00	10.00																	5.00			5.00			0.17	0.00	0.17			0.16	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5414	031	0	1	01	01	H5414_031_0	7	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												
H5414	031	0	1	01	01	H5414_031_0	7	3	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											30.61	50	50	50				28.37	50	50	50				50	50	50																50		50								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5414	031	0	1	01	01	H5414_031_0	7	2	Preferred Brand	1	4	010001	3	2		111	10	111		1				30	60	90	1	30	60	90					10	31								25.00	50.00	50.00					15.00	30.00	30.00					25.00	50.00	50.00																	25.00			25.00			0.83	0.50	0.83			0.81	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5414	031	0	1	01	01	H5414_031_0	7	1	Generic	3	4	010010	3	2		111	10	111		1				30	60	90	1	30	60	90					10	31								5.00	10.00	10.00					0.00	0.00	0.00					5.00	10.00	10.00																	5.00			5.00			0.17	0.00	0.17			0.16	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5414	032	0	1	01	01	H5414_032_0	6	2	Preferred Brand	3	4	010001	3	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	20.00					3.00	6.00	6.00					10.00	20.00	20.00																	10.00			10.00			0.33	0.10	0.33			0.32	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		1
H5414	032	0	1	01	01	H5414_032_0	6	1	Generic	3	4	010010	3	2		111	10	111		1				30	60	90	1	30	60	90					10	31								5.00	10.00	10.00					0.00	0.00	0.00					5.00	10.00	10.00																	5.00			5.00			0.17	0.00	0.17			0.16	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		1
H5414	032	0	1	01	01	H5414_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												
H5414	032	0	1	01	01	H5414_032_0	6	2	Preferred Brand	1	4	010001	3	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	20.00					3.00	6.00	6.00					10.00	20.00	20.00																	10.00			10.00			0.33	0.10	0.33			0.32	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5414	032	0	1	01	01	H5414_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											33.22	50	50	50				31.44	50	50	50				50	50	50																50		50								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5414	032	0	1	01	01	H5414_032_0	6	1	Generic	1	4	010010	3	2		111	10	111		1				30	60	90	1	30	60	90					10	31								5.00	10.00	10.00					0.00	0.00	0.00					5.00	10.00	10.00																	5.00			5.00			0.17	0.00	0.17			0.16	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5414	033	0	1	01	01	H5414_033_0	7	3	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											25.03	50	50	50				22.82	50	50	50				50	50	50																50		50								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5414	033	0	1	01	01	H5414_033_0	7	1	Generic	1	4	010010	3	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	20.00					0.00	0.00	0.00					10.00	20.00	20.00																	10.00			10.00			0.33	0.00	0.33			0.32	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5414	033	0	1	01	01	H5414_033_0	7	2	Preferred Brand	1	4	010001	3	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	94.00					35.00	70.00	70.00					47.00	94.00	94.00																	47.00			47.00			1.57	1.17	1.57			1.52	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5414	033	0	1	01	01	H5414_033_0	7	1	Generic	3	4	010010	3	2		111	10	111		1				30	60	90	1	30	60	90					10	31								15.00	30.00	30.00					5.00	10.00	10.00					15.00	30.00	30.00																	15.00			15.00			0.50	0.17	0.50			0.48	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5414	033	0	1	01	01	H5414_033_0	7	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												
H5414	034	0	1	01	01	H5414_034_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												
H5414	034	0	1	01	01	H5414_034_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												
H5414	034	0	1	01	01	H5414_034_0	7	3	Non-Preferred Brand	1	4	110000	1	1	111		10	111		1	30	60	90				1	30	60	90					10	31				34.85	50	50	50																		50	50	50																50		50								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5414	034	0	1	01	01	H5414_034_0	7	2	Preferred Brand	1	4	010001	3	2	111		10	111		1	30	60	90				1	30	60	90					10	31	47.00	94.00	94.00																			47.00	94.00	94.00																	47.00			47.00		1.57			1.57			1.52	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5415	056	0	1	04	01	H5415_056_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5415	056	0	1	04	01	H5415_056_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5415	056	0	1	04	01	H5415_056_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5415	056	0	1	04	01	H5415_056_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5415	056	0	1	04	01	H5415_056_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5415	056	0	1	04	01	H5415_056_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5415	056	0	1	04	01	H5415_056_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5415	056	0	1	04	01	H5415_056_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5415	056	0	1	04	01	H5415_056_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5415	056	0	1	04	01	H5415_056_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5415	070	0	1	04	01	H5415_070_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, 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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5415	070	0	1	04	01	H5415_070_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5420	001	0	1	01	01	H5420_001_0	5	3	Preferred Brand	1	4	010001	3	2	110		01		100	1	30		90				1						90	30		31	20.00		60.00																											60.00						50.00				20.00				20.00		0.66						0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5420	001	0	1	01	01	H5420_001_0	5	2	Generic	1	4	000100	3	2	110		01		100	1	30		90				1						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5420	001	0	1	01	01	H5420_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						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5420	001	0	1	01	01	H5420_001_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5420	001	0	1	01	01	H5420_001_0	5	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				771.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5420	001	0	1	01	01	H5420_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						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5420	001	0	1	01	01	H5420_001_0	5	2	Generic	3	4	000100	3	2	110		01		100	1	30		90				1						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5420	003	0	1	01	01	H5420_003_0	4	3	Preferred Brand	1	4	010001	3	2	110		01		100	1	30		90				1						90	30		31	30.00		90.00																											90.00						80.00				30.00				30.00		1.00						0.96	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5420	003	0	1	01	01	H5420_003_0	4	2	Generic	1	4	000100	3	2	110		01		100	1	30		90				1						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5420	003	0	1	01	01	H5420_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5420	003	0	1	01	01	H5420_003_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	89.00		267.00																											267.00						257.00				89.00				89.00		2.96						2.87	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5420	003	0	1	01	01	H5420_003_0	4	2	Generic	3	4	000100	3	2	110		01		100	1	30		90				1						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5420	003	0	1	01	01	H5420_003_0	4	1	Preferred Generic	3	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5420	003	0	1	01	01	H5420_003_0	4	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				811.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5420	006	0	1	01	01	H5420_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5420	006	0	1	01	01	H5420_006_0	5	2	Generic	1	4	000100	3	2	110		01	100		1	30		90				1			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5420	006	0	1	01	01	H5420_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5420	006	0	1	01	01	H5420_006_0	5	4	Non-Preferred Brand	1	4	110000	1	1	110		01	100		1	30		90				1			90				30		31				36.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5420	006	0	1	01	01	H5420_006_0	5	3	Preferred Brand	1	4	010001	3	1	110		01	100		1	30		90				1			90				30		31				37.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5420	006	0	1	01	01	H5420_006_0	5	2	Generic	3	4	000100	3	2	110		01	100		1	30		90				1			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5420	006	0	1	01	01	H5420_006_0	5	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31				526.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5422	007	0	1	01	01	H5422_007_0	9	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								95.00	190.00	285.00					90.00	180.00	270.00					90.00	270.00	270.00																95.00				95.00			3.17	3.00	3.00			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5422	007	0	1	01	01	H5422_007_0	9	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5422	007	0	1	01	01	H5422_007_0	9	2	Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								2.00	4.00	6.00					2.00	4.00	6.00					2.00	6.00	6.00																2.00				2.00			0.07	0.07	0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5422	007	0	1	01	01	H5422_007_0	9	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5422	007	0	1	01	01	H5422_007_0	9	5	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34											800.83	25						800.83	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5422	007	0	1	01	01	H5422_007_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5422	008	0	1	01	01	H5422_008_0	9	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5422	008	0	1	01	01	H5422_008_0	9	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5422	008	0	1	01	01	H5422_008_0	9	2	Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5422	008	0	1	01	01	H5422_008_0	9	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5422	008	0	1	01	01	H5422_008_0	9	5	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34											923.57	31						923.57	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5422	008	0	1	01	01	H5422_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5422	009	0	1	01	01	H5422_009_0	7	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5422	009	0	1	01	01	H5422_009_0	7	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00	36.00	36.00																17.00				17.00			0.57	0.40	0.40			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5422	009	0	1	01	01	H5422_009_0	7	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5422	009	0	1	01	01	H5422_009_0	7	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5422	009	0	1	01	01	H5422_009_0	7	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5422	009	0	1	01	01	H5422_009_0	7	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5422	009	0	1	01	01	H5422_009_0	7	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5422	009	0	1	01	01	H5422_009_0	7	2	Generic	3	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00	36.00	36.00																17.00				17.00			0.57	0.40	0.40			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5422	009	0	1	01	01	H5422_009_0	7	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34											1004.07	33						1004.07	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	001	0	1	01	01	H5425_001_0	10	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	290.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	001	0	1	01	01	H5425_001_0	10	3	Preferred Brand	1	4	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	131.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	001	0	1	01	01	H5425_001_0	10	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	10.00	20.00	20.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	001	0	1	01	01	H5425_001_0	10	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	7.00	14.00	14.00																			7.00	14.00	14.00																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	001	0	1	01	01	H5425_001_0	10	6	Select Care Drugs	1	4	000010	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	11.00	22.00	33.00																			11.00	22.00	23.00																11.00				11.00		0.37			0.37			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	001	0	1	01	01	H5425_001_0	10	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				1.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	004	0	1	01	01	H5425_004_0	5	2	Generic	3	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	8.00	16.00	16.00																			8.00	16.00	16.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5425	004	0	1	01	01	H5425_004_0	5	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	5.00	10.00	10.00																			5.00	10.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5425	004	0	1	01	01	H5425_004_0	5	6	Select Care Drugs	1	4	000010	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	004	0	1	01	01	H5425_004_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	275.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	004	0	1	01	01	H5425_004_0	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				1.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	004	0	1	01	01	H5425_004_0	5	3	Preferred Brand	1	4	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	131.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	004	0	1	01	01	H5425_004_0	5	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	8.00	16.00	16.00																			8.00	16.00	16.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	004	0	1	01	01	H5425_004_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	5.00	10.00	10.00																			5.00	10.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	005	0	1	01	01	H5425_005_0	6	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	5.00	10.00	10.00																			5.00	10.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	005	0	1	01	01	H5425_005_0	6	6	Select Care Drugs	1	4	000010	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	005	0	1	01	01	H5425_005_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	005	0	1	01	01	H5425_005_0	6	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	275.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	005	0	1	01	01	H5425_005_0	6	3	Preferred Brand	1	4	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	131.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	005	0	1	01	01	H5425_005_0	6	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	10.00	20.00	20.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	006	0	1	01	01	H5425_006_0	5	2	Generic	3	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	10.00	20.00	20.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5425	006	0	1	01	01	H5425_006_0	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				1.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	006	0	1	01	01	H5425_006_0	5	6	Select Care Drugs	1	4	000010	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	11.00	22.00	33.00																			11.00	22.00	23.00																11.00				11.00		0.37			0.37			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	006	0	1	01	01	H5425_006_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	290.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	006	0	1	01	01	H5425_006_0	5	3	Preferred Brand	1	4	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	131.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	006	0	1	01	01	H5425_006_0	5	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	10.00	20.00	20.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	006	0	1	01	01	H5425_006_0	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5425	006	0	1	01	01	H5425_006_0	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	007	0	1	01	01	H5425_007_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	007	0	1	01	01	H5425_007_0	5	2	Generic	3	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	10.00	20.00	20.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5425	007	0	1	01	01	H5425_007_0	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5425	007	0	1	01	01	H5425_007_0	5	6	Select Care Drugs	1	4	000010	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	11.00	22.00	33.00																			11.00	22.00	23.00																11.00				11.00		0.37			0.37			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	007	0	1	01	01	H5425_007_0	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				1.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	007	0	1	01	01	H5425_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	100.00	200.00	300.00																			100.00	200.00	290.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	007	0	1	01	01	H5425_007_0	5	3	Preferred Brand	1	4	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	131.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	007	0	1	01	01	H5425_007_0	5	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	10.00	20.00	20.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	008	0	1	01	01	H5425_008_0	5	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	12.00	24.00	24.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	008	0	1	01	01	H5425_008_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	5.00	10.00	10.00																			5.00	10.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	008	0	1	01	01	H5425_008_0	5	3	Preferred Brand	1	4	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	131.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	008	0	1	01	01	H5425_008_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	290.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	008	0	1	01	01	H5425_008_0	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				1.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	008	0	1	01	01	H5425_008_0	5	6	Select Care Drugs	1	4	000010	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	11.00	22.00	33.00																			11.00	22.00	23.00																11.00				11.00		0.37			0.37			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	008	0	1	01	01	H5425_008_0	5	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	5.00	10.00	10.00																			5.00	10.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5425	008	0	1	01	01	H5425_008_0	5	2	Generic	3	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	12.00	24.00	24.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5425	009	0	1	01	01	H5425_009_0	5	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	12.00	24.00	24.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	009	0	1	01	01	H5425_009_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	5.00	10.00	10.00																			5.00	10.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	009	0	1	01	01	H5425_009_0	5	3	Preferred Brand	1	4	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	131.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	009	0	1	01	01	H5425_009_0	5	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	5.00	10.00	10.00																			5.00	10.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5425	009	0	1	01	01	H5425_009_0	5	2	Generic	3	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	12.00	24.00	24.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5425	009	0	1	01	01	H5425_009_0	5	6	Select Care Drugs	1	4	000010	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	11.00	22.00	33.00																			11.00	22.00	23.00																11.00				11.00		0.37			0.37			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	009	0	1	01	01	H5425_009_0	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				1.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	009	0	1	01	01	H5425_009_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	290.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	019	0	1	01	01	H5425_019_0	6	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	290.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	019	0	1	01	01	H5425_019_0	6	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				1.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	019	0	1	01	01	H5425_019_0	6	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	5.00	10.00	10.00																			5.00	10.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	019	0	1	01	01	H5425_019_0	6	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	10.00	20.00	20.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	019	0	1	01	01	H5425_019_0	6	3	Preferred Brand	1	4	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	131.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	019	0	1	01	01	H5425_019_0	6	6	Select Care Drugs	1	4	000010	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	11.00	22.00	33.00																			11.00	22.00	23.00																11.00				11.00		0.37			0.37			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	020	0	1	01	01	H5425_020_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	5.00	10.00	10.00																			5.00	10.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	020	0	1	01	01	H5425_020_0	5	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	10.00	20.00	20.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	020	0	1	01	01	H5425_020_0	5	3	Preferred Brand	1	4	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	131.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	020	0	1	01	01	H5425_020_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	290.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	020	0	1	01	01	H5425_020_0	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				1.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	020	0	1	01	01	H5425_020_0	5	6	Select Care Drugs	1	4	000010	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	11.00	22.00	33.00																			11.00	22.00	23.00																11.00				11.00		0.37			0.37			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	028	0	1	01	01	H5425_028_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.00	6.00	6.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	028	0	1	01	01	H5425_028_0	5	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	7.00	14.00	14.00																			7.00	14.00	14.00																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	028	0	1	01	01	H5425_028_0	5	3	Preferred Brand	1	4	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	131.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	028	0	1	01	01	H5425_028_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	290.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	028	0	1	01	01	H5425_028_0	5	6	Select Care Drugs	3	4	000010	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5425	028	0	1	01	01	H5425_028_0	5	6	Select Care Drugs	1	4	000010	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	028	0	1	01	01	H5425_028_0	5	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.00	6.00	6.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5425	028	0	1	01	01	H5425_028_0	5	2	Generic	3	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	7.00	14.00	14.00																			7.00	14.00	14.00																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5425	028	0	1	01	01	H5425_028_0	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				1.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	033	0	1	01	01	H5425_033_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	290.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	033	0	1	01	01	H5425_033_0	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				1.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	033	0	1	01	01	H5425_033_0	5	6	Select Care Drugs	1	4	000010	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	11.00	22.00	33.00																			11.00	22.00	23.00																11.00				11.00		0.37			0.37			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	033	0	1	01	01	H5425_033_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	5.00	10.00	10.00																			5.00	10.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	033	0	1	01	01	H5425_033_0	5	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	12.00	24.00	24.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	033	0	1	01	01	H5425_033_0	5	3	Preferred Brand	1	4	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	131.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	033	0	1	01	01	H5425_033_0	5	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	5.00	10.00	10.00																			5.00	10.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5425	033	0	1	01	01	H5425_033_0	5	2	Generic	3	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	12.00	24.00	24.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5425	034	0	1	01	01	H5425_034_0	5	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	7.00	14.00	14.00																			7.00	14.00	14.00																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	034	0	1	01	01	H5425_034_0	5	3	Preferred Brand	1	4	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	131.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	034	0	1	01	01	H5425_034_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.00	6.00	6.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	034	0	1	01	01	H5425_034_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	290.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	034	0	1	01	01	H5425_034_0	5	6	Select Care Drugs	3	4	000010	1	2	111		01	111		1	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5425	034	0	1	01	01	H5425_034_0	5	6	Select Care Drugs	1	4	000010	1	2	111		01	111		1	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	034	0	1	01	01	H5425_034_0	5	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.00	6.00	6.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5425	034	0	1	01	01	H5425_034_0	5	2	Generic	3	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	7.00	14.00	14.00																			7.00	14.00	14.00																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5425	034	0	1	01	01	H5425_034_0	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				1.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	046	0	1	01	01	H5425_046_0	6	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	7.00	14.00	14.00																			7.00	14.00	14.00																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	046	0	1	01	01	H5425_046_0	6	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.00	6.00	6.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	046	0	1	01	01	H5425_046_0	6	3	Preferred Brand	1	4	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	125.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	046	0	1	01	01	H5425_046_0	6	6	Select Care Drugs	1	4	000010	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	046	0	1	01	01	H5425_046_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	046	0	1	01	01	H5425_046_0	6	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	85.00	170.00	255.00																			85.00	170.00	245.00																85.00				85.00		2.83			2.83			2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	047	0	1	01	01	H5425_047_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.00	6.00	6.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	047	0	1	01	01	H5425_047_0	5	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	7.00	14.00	14.00																			7.00	14.00	14.00																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	047	0	1	01	01	H5425_047_0	5	3	Preferred Brand	1	4	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	125.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	047	0	1	01	01	H5425_047_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	275.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	047	0	1	01	01	H5425_047_0	5	6	Select Care Drugs	3	4	000010	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5425	047	0	1	01	01	H5425_047_0	5	2	Generic	3	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	7.00	14.00	14.00																			7.00	14.00	14.00																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5425	047	0	1	01	01	H5425_047_0	5	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.00	6.00	6.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5425	047	0	1	01	01	H5425_047_0	5	6	Select Care Drugs	1	4	000010	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	047	0	1	01	01	H5425_047_0	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				1.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	048	0	1	01	01	H5425_048_0	5	3	Preferred Brand	1	4	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	125.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	048	0	1	01	01	H5425_048_0	5	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	7.00	14.00	14.00																			7.00	14.00	14.00																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	048	0	1	01	01	H5425_048_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.00	6.00	6.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	048	0	1	01	01	H5425_048_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	275.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	048	0	1	01	01	H5425_048_0	5	6	Select Care Drugs	3	4	000010	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5425	048	0	1	01	01	H5425_048_0	5	2	Generic	3	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	7.00	14.00	14.00																			7.00	14.00	14.00																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5425	048	0	1	01	01	H5425_048_0	5	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.00	6.00	6.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5425	048	0	1	01	01	H5425_048_0	5	6	Select Care Drugs	1	4	000010	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	048	0	1	01	01	H5425_048_0	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				1.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	052	0	1	01	01	H5425_052_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	290.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	052	0	1	01	01	H5425_052_0	5	3	Preferred Brand	1	4	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	131.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	052	0	1	01	01	H5425_052_0	5	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	15.00	30.00	30.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	052	0	1	01	01	H5425_052_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	5.00	10.00	10.00																			5.00	10.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	052	0	1	01	01	H5425_052_0	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				1.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	052	0	1	01	01	H5425_052_0	5	6	Select Care Drugs	1	4	000010	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	11.00	22.00	33.00																			11.00	22.00	23.00																11.00				11.00		0.37			0.37			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	053	0	1	01	01	H5425_053_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	290.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	053	0	1	01	01	H5425_053_0	5	3	Preferred Brand	1	4	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	131.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	053	0	1	01	01	H5425_053_0	5	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	15.00	30.00	30.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	053	0	1	01	01	H5425_053_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	5.00	10.00	10.00																			5.00	10.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	053	0	1	01	01	H5425_053_0	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				1.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	053	0	1	01	01	H5425_053_0	5	6	Select Care Drugs	3	4	000010	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5425	053	0	1	01	01	H5425_053_0	5	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	5.00	10.00	10.00																			5.00	10.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5425	053	0	1	01	01	H5425_053_0	5	6	Select Care Drugs	1	4	000010	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	054	0	1	01	01	H5425_054_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	5.00	10.00	10.00																			5.00	10.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	054	0	1	01	01	H5425_054_0	5	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	15.00	30.00	30.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	054	0	1	01	01	H5425_054_0	5	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	5.00	10.00	10.00																			5.00	10.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5425	054	0	1	01	01	H5425_054_0	5	6	Select Care Drugs	1	4	000010	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	054	0	1	01	01	H5425_054_0	5	3	Preferred Brand	1	4	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	131.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	054	0	1	01	01	H5425_054_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	290.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	054	0	1	01	01	H5425_054_0	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				1.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	054	0	1	01	01	H5425_054_0	5	6	Select Care Drugs	3	4	000010	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5425	055	0	1	01	01	H5425_055_0	5	6	Select Care Drugs	3	4	000010	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5425	055	0	1	01	01	H5425_055_0	5	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	10.00	20.00	20.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	055	0	1	01	01	H5425_055_0	5	3	Preferred Brand	1	4	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	131.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	055	0	1	01	01	H5425_055_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	290.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	055	0	1	01	01	H5425_055_0	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				1.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	055	0	1	01	01	H5425_055_0	5	6	Select Care Drugs	1	4	000010	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	055	0	1	01	01	H5425_055_0	5	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	5.00	10.00	10.00																			5.00	10.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5425	055	0	1	01	01	H5425_055_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	5.00	10.00	10.00																			5.00	10.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, 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	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	131.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	056	0	1	01	01	H5425_056_0	7	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	10.00	20.00	20.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, 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	30	60	90				1	30	60	90				30		31	7.00	14.00	14.00																			7.00	14.00	14.00																7.00				7.00		0.23			0.23			0.23	Preferred Generic, 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	30	60	90				1	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	290.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, 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	30							30						30		31				1.00	33																				33																	33			33								Preferred Generic, 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	30	60	90				1	30	60	90				30		31	11.00	22.00	33.00																			11.00	22.00	23.00																11.00				11.00		0.37			0.37			0.35	Preferred Generic, 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	30	60	90				1	30	60	90				30		31	7.00	14.00	14.00																			7.00	14.00	14.00																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5425	061	0	1	01	01	H5425_061_0	5	3	Preferred Brand	1	4	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	131.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	061	0	1	01	01	H5425_061_0	5	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	12.00	24.00	24.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	061	0	1	01	01	H5425_061_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	7.00	14.00	14.00																			7.00	14.00	14.00																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	061	0	1	01	01	H5425_061_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	290.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	061	0	1	01	01	H5425_061_0	5	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	7.00	14.00	14.00																			7.00	14.00	14.00																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5425	061	0	1	01	01	H5425_061_0	5	6	Select Care Drugs	1	4	000010	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	11.00	22.00	33.00																			11.00	22.00	23.00																11.00				11.00		0.37			0.37			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	061	0	1	01	01	H5425_061_0	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				1.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	062	0	1	01	01	H5425_062_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	7.00	14.00	14.00																			7.00	14.00	14.00																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	062	0	1	01	01	H5425_062_0	5	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	12.00	24.00	24.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	062	0	1	01	01	H5425_062_0	5	3	Preferred Brand	1	4	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	131.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	062	0	1	01	01	H5425_062_0	5	6	Select Care Drugs	1	4	000010	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	11.00	22.00	33.00																			11.00	22.00	23.00																11.00				11.00		0.37			0.37			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	062	0	1	01	01	H5425_062_0	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				1.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	062	0	1	01	01	H5425_062_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	290.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5425	062	0	1	01	01	H5425_062_0	5	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	7.00	14.00	14.00																			7.00	14.00	14.00																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5427	059	0	1	01	01	H5427_059_0	6	1	Generic	1	4	001000	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	059	0	1	01	01	H5427_059_0	6	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	059	0	1	01	01	H5427_059_0	6	3	Non-Preferred Brand	1	4	100100	3	2	110		01	110		1	30		90				1	30		90				30		31	95.00		285.00																			95.00		190.00																95.00				95.00		3.17			3.17			3.06	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	059	0	1	01	01	H5427_059_0	6	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31				1077.23	33		33																		33		33															33			33								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	059	0	1	01	01	H5427_059_0	6	1	Generic	3	4	001000	3	2	110		01	110		1	30		90				1	30		90				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.17			0.17			0.16	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5427	060	0	1	01	01	H5427_060_0	6	1	Generic	1	4	001000	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	060	0	1	01	01	H5427_060_0	6	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	060	0	1	01	01	H5427_060_0	6	3	Non-Preferred Brand	1	4	100100	3	2	110		01	110		1	30		90				1	30		90				30		31	95.00		285.00																			95.00		190.00																95.00				95.00		3.17			3.17			3.06	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	060	0	1	01	01	H5427_060_0	6	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31				1505.11	33		33																		33		33															33			33								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	060	0	1	01	01	H5427_060_0	6	1	Generic	3	4	001000	3	2	110		01	110		1	30		90				1	30		90				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.17			0.17			0.16	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5427	070	0	1	01	01	H5427_070_0	5	1	Generic	1	4	001000	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	070	0	1	01	01	H5427_070_0	5	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	25.00		75.00																			25.00		50.00																25.00				25.00		0.83			0.83			0.81	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	070	0	1	01	01	H5427_070_0	5	3	Non-Preferred Brand	1	4	100100	3	2	110		01	110		1	30		90				1	30		90				30		31	75.00		225.00																			75.00		150.00																75.00				75.00		2.50			2.50			2.42	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	070	0	1	01	01	H5427_070_0	5	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31				816.53	33		33																		33		33															33			33								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	070	0	1	01	01	H5427_070_0	5	1	Generic	3	4	001000	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5427	072	0	1	01	01	H5427_072_0	5	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	35.00		105.00																			35.00		70.00																35.00				35.00		1.17			1.17			1.13	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	072	0	1	01	01	H5427_072_0	5	1	Generic	1	4	001000	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	072	0	1	01	01	H5427_072_0	5	1	Generic	3	4	001000	3	2	110		01	110		1	30		90				1	30		90				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.17			0.17			0.16	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5427	072	0	1	01	01	H5427_072_0	5	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31				1212.00	33		33																		33		33															33			33								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	072	0	1	01	01	H5427_072_0	5	3	Non-Preferred Brand	1	4	100100	3	2	110		01	110		1	30		90				1	30		90				30		31	80.00		240.00																			80.00		160.00																80.00				80.00		2.67			2.67			2.58	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	077	0	1	01	01	H5427_077_0	5	3	Non-Preferred Brand	1	4	100100	3	2	110		01	110		1	30		90				1	30		90				30		31	80.00		240.00																			80.00		160.00																80.00				80.00		2.67			2.67			2.58	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	077	0	1	01	01	H5427_077_0	5	1	Generic	3	4	001000	3	2	110		01	110		1	30		90				1	30		90				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.17			0.17			0.16	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5427	077	0	1	01	01	H5427_077_0	5	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31				1536.97	33		33																		33		33															33			33								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	077	0	1	01	01	H5427_077_0	5	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	35.00		105.00																			35.00		70.00																35.00				35.00		1.17			1.17			1.13	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	077	0	1	01	01	H5427_077_0	5	1	Generic	1	4	001000	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	082	0	1	01	01	H5427_082_0	6	3	Non-Preferred Brand	1	4	100100	3	2	110		01	110		1	30		90				1	30		90				30		31	90.00		270.00																			90.00		180.00																90.00				90.00		3.00			3.00			2.90	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	082	0	1	01	01	H5427_082_0	6	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31				1021.10	33		33																		33		33															33			33								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	082	0	1	01	01	H5427_082_0	6	1	Generic	3	4	001000	3	2	110		01	110		1	30		90				1	30		90				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.17			0.17			0.16	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5427	082	0	1	01	01	H5427_082_0	6	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	40.00		120.00																			40.00		80.00																40.00				40.00		1.33			1.33			1.29	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	082	0	1	01	01	H5427_082_0	6	1	Generic	1	4	001000	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	083	0	1	01	01	H5427_083_0	6	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31				1158.53	33		33																		33		33															33			33								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	083	0	1	01	01	H5427_083_0	6	1	Generic	3	4	001000	3	2	110		01	110		1	30		90				1	30		90				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.17			0.17			0.16	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5427	083	0	1	01	01	H5427_083_0	6	3	Non-Preferred Brand	1	4	100100	3	2	110		01	110		1	30		90				1	30		90				30		31	90.00		270.00																			90.00		180.00																90.00				90.00		3.00			3.00			2.90	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	083	0	1	01	01	H5427_083_0	6	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	40.00		120.00																			40.00		80.00																40.00				40.00		1.33			1.33			1.29	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	083	0	1	01	01	H5427_083_0	6	1	Generic	1	4	001000	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	088	0	1	01	01	H5427_088_0	5	1	Generic	3	4	001000	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5427	088	0	1	01	01	H5427_088_0	5	1	Generic	1	4	001000	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	088	0	1	01	01	H5427_088_0	5	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31				1170.02	33		33																		33		33															33			33								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	088	0	1	01	01	H5427_088_0	5	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	30.00		90.00																			30.00		60.00																30.00				30.00		1.00			1.00			0.97	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	088	0	1	01	01	H5427_088_0	5	3	Non-Preferred Brand	1	4	100100	3	2	110		01	110		1	30		90				1	30		90				30		31	95.00		285.00																			95.00		190.00																95.00				95.00		3.17			3.17			3.06	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	089	0	1	01	01	H5427_089_0	5	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	35.00		105.00																			35.00		70.00																35.00				35.00		1.17			1.17			1.13	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	089	0	1	01	01	H5427_089_0	5	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31				990.06	33		33																		33		33															33			33								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	089	0	1	01	01	H5427_089_0	5	3	Non-Preferred Brand	1	4	100100	3	2	110		01	110		1	30		90				1	30		90				30		31	85.00		255.00																			85.00		170.00																85.00				85.00		2.83			2.83			2.74	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	089	0	1	01	01	H5427_089_0	5	1	Generic	3	4	001000	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5427	089	0	1	01	01	H5427_089_0	5	1	Generic	1	4	001000	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	091	0	1	01	01	H5427_091_0	5	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	35.00		105.00																			35.00		70.00																35.00				35.00		1.17			1.17			1.13	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	091	0	1	01	01	H5427_091_0	5	1	Generic	1	4	001000	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	091	0	1	01	01	H5427_091_0	5	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31				990.06	33		33																		33		33															33			33								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	091	0	1	01	01	H5427_091_0	5	3	Non-Preferred Brand	1	4	100100	3	2	110		01	110		1	30		90				1	30		90				30		31	80.00		240.00																			80.00		160.00																80.00				80.00		2.67			2.67			2.58	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	091	0	1	01	01	H5427_091_0	5	1	Generic	3	4	001000	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5427	092	0	1	01	01	H5427_092_0	5	1	Generic	3	4	001000	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5427	092	0	1	01	01	H5427_092_0	5	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31				990.06	33		33																		33		33															33			33								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	092	0	1	01	01	H5427_092_0	5	3	Non-Preferred Brand	1	4	100100	3	2	110		01	110		1	30		90				1	30		90				30		31	80.00		240.00																			80.00		160.00																80.00				80.00		2.67			2.67			2.58	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	092	0	1	01	01	H5427_092_0	5	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	30.00		90.00																			30.00		60.00																30.00				30.00		1.00			1.00			0.97	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	092	0	1	01	01	H5427_092_0	5	1	Generic	1	4	001000	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	093	0	1	01	01	H5427_093_0	5	1	Generic	1	4	001000	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	093	0	1	01	01	H5427_093_0	5	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	30.00		90.00																			30.00		60.00																30.00				30.00		1.00			1.00			0.97	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	093	0	1	01	01	H5427_093_0	5	3	Non-Preferred Brand	1	4	100100	3	2	110		01	110		1	30		90				1	30		90				30		31	69.00		207.00																			69.00		138.00																69.00				69.00		2.30			2.30			2.23	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	093	0	1	01	01	H5427_093_0	5	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31				990.05	33		33																		33		33															33			33								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	093	0	1	01	01	H5427_093_0	5	1	Generic	3	4	001000	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5427	094	0	1	01	01	H5427_094_0	5	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31				990.06	33		33																		33		33															33			33								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	094	0	1	01	01	H5427_094_0	5	3	Non-Preferred Brand	1	4	100100	3	2	110		01	110		1	30		90				1	30		90				30		31	80.00		240.00																			80.00		160.00																80.00				80.00		2.67			2.67			2.58	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	094	0	1	01	01	H5427_094_0	5	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	30.00		90.00																			30.00		60.00																30.00				30.00		1.00			1.00			0.97	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	094	0	1	01	01	H5427_094_0	5	1	Generic	1	4	001000	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5427	094	0	1	01	01	H5427_094_0	5	1	Generic	3	4	001000	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5428	001	0	1	01	01	H5428_001_0	4	2	Brand	1	3	000010	1	2	110		01			1	31		93				2							31		31	47.00		141.00																																					47.00				47.00		1.52						1.52	Generic, Brand												
H5428	001	0	1	01	01	H5428_001_0	4	1	Generic	1	3	010000	1	2	110		01			1	31		93				2							31		31	10.50		31.50																																					10.50				10.50		0.34						0.34	Generic, Brand												
H5430	001	0	1	01	01	H5430_001_0	6	2	Generic	1	3	000100	1	1		110	01			1				30		90	2							30		31											7.00	25		25				7.00	25		25																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5430	001	0	1	01	01	H5430_001_0	6	1	Preferred Generic	1	3	001000	1	1		110	01			1				30		90	2							30		31											2.00	25		25				0.00	0		0																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5430	001	0	1	01	01	H5430_001_0	6	5	Specialty Tier	1	3	010010	1	1		110	01			1				30		90	2							30		31											819.00	25		25				819.00	25		25																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5430	001	0	1	01	01	H5430_001_0	6	4	Non-Preferred Brand	1	3	100100	1	1		110	01			1				30		90	2							30		31											83.00	25		25				83.00	25		25																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5430	001	0	1	01	01	H5430_001_0	6	3	Preferred Brand	1	3	000001	1	1		110	01			1				30		90	2							30		31											79.00	25		25				79.00	25		25																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5431	001	0	1	01	01	H5431_001_0	5	4	Non-Preferred Brand	1	4	100000	1	2		010	01			1				30										30		31								50.00							0.00																									50.00				0.00			1.67	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	001	0	1	01	01	H5431_001_0	5	2	Generic	3	4	000100	1	2		010	01			1				30										30		31								10.00							0.00																									10.00				10.00			.33	0.00				.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs										1		
H5431	001	0	1	01	01	H5431_001_0	5	1	Preferred Generic	3	4	001000	1	2		010	01			1				30										30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs										1		
H5431	001	0	1	01	01	H5431_001_0	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	001	0	1	01	01	H5431_001_0	5	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31											1475.04	33						753.68	33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	001	0	1	01	01	H5431_001_0	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	001	0	1	01	01	H5431_001_0	5	2	Generic	1	4	000100	1	2		010	01			1				30										30		31								10.00							0.00																									10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	001	0	1	01	01	H5431_001_0	5	1	Preferred Generic	1	4	001000	1	2		010	01			1				30										30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	006	0	1	01	01	H5431_006_0	6	6	Supplemental Brand and Generic Drugs	1	4	010010	2	2	010		01			1	30													30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	006	0	1	01	01	H5431_006_0	6	3	Preferred Brand	1	4	000001	1	1	010		01			1	30													30		31				63.49	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	006	0	1	01	01	H5431_006_0	6	4	Non-Preferred Brand	1	4	100000	1	1	010		01			1	30													30		31				57.52	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	006	0	1	01	01	H5431_006_0	6	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31				577.31	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	006	0	1	01	01	H5431_006_0	6	2	Generic	1	4	000100	1	1	010		01			1	30													30		31				27.17	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	006	0	1	01	01	H5431_006_0	6	1	Preferred Generic	1	4	001000	1	1	010		01			1	30													30		31				2.75	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	006	0	1	01	01	H5431_006_0	6	6	Supplemental Brand and Generic Drugs	3	4	010010	2	2	010		01			1	30													30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs										1		
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, 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	Generic	3	4	000100	1	2		010	01			1				30										30		31								10.00							0.00																									10.00				10.00			.32	0.00				.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs										1		
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								50.00							0.00																									50.00				0.00			1.61	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	011	0	1	02	01	H5431_011_0	6	2	Generic	1	4	000100	1	2		010	01			1				30										30		31								10.00							0.00																									10.00				10.00			.32	0.00				.32	Preferred Generic, 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, 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, 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											828.14	33						621.39	33																							33			33								Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	012	0	1	01	01	H5431_012_0	6	2	Generic	1	4	000100	1	2		010	01			1				30										30		31								10.00							0.00																									10.00				10.00			.32	0.00				.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
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, 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								50.00							30.00																									50.00				50.00			1.61	.96				1.61	Preferred Generic, 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											823.78	33						616.37	33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
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, 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								25.00							15.00																									25.00				25.00			.80	0.48				.80	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	012	0	1	01	01	H5431_012_0	6	2	Generic	3	4	000100	1	2		010	01			1				30										30		31								10.00							0.00																									10.00				10.00			0.33	0.00				0.32	Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs										1		
H5433	001	0	1	01	01	H5433_001_0	8	2	Brand	1	2	000010	1	1	111		01			1	30	60	90				1							30		31				118.00	25	25	25																																			25			25								Generic, Brand												
H5433	001	0	1	01	01	H5433_001_0	8	1	Generic	1	2	010000	1	2	111		01			1	30	60	90				1							30		31	8.00	16.00	24.00																																					8.00				8.00		0.27						0.26	Generic, Brand												
H5434	002	0	1	04	01	H5434_002_0	6	2	Generic	1	3	000100	1	2		110	01	110		1				31		90	1	31		90				31		31								20.00		60.00					15.00		45.00					15.00		45.00																20.00				15.00			0.65	0.48	0.48			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5434	002	0	1	04	01	H5434_002_0	6	3	Preferred Brand	1	3	010001	1	2		110	01	110		1				31		90	1	31		90				31		31								47.00		141.00					42.00		126.00					42.00		126.00																47.00				42.00			1.52	1.35	1.35			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5434	002	0	1	04	01	H5434_002_0	6	4	Non-Preferred Brand	1	3	110000	1	2		110	01	110		1				31		90	1	31		90				31		31								100.00		300.00					95.00		285.00					95.00		285.00																100.00				95.00			3.23	3.06	3.06			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5434	002	0	1	04	01	H5434_002_0	6	5	Specialty Tier	1	3	110001	1	1		010	01	010		1				31				31						31		31											513.87	26						513.87	26						26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5434	002	0	1	04	01	H5434_002_0	6	1	Preferred Generic	1	3	001000	1	2		110	01	110		1				31		90	1	31		90				31		31								19.00		57.00					14.00		42.00					14.00		42.00																19.00				14.00			0.61	0.45	0.45			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5435	024	0	1	09	04	H5435_024_0	2	4	Non-Preferred Brand	1	3	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5435	024	0	1	09	04	H5435_024_0	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31				553.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5435	024	0	1	09	04	H5435_024_0	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5435	024	0	1	09	04	H5435_024_0	2	2	Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5435	024	0	1	09	04	H5435_024_0	2	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5439	005	0	1	04	01	H5439_005_0	4	3	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5439	005	0	1	04	01	H5439_005_0	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5439	005	0	1	04	01	H5439_005_0	4	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	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5439	005	0	1	04	01	H5439_005_0	4	6	Select Care Drugs	1	4	010010	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	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5439	005	0	1	04	01	H5439_005_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	10.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5439	005	0	1	04	01	H5439_005_0	4	2	Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	30.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5439	007	0	1	04	01	H5439_007_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	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5439	007	0	1	04	01	H5439_007_0	5	4	Non-Preferred Brand	1	4	100100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5439	007	0	1	04	01	H5439_007_0	5	3	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5439	007	0	1	04	01	H5439_007_0	5	2	Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	30.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5439	007	0	1	04	01	H5439_007_0	5	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	10.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5439	007	0	1	04	01	H5439_007_0	5	6	Select Care Drugs	1	4	010010	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	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5441	001	0	1	48	05	H5441_001_0	3	1	Generic Drugs	1	4	010000			110		01	100		1	30		90				1			90				30		31																																														0.00						0.00	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	3	3	Non-Medicare Rx/OTC Drugs	1	4	010010			010		01			1	30													30		31																																														0.00						0.00	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	3	2	Brand Drugs	1	4	000010			110		01	100		1	30		90				1			90				30		31																																														0.00						0.00	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	5	1	Preferred Generic	3	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	001	0	1	01	01	H5471_001_0	5	5	Specialty Tier	1	4	101101	1	1	010		01			1	30													30		31					25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	001	0	1	01	01	H5471_001_0	5	4	Non-Preferred Brand	1	4	100000	1	2	010		01			1	30													30		31	75.00																																							75.00				75.00		2.50						2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	001	0	1	01	01	H5471_001_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	45.00		135.00																					135.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	001	0	1	01	01	H5471_001_0	5	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	001	0	1	01	01	H5471_001_0	5	1	Preferred Generic	1	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	001	0	1	01	01	H5471_001_0	5	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	002	0	1	01	01	H5471_002_0	5	1	Preferred Generic	1	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	002	0	1	01	01	H5471_002_0	5	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	002	0	1	01	01	H5471_002_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	002	0	1	01	01	H5471_002_0	5	4	Non-Preferred Brand	1	4	100000	1	2	010		01			1	30													30		31	15.00																																							15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	002	0	1	01	01	H5471_002_0	5	5	Specialty Tier	1	4	101101	1	1	010		01			1	30													30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	002	0	1	01	01	H5471_002_0	5	1	Preferred Generic	3	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	002	0	1	01	01	H5471_002_0	5	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	004	0	1	01	01	H5471_004_0	5	1	Preferred Generic	3	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	004	0	1	01	01	H5471_004_0	5	5	Specialty Tier	1	4	101101	1	1	010		01			1	30													30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	004	0	1	01	01	H5471_004_0	5	4	Non-Preferred Brand	1	4	100000	1	2	010		01			1	30													30		31	55.00																																							55.00				55.00		1.83						1.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	004	0	1	01	01	H5471_004_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	40.00		120.00																					120.00																40.00				40.00		1.33						1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	004	0	1	01	01	H5471_004_0	5	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	004	0	1	01	01	H5471_004_0	5	1	Preferred Generic	1	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	004	0	1	01	01	H5471_004_0	5	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	007	0	1	01	01	H5471_007_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	45.00		135.00																					135.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	007	0	1	01	01	H5471_007_0	5	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	007	0	1	01	01	H5471_007_0	5	1	Preferred Generic	1	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	007	0	1	01	01	H5471_007_0	5	4	Non-Preferred Brand	1	4	100000	1	2	010		01			1	30													30		31	90.00																																							90.00				90.00		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	007	0	1	01	01	H5471_007_0	5	5	Specialty Tier	1	4	101101	1	1	010		01			1	30													30		31					25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	007	0	1	01	01	H5471_007_0	5	1	Preferred Generic	3	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	007	0	1	01	01	H5471_007_0	5	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	008	0	1	01	01	H5471_008_0	5	3	Preferred Brand	1	4	000001	1	2	110		01			1	30		90				2							30		31	15.00		45.00																																					15.00				15.00		.50						.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	008	0	1	01	01	H5471_008_0	5	2	Generic	1	4	000100	1	2	110		01			1	30		90				2							30		31	10.00		30.00																																					10.00				10.00		.33						.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	008	0	1	01	01	H5471_008_0	5	1	Preferred Generic	1	4	001000	1	2	110		01			1	30		90				2							30		31	5.00		15.00																																					5.00				5.00		.17						.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	008	0	1	01	01	H5471_008_0	5	4	Non-Preferred Brand	1	4	100000	1	2	010		01			1	30													30		31	35.00																																							35.00				35.00		1.17						1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	008	0	1	01	01	H5471_008_0	5	2	Generic	3	4	000100	1	2	110		01			1	30		90				2							30		31	10.00		30.00																																					10.00				10.00		.33						.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	008	0	1	01	01	H5471_008_0	5	1	Preferred Generic	3	4	001000	1	2	110		01			1	30		90				2							30		31	5.00		15.00																																					5.00				5.00		.17						.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	008	0	1	01	01	H5471_008_0	5	5	Specialty Tier	1	4	101101	1	1	010		01			1	30													30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	009	0	1	01	01	H5471_009_0	5	1	Preferred Generic	1	4	001000	3	2	110		01			1	30		90				2							30		31	5.00		15.00																																					5.00				5.00		.17						.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	009	0	1	01	01	H5471_009_0	5	2	Generic	1	4	000100	1	2	110		01			1	30		90				2							30		31	10.00		30.00																																					10.00				10.00		.33						.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	009	0	1	01	01	H5471_009_0	5	3	Preferred Brand	1	4	000001	1	2	110		01			1	30		90				2							30		31	15.00		45.00																																					15.00				15.00		.50						.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	009	0	1	01	01	H5471_009_0	5	1	Preferred Generic	3	4	001000	3	2	110		01			1	30		90				2							30		31	5.00		15.00																																					5.00				5.00		.17						.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	009	0	1	01	01	H5471_009_0	5	5	Specialty Tier	1	4	101101	1	1	010		01			1	30													30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	009	0	1	01	01	H5471_009_0	5	4	Non-Preferred Brand	1	4	100000	1	2	010		01			1	30													30		31	35.00																																							35.00				35.00		1.17						1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	009	0	1	01	01	H5471_009_0	5	2	Generic	3	4	000100	1	2	110		01			1	30		90				2							30		31	10.00		30.00																																					10.00				10.00		.33						.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	012	0	1	01	01	H5471_012_0	5	1	Preferred Generic	1	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	012	0	1	01	01	H5471_012_0	5	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	012	0	1	01	01	H5471_012_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	012	0	1	01	01	H5471_012_0	5	4	Non-Preferred Brand	1	4	100000	1	2	010		01			1	30													30		31	15.00																																							15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	012	0	1	01	01	H5471_012_0	5	4	Non-Preferred Brand	3	4	100000	1	2	010		01			1	30													30		31	15.00																																							15.00				15.00		0.50						.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H5471	012	0	1	01	01	H5471_012_0	5	1	Preferred Generic	3	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	012	0	1	01	01	H5471_012_0	5	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	012	0	1	01	01	H5471_012_0	5	3	Preferred Brand	3	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H5471	012	0	1	01	01	H5471_012_0	5	5	Specialty Tier	1	4	101101	1	1	010		01			1	30													30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	020	0	1	01	01	H5471_020_0	6	1	Preferred Generic	1	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	020	0	1	01	01	H5471_020_0	6	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	020	0	1	01	01	H5471_020_0	6	4	Non-Preferred Brand	3	4	100000	1	2	010		01			1	30													30		31	55.00																																							55.00				55.00		1.83						1.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H5471	020	0	1	01	01	H5471_020_0	6	3	Preferred Brand	3	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	15.00		45.00																					45.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H5471	020	0	1	01	01	H5471_020_0	6	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	020	0	1	01	01	H5471_020_0	6	1	Preferred Generic	3	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	020	0	1	01	01	H5471_020_0	6	5	Specialty Tier	1	4	101101	1	1	010		01			1	30													30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	020	0	1	01	01	H5471_020_0	6	4	Non-Preferred Brand	1	4	100000	1	2	010		01			1	30													30		31	55.00																																							55.00				55.00		1.83						1.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	020	0	1	01	01	H5471_020_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	15.00		45.00																					45.00																15.00				15.00		.50						.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	021	0	1	01	01	H5471_021_0	5	5	Specialty Tier	1	4	101101	1	1	010		01			1	30													30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	021	0	1	01	01	H5471_021_0	5	4	Non-Preferred Brand	1	4	100000	1	2	010		01			1	30													30		31	55.00																																							55.00				55.00		1.83						1.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	021	0	1	01	01	H5471_021_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	15.00		45.00																					45.00																15.00				15.00		.50						.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	021	0	1	01	01	H5471_021_0	5	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	021	0	1	01	01	H5471_021_0	5	1	Preferred Generic	1	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	021	0	1	01	01	H5471_021_0	5	1	Preferred Generic	3	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	021	0	1	01	01	H5471_021_0	5	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	039	0	1	01	01	H5471_039_0	5	5	Specialty Tier	1	4	101101	1	1	010		01			1	30													30		31					25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	039	0	1	01	01	H5471_039_0	5	1	Preferred Generic	3	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	039	0	1	01	01	H5471_039_0	5	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	039	0	1	01	01	H5471_039_0	5	1	Preferred Generic	1	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	039	0	1	01	01	H5471_039_0	5	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	039	0	1	01	01	H5471_039_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	45.00		135.00																					135.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	039	0	1	01	01	H5471_039_0	5	4	Non-Preferred Brand	1	4	100000	1	2	010		01			1	30													30		31	95.00																																							95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	042	0	1	01	01	H5471_042_0	5	1	Preferred Generic	1	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	042	0	1	01	01	H5471_042_0	5	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	5.00		15.00																					15.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	042	0	1	01	01	H5471_042_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	35.00		105.00																					105.00																35.00				35.00		1.17						1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	042	0	1	01	01	H5471_042_0	5	4	Non-Preferred Brand	1	4	100000	1	2	010		01			1	30													30		31	75.00																																							75.00				75.00		2.50						2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	042	0	1	01	01	H5471_042_0	5	4	Non-Preferred Brand	3	4	100000	1	2	010		01			1	30													30		31	75.00																																							75.00				75.00		2.50						2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H5471	042	0	1	01	01	H5471_042_0	5	1	Preferred Generic	3	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	042	0	1	01	01	H5471_042_0	5	2	Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	5.00		15.00																					15.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	042	0	1	01	01	H5471_042_0	5	3	Preferred Brand	3	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	35.00		105.00																					105.00																35.00				35.00		1.17						1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H5471	042	0	1	01	01	H5471_042_0	5	5	Specialty Tier	1	4	101101	1	1	010		01			1	30													30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	043	0	1	01	01	H5471_043_0	5	1	Preferred Generic	1	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	043	0	1	01	01	H5471_043_0	5	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	5.00		15.00																					15.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	043	0	1	01	01	H5471_043_0	5	2	Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	5.00		15.00																					15.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	043	0	1	01	01	H5471_043_0	5	1	Preferred Generic	3	4	001000	3	2	110		01	100		1	30		90				2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	043	0	1	01	01	H5471_043_0	5	5	Specialty Tier	1	4	101101	1	1	010		01			1	30													30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	043	0	1	01	01	H5471_043_0	5	4	Non-Preferred Brand	1	4	100000	1	2	010		01			1	30													30		31	75.00																																							75.00				75.00		2.50						2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	043	0	1	01	01	H5471_043_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	35.00		105.00																					105.00																35.00				35.00		1.17						1.13	Preferred Generic, 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	47.00		141.00																					94.00																47.00				47.00		1.52						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5475	002	0	1	01	01	H5475_002_0	6	2	Generic	1	4	000100	1	2	110		01	100		1	31		90				2			90				31		31	5.00		15.00																					10.00																5.00				5.00		0.16						0.16	Preferred Generic, 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, 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	100.00		300.00																					200.00																100.00				100.00		3.23						3.23	Preferred Generic, 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				198.00	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5508	001	0	1	04	01	H5508_001_0	7	2	Generic	3	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5508	001	0	1	04	01	H5508_001_0	7	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5508	001	0	1	04	01	H5508_001_0	7	6	Select Care Drugs	1	4	010000	1	2	110		01	110		1	30		90				2	30		90				30		31	3.00		9.00																			3.00		6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5508	001	0	1	04	01	H5508_001_0	7	5	Specialty Tier	1	4	000010	1	1	110		01	110		1	30		90				2	30		90				30		31				33.00	33		33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5508	001	0	1	04	01	H5508_001_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				2	30		90				30		31	47.00		141.00																			47.00		94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5508	001	0	1	04	01	H5508_001_0	7	6	Select Care Drugs	3	4	010000	1	2	110		01	110		1	30		90				2	30		90				30		31	3.00		9.00																			3.00		6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5508	001	0	1	04	01	H5508_001_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5508	001	0	1	04	01	H5508_001_0	7	2	Generic	1	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5508	001	0	1	04	01	H5508_001_0	7	4	Non-Preferred Brand	1	4	100000	1	1	110		01	110		1	30		90				2	30		90				30		31				25.00	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5508	005	0	1	04	01	H5508_005_0	7	2	Generic	3	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5508	005	0	1	04	01	H5508_005_0	7	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5508	005	0	1	04	01	H5508_005_0	7	6	Select Care Drugs	1	4	010000	1	2	110		01	110		1	30		90				2	30		90				30		31	3.00		9.00																			3.00		6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5508	005	0	1	04	01	H5508_005_0	7	5	Specialty Tier	1	4	000010	1	1	110		01	110		1	30		90				2	30		90				30		31				33.00	33		33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5508	005	0	1	04	01	H5508_005_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				2	30		90				30		31	47.00		141.00																			47.00		94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5508	005	0	1	04	01	H5508_005_0	7	4	Non-Preferred Brand	1	4	100000	1	1	110		01	110		1	30		90				2	30		90				30		31				25.00	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5508	005	0	1	04	01	H5508_005_0	7	6	Select Care Drugs	3	4	010000	1	2	110		01	110		1	30		90				2	30		90				30		31	3.00		9.00																			3.00		6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5508	005	0	1	04	01	H5508_005_0	7	2	Generic	1	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5508	005	0	1	04	01	H5508_005_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5508	006	0	1	04	01	H5508_006_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5508	006	0	1	04	01	H5508_006_0	5	2	Generic	1	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5508	006	0	1	04	01	H5508_006_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				2	30		90				30		31	47.00		141.00																			47.00		94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5508	006	0	1	04	01	H5508_006_0	5	4	Non-Preferred Brand	1	4	100000	1	1	110		01	110		1	30		90				2	30		90				30		31				25.00	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5508	006	0	1	04	01	H5508_006_0	5	6	Select Care Drugs	3	4	010000	1	2	110		01	110		1	30		90				2	30		90				30		31	3.00		9.00																			3.00		6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5508	006	0	1	04	01	H5508_006_0	5	2	Generic	3	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5508	006	0	1	04	01	H5508_006_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5508	006	0	1	04	01	H5508_006_0	5	6	Select Care Drugs	1	4	010000	1	2	110		01	110		1	30		90				2	30		90				30		31	3.00		9.00																			3.00		6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5508	006	0	1	04	01	H5508_006_0	5	5	Specialty Tier	1	4	000010	1	1	110		01	110		1	30		90				2	30		90				30		31				33.00	33		33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	002	0	1	04	01	H5520_002_0	3	5	Specialty Tier	1	4	010010	1	1		111	01		111	1				30	60	90	1				30	60	90	30		31												31	31	31					31	31	31										31	31	31				31	31	31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	002	0	1	04	01	H5520_002_0	3	4	Non-Preferred Brand	1	4	100100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	225.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	002	0	1	04	01	H5520_002_0	3	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	10.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	002	0	1	04	01	H5520_002_0	3	2	Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	002	0	1	04	01	H5520_002_0	3	3	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	002	0	1	04	01	H5520_002_0	3	6	Select Care Drugs	1	4	010010	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	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	004	0	1	04	01	H5520_004_0	6	5	Specialty Tier	1	4	010010	1	1		111	01		111	1				30	60	90	1				30	60	90	30		31												31	31	31					31	31	31										31	31	31				31	31	31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	004	0	1	04	01	H5520_004_0	6	4	Non-Preferred Brand	1	4	100100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	225.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	004	0	1	04	01	H5520_004_0	6	3	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	004	0	1	04	01	H5520_004_0	6	2	Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	004	0	1	04	01	H5520_004_0	6	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	10.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	004	0	1	04	01	H5520_004_0	6	6	Select Care Drugs	1	4	010010	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	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	1	1	04	01	H5520_012_1	3	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	10.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	1	1	04	01	H5520_012_1	3	2	Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	30.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	1	1	04	01	H5520_012_1	3	3	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	1	1	04	01	H5520_012_1	3	4	Non-Preferred Brand	1	4	100100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	225.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	1	1	04	01	H5520_012_1	3	5	Specialty Tier	1	4	010010	1	1		111	01		111	1				30	60	90	1				30	60	90	30		31												28	28	28					28	28	28										28	28	28				28	28	28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	1	1	04	01	H5520_012_1	3	6	Select Care Drugs	1	4	010010	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	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	2	1	04	01	H5520_012_2	3	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	10.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	2	1	04	01	H5520_012_2	3	2	Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	30.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	2	1	04	01	H5520_012_2	3	3	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	2	1	04	01	H5520_012_2	3	4	Non-Preferred Brand	1	4	100100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	225.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	2	1	04	01	H5520_012_2	3	5	Specialty Tier	1	4	010010	1	1		111	01		111	1				30	60	90	1				30	60	90	30		31												28	28	28					28	28	28										28	28	28				28	28	28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	2	1	04	01	H5520_012_2	3	6	Select Care Drugs	1	4	010010	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	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	3	1	04	01	H5520_012_3	4	4	Non-Preferred Brand	1	4	100100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	225.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	3	1	04	01	H5520_012_3	4	5	Specialty Tier	1	4	010010	1	1		111	01		111	1				30	60	90	1				30	60	90	30		31												28	28	28					28	28	28										28	28	28				28	28	28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	3	1	04	01	H5520_012_3	4	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	10.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	3	1	04	01	H5520_012_3	4	6	Select Care Drugs	1	4	010010	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	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	3	1	04	01	H5520_012_3	4	3	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	3	1	04	01	H5520_012_3	4	2	Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	30.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	4	1	04	01	H5520_012_4	3	4	Non-Preferred Brand	1	4	100100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	225.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	4	1	04	01	H5520_012_4	3	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	10.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	4	1	04	01	H5520_012_4	3	6	Select Care Drugs	1	4	010010	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	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	4	1	04	01	H5520_012_4	3	5	Specialty Tier	1	4	010010	1	1		111	01		111	1				30	60	90	1				30	60	90	30		31												28	28	28					28	28	28										28	28	28				28	28	28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	4	1	04	01	H5520_012_4	3	2	Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	30.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	4	1	04	01	H5520_012_4	3	3	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	014	0	1	04	01	H5520_014_0	5	4	Non-Preferred Brand	1	4	100100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	225.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	014	0	1	04	01	H5520_014_0	5	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	10.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	014	0	1	04	01	H5520_014_0	5	6	Select Care Drugs	1	4	010010	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	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	014	0	1	04	01	H5520_014_0	5	5	Specialty Tier	1	4	010010	1	1		111	01		111	1				30	60	90	1				30	60	90	30		31												28	28	28					28	28	28										28	28	28				28	28	28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	014	0	1	04	01	H5520_014_0	5	2	Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	30.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	014	0	1	04	01	H5520_014_0	5	3	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	015	1	1	04	01	H5520_015_1	5	2	Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	30.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	015	1	1	04	01	H5520_015_1	5	3	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	015	1	1	04	01	H5520_015_1	5	5	Specialty Tier	1	4	010010	1	1		111	01		111	1				30	60	90	1				30	60	90	30		31												29	29	29					29	29	29										29	29	29				29	29	29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	015	1	1	04	01	H5520_015_1	5	4	Non-Preferred Brand	1	4	100100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	225.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	015	1	1	04	01	H5520_015_1	5	6	Select Care Drugs	1	4	010010	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	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	015	1	1	04	01	H5520_015_1	5	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	10.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	015	2	1	04	01	H5520_015_2	5	6	Select Care Drugs	1	4	010010	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	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	015	2	1	04	01	H5520_015_2	5	5	Specialty Tier	1	4	010010	1	1		111	01		111	1				30	60	90	1				30	60	90	30		31												29	29	29					29	29	29										29	29	29				29	29	29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	015	2	1	04	01	H5520_015_2	5	4	Non-Preferred Brand	1	4	100100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	225.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	015	2	1	04	01	H5520_015_2	5	2	Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	30.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	015	2	1	04	01	H5520_015_2	5	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	10.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	015	2	1	04	01	H5520_015_2	5	3	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5521	012	0	1	04	01	H5521_012_0	10	2	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	012	0	1	04	01	H5521_012_0	10	1	Generic	1	4	010010	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								12.00	24.00	30.00					7.00	14.00	17.50					12.00	24.00	30.00																	12.00			12.00			0.40	0.23	0.40			0.39	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	012	0	1	04	01	H5521_012_0	10	3	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											63.10	50	50	50				65.10	50	50	50				50	50	50																50		50								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	012	0	1	04	01	H5521_012_0	10	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												
H5521	013	0	1	04	01	H5521_013_0	4	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					13.00	26.00	39.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.43	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	013	0	1	04	01	H5521_013_0	4	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								12.00	24.00	36.00					5.00	10.00	15.00					12.00	24.00	36.00																	12.00			12.00			0.40	0.17	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	013	0	1	04	01	H5521_013_0	4	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	013	0	1	04	01	H5521_013_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	013	0	1	04	01	H5521_013_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											46.44	50	50	50				44.54	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	015	0	1	04	01	H5521_015_0	7	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					3.00	6.00	9.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.10	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	015	0	1	04	01	H5521_015_0	7	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					12.00	24.00	36.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.40	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	015	0	1	04	01	H5521_015_0	7	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											38.30	50	50	50				35.89	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	015	0	1	04	01	H5521_015_0	7	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	015	0	1	04	01	H5521_015_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	016	0	1	04	01	H5521_016_0	5	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					2.00	4.00	6.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.07	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	016	0	1	04	01	H5521_016_0	5	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					2.00	4.00	6.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.07	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5521	016	0	1	04	01	H5521_016_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	016	0	1	04	01	H5521_016_0	5	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											43.55	50	50	50				42.26	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	016	0	1	04	01	H5521_016_0	5	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	016	0	1	04	01	H5521_016_0	5	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					10.00	20.00	30.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.33	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	020	0	1	04	01	H5521_020_0	6	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31											1.00	29						1.00	29						29																		29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	020	0	1	04	01	H5521_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											43.36	50	50	50				38.27	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	020	0	1	04	01	H5521_020_0	6	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	020	0	1	04	01	H5521_020_0	6	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								12.00	24.00	36.00					7.00	14.00	21.00					12.00	24.00	36.00																	12.00			12.00			0.40	0.23	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	020	0	1	04	01	H5521_020_0	6	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								5.00	10.00	15.00					0.00	0.00	0.00					5.00	10.00	15.00																	5.00			5.00			0.17	0.00	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	022	0	1	04	01	H5521_022_0	8	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								5.00	10.00	15.00					0.00	0.00	0.00					5.00	10.00	15.00																	5.00			5.00			0.17	0.00	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	022	0	1	04	01	H5521_022_0	8	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								12.00	24.00	36.00					7.00	14.00	14.00					12.00	24.00	36.00																	12.00			12.00			0.40	0.23	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	022	0	1	04	01	H5521_022_0	8	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	94.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	022	0	1	04	01	H5521_022_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	022	0	1	04	01	H5521_022_0	8	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											43.32	45	45	45				38.73	45	45	45				45	45	45																45		45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	027	0	1	04	01	H5521_027_0	6	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					3.00	6.00	9.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.10	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	027	0	1	04	01	H5521_027_0	6	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					8.00	16.00	24.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.27	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	027	0	1	04	01	H5521_027_0	6	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	027	0	1	04	01	H5521_027_0	6	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											60.41	50	50	50				57.47	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	027	0	1	04	01	H5521_027_0	6	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	033	0	1	04	01	H5521_033_0	7	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								8.00	16.00	24.00					3.00	6.00	9.00					8.00	16.00	24.00																	8.00			8.00			0.27	0.10	0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	033	0	1	04	01	H5521_033_0	7	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								14.00	28.00	42.00					8.00	16.00	24.00					14.00	28.00	42.00																	14.00			14.00			0.47	0.27	0.47			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	033	0	1	04	01	H5521_033_0	7	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					45.00	90.00	135.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.50	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	033	0	1	04	01	H5521_033_0	7	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											53.93	50	50	50				52.97	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	033	0	1	04	01	H5521_033_0	7	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31											1.00	29						1.00	29						29																		29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	037	0	1	04	01	H5521_037_0	6	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	25.00					0.00	0.00	0.00					10.00	20.00	25.00																	10.00			10.00			0.33	0.00	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	037	0	1	04	01	H5521_037_0	6	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								19.00	38.00	47.50					9.00	18.00	22.50					19.00	38.00	47.50																	19.00			19.00			0.63	0.30	0.63			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	037	0	1	04	01	H5521_037_0	6	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	117.50					47.00	94.00	117.50					47.00	94.00	117.50																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	037	0	1	04	01	H5521_037_0	6	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											50.43	50	50	50				49.76	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	037	0	1	04	01	H5521_037_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	040	0	1	04	01	H5521_040_0	4	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								19.00	38.00	57.00					1.00	2.00	3.00					19.00	38.00	57.00																	19.00			19.00			0.63	0.03	0.63			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	040	0	1	04	01	H5521_040_0	4	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					9.00	18.00	27.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.30	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	040	0	1	04	01	H5521_040_0	4	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31											1.00	29						1.00	29						29																		29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	040	0	1	04	01	H5521_040_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											61.43	50	50	50				58.73	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	040	0	1	04	01	H5521_040_0	4	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								40.00	80.00	120.00					40.00	80.00	120.00					40.00	80.00	120.00																	40.00			40.00			1.33	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	052	0	1	04	01	H5521_052_0	13	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	052	0	1	04	01	H5521_052_0	13	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											46.79	50	50	50				43.72	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	052	0	1	04	01	H5521_052_0	13	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	117.50					47.00	94.00	117.50					47.00	94.00	117.50																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	052	0	1	04	01	H5521_052_0	13	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								12.00	24.00	30.00					7.00	14.00	17.50					12.00	24.00	30.00																	12.00			12.00			0.40	0.23	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	052	0	1	04	01	H5521_052_0	13	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								6.00	12.00	15.00					0.00	0.00	0.00					6.00	12.00	15.00																	6.00			6.00			0.20	0.00	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	052	0	1	04	01	H5521_052_0	13	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								6.00	12.00	15.00					0.00	0.00	0.00					6.00	12.00	15.00																	6.00			6.00			0.13	0.00	0.20			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5521	053	0	1	04	01	H5521_053_0	6	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											41.86	50	50	50				39.31	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	053	0	1	04	01	H5521_053_0	6	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								8.00	16.00	24.00					0.00	0.00	0.00					8.00	16.00	24.00																	8.00			8.00			0.27	0.00	0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	053	0	1	04	01	H5521_053_0	6	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								18.00	36.00	54.00					10.00	20.00	30.00					18.00	36.00	54.00																	18.00			18.00			0.60	0.33	0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	053	0	1	04	01	H5521_053_0	6	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								8.00	16.00	24.00					0.00	0.00	0.00					8.00	16.00	24.00																	8.00			8.00			0.27	0.00	0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5521	053	0	1	04	01	H5521_053_0	6	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	053	0	1	04	01	H5521_053_0	6	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31											1.00	29						1.00	29						29																		29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	055	0	1	04	01	H5521_055_0	7	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											33.07	45	45	45				29.47	45	45	45				45	45	45																45		45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	055	0	1	04	01	H5521_055_0	7	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	94.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	055	0	1	04	01	H5521_055_0	7	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								12.00	24.00	36.00					7.00	14.00	14.00					12.00	24.00	36.00																	12.00			12.00			0.40	0.23	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	055	0	1	04	01	H5521_055_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	055	0	1	04	01	H5521_055_0	7	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								5.00	10.00	15.00					0.00	0.00	0.00					5.00	10.00	15.00																	5.00			5.00			0.17	0.00	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	056	0	1	04	01	H5521_056_0	6	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								8.00	16.00	24.00					0.00	0.00	0.00					8.00	16.00	24.00																	8.00			8.00			0.27	0.00	0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	056	0	1	04	01	H5521_056_0	6	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								18.00	36.00	54.00					10.00	20.00	30.00					18.00	36.00	54.00																	18.00			18.00			0.60	0.33	0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	056	0	1	04	01	H5521_056_0	6	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								8.00	16.00	24.00					0.00	0.00	0.00					8.00	16.00	24.00																	8.00			8.00			0.27	0.00	0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5521	056	0	1	04	01	H5521_056_0	6	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31											1.00	29						1.00	29						29																		29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	056	0	1	04	01	H5521_056_0	6	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											45.21	50	50	50				40.91	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	056	0	1	04	01	H5521_056_0	6	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	057	0	1	04	01	H5521_057_0	8	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								12.00	24.00	36.00					7.00	14.00	14.00					12.00	24.00	36.00																	12.00			12.00			0.40	0.23	0.40			0.39	Preferred Generic, 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								5.00	10.00	15.00					0.00	0.00	0.00					5.00	10.00	15.00																	5.00			5.00			0.17	0.00	0.17			.16	Preferred Generic, 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								47.00	94.00	141.00					47.00	94.00	94.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, 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											45.24	50	50	50				43.32	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand												
H5521	058	0	1	04	01	H5521_058_0	4	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					10.00	20.00	30.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.33	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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								10.00	20.00	30.00					0.00	0.00	0.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.00	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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								47.00	94.00	141.00					42.00	84.00	126.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.40	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	058	0	1	04	01	H5521_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	058	0	1	04	01	H5521_058_0	4	4	Non-Preferred Brand	1	4	110000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	059	0	1	04	01	H5521_059_0	4	4	Non-Preferred Brand	1	4	110000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	059	0	1	04	01	H5521_059_0	4	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					42.00	84.00	126.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.40	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	059	0	1	04	01	H5521_059_0	4	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					0.00	0.00	0.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.00	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	059	0	1	04	01	H5521_059_0	4	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					10.00	20.00	30.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.33	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	059	0	1	04	01	H5521_059_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	060	0	1	04	01	H5521_060_0	5	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					0.00	0.00	0.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.00	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	060	0	1	04	01	H5521_060_0	5	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					10.00	20.00	30.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.33	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	060	0	1	04	01	H5521_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	060	0	1	04	01	H5521_060_0	5	4	Non-Preferred Brand	1	4	110000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	060	0	1	04	01	H5521_060_0	5	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					42.00	84.00	126.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.40	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	076	0	1	04	01	H5521_076_0	4	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								16.00	32.00	48.00					10.00	20.00	30.00					16.00	32.00	48.00																	16.00			16.00			0.53	0.33	0.53			0.52	Preferred Generic, 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	30						1.00	30						30																		30		30								Preferred Generic, 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											41.69	50	50	50				38.21	50	50	50				50	50	50																50		50								Preferred Generic, 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								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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								13.00	26.00	39.00					5.00	10.00	15.00					13.00	26.00	39.00																	13.00			13.00			0.43	0.17	0.43			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	077	0	1	04	01	H5521_077_0	4	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					10.00	20.00	30.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.33	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	077	0	1	04	01	H5521_077_0	4	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								15.00	30.00	45.00					3.00	6.00	9.00					15.00	30.00	45.00																	15.00			15.00			0.50	0.10	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	077	0	1	04	01	H5521_077_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	077	0	1	04	01	H5521_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											47.50	50	50	50				42.25	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	077	0	1	04	01	H5521_077_0	4	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	081	0	1	04	01	H5521_081_0	6	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								8.00	16.00	24.00					3.00	6.00	9.00					8.00	16.00	24.00																	8.00			8.00			0.27	0.10	0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	081	0	1	04	01	H5521_081_0	6	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					15.00	30.00	45.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.50	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	081	0	1	04	01	H5521_081_0	6	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	081	0	1	04	01	H5521_081_0	6	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											55.25	50	50	50				49.53	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	081	0	1	04	01	H5521_081_0	6	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31											1.00	29						1.00	29						29																		29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	082	0	1	04	01	H5521_082_0	5	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					3.00	6.00	9.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.10	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	082	0	1	04	01	H5521_082_0	5	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					9.00	18.00	27.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.30	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	082	0	1	04	01	H5521_082_0	5	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	082	0	1	04	01	H5521_082_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	082	0	1	04	01	H5521_082_0	5	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											37.69	50	50	50				35.70	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	083	0	1	04	01	H5521_083_0	5	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	083	0	1	04	01	H5521_083_0	5	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					9.00	18.00	27.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.30	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	083	0	1	04	01	H5521_083_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	083	0	1	04	01	H5521_083_0	5	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											35.98	50	50	50				33.90	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	083	0	1	04	01	H5521_083_0	5	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					3.00	6.00	9.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.10	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	084	0	1	04	01	H5521_084_0	7	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	084	0	1	04	01	H5521_084_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	084	0	1	04	01	H5521_084_0	7	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					3.00	6.00	9.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.10	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	084	0	1	04	01	H5521_084_0	7	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					9.00	18.00	27.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.30	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	084	0	1	04	01	H5521_084_0	7	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											39.04	50	50	50				37.17	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	085	0	1	04	01	H5521_085_0	4	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					12.00	24.00	36.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.40	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	085	0	1	04	01	H5521_085_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											41.13	50	50	50				40.14	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	085	0	1	04	01	H5521_085_0	4	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	085	0	1	04	01	H5521_085_0	4	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31											1.00	29						1.00	29						29																		29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	085	0	1	04	01	H5521_085_0	4	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								5.00	10.00	15.00					0.00	0.00	0.00					5.00	10.00	15.00																	5.00			5.00			0.17	0.00	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	086	0	1	04	01	H5521_086_0	7	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					4.00	8.00	12.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.13	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5521	086	0	1	04	01	H5521_086_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	086	0	1	04	01	H5521_086_0	7	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											35.09	50	50	50				32.78	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	086	0	1	04	01	H5521_086_0	7	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					10.00	20.00	30.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.33	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	086	0	1	04	01	H5521_086_0	7	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					4.00	8.00	12.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.13	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	086	0	1	04	01	H5521_086_0	7	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, 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								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	087	0	1	04	01	H5521_087_0	4	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								16.00	32.00	48.00					10.00	20.00	30.00					16.00	32.00	48.00																	16.00			16.00			0.53	0.33	0.53			0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	29						1.00	29						29																		29		29								Preferred Generic, 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	2		111	10	111		1				30	60	90	1	30	60	90					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, 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								5.00	10.00	15.00					0.00	0.00	0.00					5.00	10.00	15.00																	5.00			5.00			0.17	0.00	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	088	0	1	04	01	H5521_088_0	4	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								14.00	28.00	42.00					9.00	18.00	27.00					14.00	28.00	42.00																	14.00			14.00			0.47	0.30	0.47			0.45	Preferred Generic, 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								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, 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	29						1.00	29						29																		29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	088	0	1	04	01	H5521_088_0	4	4	Non-Preferred Brand	1	4	110000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, 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								5.00	10.00	15.00					0.00	0.00	0.00					5.00	10.00	15.00																	5.00			5.00			0.17	0.00	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	28						1.00	28						28																		28		28								Preferred Generic, 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	2		111	10	111		1				30	60	90	1	30	60	90					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, 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								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, 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								7.00	14.00	21.00					0.00	0.00	0.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.00	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	089	0	1	04	01	H5521_089_0	4	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								19.00	38.00	57.00					12.00	24.00	36.00					19.00	38.00	57.00																	19.00			19.00			0.63	0.40	0.63			0.61	Preferred Generic, 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	29						1.00	29						29																		29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	090	0	1	04	01	H5521_090_0	4	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								17.00	34.00	51.00					12.00	24.00	36.00					17.00	34.00	51.00																	17.00			17.00			0.57	0.40	0.57			0.55	Preferred Generic, 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								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, 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											42.10	50	50	50				38.52	50	50	50				50	50	50																50		50								Preferred Generic, 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								6.00	12.00	18.00					0.00	0.00	0.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.00	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	091	0	1	04	01	H5521_091_0	8	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											56.92	50	50	50				51.34	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	091	0	1	04	01	H5521_091_0	8	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					4.00	8.00	12.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.13	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	091	0	1	04	01	H5521_091_0	8	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					15.00	30.00	45.00					20.00	40.00	60.00																	20.00			20.00			.67	.50	.67			.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	091	0	1	04	01	H5521_091_0	8	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	091	0	1	04	01	H5521_091_0	8	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31											1.00	29						1.00	29						29																		29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	092	0	1	04	01	H5521_092_0	6	1	Generic	3	4	010010	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					0.00	0.00	0.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.00	0.33			0.32	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5521	092	0	1	04	01	H5521_092_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												
H5521	092	0	1	04	01	H5521_092_0	6	1	Generic	1	4	010010	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					0.00	0.00	0.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.00	0.33			0.32	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	092	0	1	04	01	H5521_092_0	6	2	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					10.00	20.00	30.00					47.00	94.00	141.00																	47.00			47.00			1.57	0.33	1.57			1.52	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	092	0	1	04	01	H5521_092_0	6	3	Non-Preferred Brand	1	4	110000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	093	0	1	04	01	H5521_093_0	7	1	Generic	1	4	010010	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					0.00	0.00	0.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.00	0.33			0.32	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	093	0	1	04	01	H5521_093_0	7	2	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					10.00	20.00	30.00					47.00	94.00	141.00																	47.00			47.00			1.57	0.33	1.57			1.52	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	093	0	1	04	01	H5521_093_0	7	3	Non-Preferred Brand	1	4	110000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	093	0	1	04	01	H5521_093_0	7	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												
H5521	093	0	1	04	01	H5521_093_0	7	1	Generic	3	4	010010	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					0.00	0.00	0.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.00	0.33			0.32	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5521	094	0	1	04	01	H5521_094_0	6	1	Generic	1	4	010010	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					0.00	0.00	0.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.00	0.33			0.32	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	094	0	1	04	01	H5521_094_0	6	2	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					10.00	20.00	30.00					47.00	94.00	141.00																	47.00			47.00			1.57	0.33	1.57			1.52	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	094	0	1	04	01	H5521_094_0	6	3	Non-Preferred Brand	1	4	110000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	094	0	1	04	01	H5521_094_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												
H5521	094	0	1	04	01	H5521_094_0	6	1	Generic	3	4	010010	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					0.00	0.00	0.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.00	0.33			0.32	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5521	095	0	1	04	01	H5521_095_0	4	1	Preferred Generic	1	3	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								11.00	22.00	27.50					4.00	8.00	10.00					11.00	22.00	27.50																	11.00			11.00			0.37	0.13	0.37			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	095	0	1	04	01	H5521_095_0	4	2	Generic	1	3	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								19.00	38.00	47.50					14.00	28.00	35.00					19.00	38.00	47.50																	19.00			19.00			0.63	0.47	0.63			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	095	0	1	04	01	H5521_095_0	4	3	Preferred Brand	1	3	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	095	0	1	04	01	H5521_095_0	4	4	Non-Preferred Brand	1	3	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											36.52	50	50	50				35.68	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	095	0	1	04	01	H5521_095_0	4	5	Specialty Tier	1	3	010010	1	1		010	10	010		1				30				30							10	31											1.00	33						1.00	33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	098	0	1	04	01	H5521_098_0	4	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								15.00	30.00	45.00					5.00	10.00	15.00					15.00	30.00	45.00																	15.00			15.00			0.50	0.17	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	098	0	1	04	01	H5521_098_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	098	0	1	04	01	H5521_098_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											42.47	50	50	50				40.04	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	098	0	1	04	01	H5521_098_0	4	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	098	0	1	04	01	H5521_098_0	4	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					10.00	20.00	30.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.33	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	099	0	1	04	01	H5521_099_0	5	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					4.00	8.00	12.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.13	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	099	0	1	04	01	H5521_099_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	099	0	1	04	01	H5521_099_0	5	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											39.28	50	50	50				36.95	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	099	0	1	04	01	H5521_099_0	5	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	099	0	1	04	01	H5521_099_0	5	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					10.00	20.00	30.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.33	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	099	0	1	04	01	H5521_099_0	5	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					4.00	8.00	12.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.13	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5521	100	0	1	04	01	H5521_100_0	6	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								12.00	24.00	36.00					7.00	14.00	14.00					12.00	24.00	36.00																	12.00			12.00			0.40	0.23	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand												
H5521	100	0	1	04	01	H5521_100_0	6	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								5.00	10.00	15.00					0.00	0.00	0.00					5.00	10.00	15.00																	5.00			5.00			0.17	0.00	0.17			.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand												
H5521	100	0	1	04	01	H5521_100_0	6	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	94.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand												
H5521	100	0	1	04	01	H5521_100_0	6	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											43.06	50	50	50				41.35	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand												
H5521	101	0	1	04	01	H5521_101_0	5	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								12.00	24.00	36.00					7.00	14.00	14.00					12.00	24.00	36.00																	12.00			12.00			0.40	0.23	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	101	0	1	04	01	H5521_101_0	5	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								5.00	10.00	15.00					0.00	0.00	0.00					5.00	10.00	15.00																	5.00			5.00			0.17	0.00	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	101	0	1	04	01	H5521_101_0	5	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	94.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	101	0	1	04	01	H5521_101_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	101	0	1	04	01	H5521_101_0	5	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											42.06	50	50	50				39.80	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	102	0	1	04	01	H5521_102_0	4	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					3.00	6.00	9.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.10	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	102	0	1	04	01	H5521_102_0	4	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					9.00	18.00	27.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.30	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	102	0	1	04	01	H5521_102_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											39.26	50	50	50				37.18	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	102	0	1	04	01	H5521_102_0	4	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	102	0	1	04	01	H5521_102_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	103	0	1	04	01	H5521_103_0	7	4	Non-Preferred Brand	1	4	110000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	103	0	1	04	01	H5521_103_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	103	0	1	04	01	H5521_103_0	7	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					0.00	0.00	0.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.00	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	103	0	1	04	01	H5521_103_0	7	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					10.00	20.00	30.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.33	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	103	0	1	04	01	H5521_103_0	7	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					42.00	84.00	126.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.40	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	104	0	1	04	01	H5521_104_0	8	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					10.00	20.00	30.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.33	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	104	0	1	04	01	H5521_104_0	8	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					42.00	84.00	126.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.40	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	104	0	1	04	01	H5521_104_0	8	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					0.00	0.00	0.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.00	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	104	0	1	04	01	H5521_104_0	8	4	Non-Preferred Brand	1	4	110000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	104	0	1	04	01	H5521_104_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	105	0	1	04	01	H5521_105_0	8	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					10.00	20.00	30.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.33	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	105	0	1	04	01	H5521_105_0	8	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					0.00	0.00	0.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.00	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	105	0	1	04	01	H5521_105_0	8	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					42.00	84.00	126.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.40	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	105	0	1	04	01	H5521_105_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	105	0	1	04	01	H5521_105_0	8	4	Non-Preferred Brand	1	4	110000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	106	0	1	04	01	H5521_106_0	8	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					0.00	0.00	0.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.00	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	106	0	1	04	01	H5521_106_0	8	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					10.00	20.00	30.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.33	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	106	0	1	04	01	H5521_106_0	8	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					42.00	84.00	126.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.40	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	106	0	1	04	01	H5521_106_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	106	0	1	04	01	H5521_106_0	8	4	Non-Preferred Brand	1	4	110000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	106	0	1	04	01	H5521_106_0	8	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					0.00	0.00	0.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.00	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5521	107	0	1	04	01	H5521_107_0	5	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					42.00	84.00	126.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.40	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	107	0	1	04	01	H5521_107_0	5	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					10.00	20.00	30.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.33	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	107	0	1	04	01	H5521_107_0	5	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					0.00	0.00	0.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.00	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	107	0	1	04	01	H5521_107_0	5	4	Non-Preferred Brand	1	4	110000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	107	0	1	04	01	H5521_107_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	108	0	1	04	01	H5521_108_0	9	4	Non-Preferred Brand	1	4	110000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	108	0	1	04	01	H5521_108_0	9	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					42.00	84.00	126.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.40	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	108	0	1	04	01	H5521_108_0	9	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					10.00	20.00	30.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.33	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	108	0	1	04	01	H5521_108_0	9	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					0.00	0.00	0.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.00	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	108	0	1	04	01	H5521_108_0	9	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					0.00	0.00	0.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.00	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5521	108	0	1	04	01	H5521_108_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	109	0	1	04	01	H5521_109_0	5	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					10.00	20.00	30.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.33	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	109	0	1	04	01	H5521_109_0	5	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					42.00	84.00	126.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.40	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	109	0	1	04	01	H5521_109_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	109	0	1	04	01	H5521_109_0	5	4	Non-Preferred Brand	1	4	110000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	109	0	1	04	01	H5521_109_0	5	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					0.00	0.00	0.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.00	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	110	0	1	04	01	H5521_110_0	6	5	Specialty Tier	1	3	010010	1	1		010	10	010		1				30				30							10	31											1.00	28						1.00	28						28																		28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	110	0	1	04	01	H5521_110_0	6	3	Preferred Brand	1	3	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	110	0	1	04	01	H5521_110_0	6	4	Non-Preferred Brand	1	3	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											45.75	50	50	50				43.49	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	110	0	1	04	01	H5521_110_0	6	2	Generic	1	3	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					10.00	20.00	30.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.33	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	110	0	1	04	01	H5521_110_0	6	1	Preferred Generic	1	3	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								15.00	30.00	45.00					1.00	2.00	3.00					15.00	30.00	45.00																	15.00			15.00			0.50	0.03	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	111	0	1	04	01	H5521_111_0	5	2	Generic	1	3	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								18.00	36.00	54.00					8.00	16.00	24.00					18.00	36.00	54.00																	18.00			18.00			0.60	0.27	0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	111	0	1	04	01	H5521_111_0	5	1	Preferred Generic	1	3	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					2.00	4.00	6.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.07	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	111	0	1	04	01	H5521_111_0	5	5	Specialty Tier	1	3	010010	1	1		010	10	010		1				30				30							10	31											1.00	28						1.00	28						28																		28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	111	0	1	04	01	H5521_111_0	5	4	Non-Preferred Brand	1	3	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											46.36	50	50	50				44.07	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	111	0	1	04	01	H5521_111_0	5	3	Preferred Brand	1	3	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	112	0	1	04	01	H5521_112_0	4	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31											1.00	27						1.00	27						27																		27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	112	0	1	04	01	H5521_112_0	4	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								8.00	16.00	24.00					2.00	4.00	6.00					8.00	16.00	24.00																	8.00			8.00			0.27	0.07	0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	112	0	1	04	01	H5521_112_0	4	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	112	0	1	04	01	H5521_112_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											46.56	50	50	50				44.26	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	112	0	1	04	01	H5521_112_0	4	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								15.00	30.00	45.00					8.00	16.00	24.00					15.00	30.00	45.00																	15.00			15.00			0.50	0.27	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	113	0	1	04	01	H5521_113_0	4	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								8.00	16.00	24.00					1.00	2.00	3.00					8.00	16.00	24.00																	8.00			8.00			0.27	0.03	0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	113	0	1	04	01	H5521_113_0	4	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								15.00	30.00	45.00					7.00	14.00	21.00					15.00	30.00	45.00																	15.00			15.00			0.50	0.23	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	113	0	1	04	01	H5521_113_0	4	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	113	0	1	04	01	H5521_113_0	4	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31											1.00	26						1.00	26						26																		26		26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5521	113	0	1	04	01	H5521_113_0	4	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											47.96	50	50	50				45.59	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	001	0	1	04	01	H5522_001_0	7	2	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	001	0	1	04	01	H5522_001_0	7	3	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											42.34	50	50	50				36.79	50	50	50				50	50	50																50		50								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	001	0	1	04	01	H5522_001_0	7	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												
H5522	001	0	1	04	01	H5522_001_0	7	1	Generic	1	4	010010	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								15.00	30.00	37.50					5.00	10.00	12.50					15.00	30.00	37.50																	15.00			15.00			0.50	0.17	0.50			0.48	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	002	0	1	04	01	H5522_002_0	6	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	25.00					4.00	8.00	10.00					10.00	20.00	25.00																	10.00			10.00			0.33	0.13	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	002	0	1	04	01	H5522_002_0	6	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	117.50					47.00	94.00	117.50					47.00	94.00	117.50																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	002	0	1	04	01	H5522_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											52.67	50	50	50				46.08	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	002	0	1	04	01	H5522_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	002	0	1	04	01	H5522_002_0	6	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	25.00					4.00	8.00	10.00					10.00	20.00	25.00																	10.00			10.00			0.33	0.13	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5522	002	0	1	04	01	H5522_002_0	6	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								18.00	36.00	45.00					10.00	20.00	25.00					18.00	36.00	45.00																	18.00			18.00			0.60	0.33	0.60			0.58	Preferred Generic, 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, 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											51.04	50	50	50				47.50	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	004	0	1	04	01	H5522_004_0	3	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	50.00					15.00	30.00	37.50					20.00	40.00	50.00																	20.00			20.00			0.67	0.50	0.67			0.65	Preferred Generic, 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								15.00	30.00	37.50					9.00	18.00	22.50					15.00	30.00	37.50																	15.00			15.00			0.50	0.30	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	005	0	1	04	01	H5522_005_0	3	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					10.00	20.00	30.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.33	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	005	0	1	04	01	H5522_005_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	005	0	1	04	01	H5522_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											53.79	50	50	50				47.40	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	005	0	1	04	01	H5522_005_0	3	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								17.00	34.00	51.00					5.00	10.00	15.00					17.00	34.00	51.00																	17.00			17.00			0.57	0.17	0.57			0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	005	0	1	04	01	H5522_005_0	3	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	013	0	1	04	01	H5522_013_0	5	2	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	013	0	1	04	01	H5522_013_0	5	3	Non-Preferred Brand	1	4	110000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	013	0	1	04	01	H5522_013_0	5	1	Generic	1	4	010010	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	50.00					4.00	8.00	10.00					20.00	40.00	50.00																	20.00			20.00			0.67	0.13	0.67			0.65	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	013	0	1	04	01	H5522_013_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												
H5522	014	0	1	04	01	H5522_014_0	6	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								19.00	38.00	47.50					5.00	10.00	12.50					19.00	38.00	47.50																	19.00			19.00			0.63	0.17	0.63			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	014	0	1	04	01	H5522_014_0	6	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	50.00					11.00	22.00	27.50					20.00	40.00	50.00																	20.00			20.00			0.67	0.37	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	014	0	1	04	01	H5522_014_0	6	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	014	0	1	04	01	H5522_014_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	014	0	1	04	01	H5522_014_0	6	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											43.26	50	50	50				38.10	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	015	0	1	04	01	H5522_015_0	8	2	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	015	0	1	04	01	H5522_015_0	8	3	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											44.25	50	50	50				36.57	50	50	50				50	50	50																50		50								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	015	0	1	04	01	H5522_015_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												
H5522	015	0	1	04	01	H5522_015_0	8	1	Generic	1	4	010010	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	50.00					2.00	4.00	5.00					20.00	40.00	50.00																	20.00			20.00			0.67	0.07	0.67			0.65	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	017	0	1	04	01	H5522_017_0	3	4	Non-Preferred Brand	1	4	110000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	017	0	1	04	01	H5522_017_0	3	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								15.00	30.00	45.00					8.00	16.00	24.00					15.00	30.00	45.00																	15.00			15.00			0.50	0.27	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	017	0	1	04	01	H5522_017_0	3	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					15.00	30.00	45.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.50	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	017	0	1	04	01	H5522_017_0	3	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	017	0	1	04	01	H5522_017_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, 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								16.00	32.00	40.00					9.00	18.00	22.50					16.00	32.00	40.00																	16.00			16.00			0.53	0.30	0.53			0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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, 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								16.00	32.00	40.00					9.00	18.00	22.50					16.00	32.00	40.00																	16.00			16.00			0.53	0.30	0.53			0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5522	018	0	1	04	01	H5522_018_0	3	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	50.00					15.00	30.00	37.50					20.00	40.00	50.00																	20.00			20.00			0.67	0.50	0.67			0.65	Preferred Generic, 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								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, 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	2		111	10	111		1				30	60	90	1	30	60	90					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, 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, 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	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	004	0	1	04	01	H5525_004_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, 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, 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	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5525	004	0	1	04	01	H5525_004_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, 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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	005	0	1	04	01	H5525_005_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5525	005	0	1	04	01	H5525_005_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	006	0	1	04	01	H5525_006_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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, 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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	006	0	1	04	01	H5525_006_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5525	007	0	1	04	01	H5525_007_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	007	0	1	04	01	H5525_007_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5525	008	0	1	04	01	H5525_008_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, 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, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	008	0	1	04	01	H5525_008_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, 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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	009	0	1	04	01	H5525_009_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5525	009	0	1	04	01	H5525_009_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	015	0	1	04	01	H5525_015_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	11.00		33.00																									11.00		33.00				11.00		0.00				11.00				11.00		0.36				0.36	0.36	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5525	015	0	1	04	01	H5525_015_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	11.00		33.00																									11.00		33.00				11.00		0.00				11.00				11.00		0.36				0.36	0.36	0.35	Preferred Generic, 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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	017	0	1	04	01	H5525_017_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, 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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5525	017	0	1	04	01	H5525_017_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, 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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5525	020	0	1	04	01	H5525_020_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	020	0	1	04	01	H5525_020_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, 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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	021	0	1	04	01	H5525_021_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5525	021	0	1	04	01	H5525_021_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5525	021	0	1	04	01	H5525_021_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5525	021	0	1	04	01	H5525_021_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5525	021	0	1	04	01	H5525_021_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	021	0	1	04	01	H5525_021_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	021	0	1	04	01	H5525_021_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	021	0	1	04	01	H5525_021_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	021	0	1	04	01	H5525_021_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	021	0	1	04	01	H5525_021_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5525	022	0	1	04	01	H5525_022_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	022	0	1	04	01	H5525_022_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	022	0	1	04	01	H5525_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5525	022	0	1	04	01	H5525_022_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5525	022	0	1	04	01	H5525_022_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5525	022	0	1	04	01	H5525_022_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5525	022	0	1	04	01	H5525_022_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5525	022	0	1	04	01	H5525_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	022	0	1	04	01	H5525_022_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	022	0	1	04	01	H5525_022_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	023	0	1	04	01	H5525_023_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	023	0	1	04	01	H5525_023_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5525	023	0	1	04	01	H5525_023_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5525	023	0	1	04	01	H5525_023_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5525	023	0	1	04	01	H5525_023_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5525	023	0	1	04	01	H5525_023_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	023	0	1	04	01	H5525_023_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	023	0	1	04	01	H5525_023_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	023	0	1	04	01	H5525_023_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	023	0	1	04	01	H5525_023_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5525	024	0	1	04	01	H5525_024_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	024	0	1	04	01	H5525_024_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	024	0	1	04	01	H5525_024_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	024	0	1	04	01	H5525_024_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	024	0	1	04	01	H5525_024_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	024	0	1	04	01	H5525_024_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5525	024	0	1	04	01	H5525_024_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5525	024	0	1	04	01	H5525_024_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5525	024	0	1	04	01	H5525_024_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5525	024	0	1	04	01	H5525_024_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5525	025	0	1	04	01	H5525_025_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5525	025	0	1	04	01	H5525_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5525	025	0	1	04	01	H5525_025_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5525	025	0	1	04	01	H5525_025_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5525	025	0	1	04	01	H5525_025_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5525	025	0	1	04	01	H5525_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	025	0	1	04	01	H5525_025_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	025	0	1	04	01	H5525_025_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	025	0	1	04	01	H5525_025_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	025	0	1	04	01	H5525_025_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	026	0	1	04	01	H5525_026_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5525	026	0	1	04	01	H5525_026_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	026	0	1	04	01	H5525_026_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	18.00		54.00																									18.00		54.00				18.00		0.00				18.00				18.00		0.60				0.60	0.60	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	026	0	1	04	01	H5525_026_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	026	0	1	04	01	H5525_026_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	026	0	1	04	01	H5525_026_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	026	0	1	04	01	H5525_026_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5525	026	0	1	04	01	H5525_026_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5525	026	0	1	04	01	H5525_026_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5525	026	0	1	04	01	H5525_026_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	18.00		54.00																									18.00		54.00				18.00		0.00				18.00				18.00		0.60				0.60	0.60	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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, 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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	027	0	1	04	01	H5525_027_0	3	2	Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		0.00				12.00				12.00		0.40				0.40	0.40	0.38	Preferred Generic, 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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	030	0	1	04	01	H5525_030_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5525	030	0	1	04	01	H5525_030_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5525	030	0	1	04	01	H5525_030_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5525	030	0	1	04	01	H5525_030_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5525	030	0	1	04	01	H5525_030_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	1.00		3.00																									1.00		3.00				1.00		0.00				1.00				1.00		0.03				0.03	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	030	0	1	04	01	H5525_030_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	030	0	1	04	01	H5525_030_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	030	0	1	04	01	H5525_030_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	030	0	1	04	01	H5525_030_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5525	030	0	1	04	01	H5525_030_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	1.00		3.00																									1.00		3.00				1.00		0.00				1.00				1.00		0.03				0.03	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5526	004	0	1	04	01	H5526_004_0	4	1	Preferred Generic	1	4	001000	1	2		110	10	110		1				30		90	2	30		90					29	31								10.00		30.00					5.00		15.00					5.00		12.50																	10.00			10.00			0.33	0.17	0.17			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5526	004	0	1	04	01	H5526_004_0	4	2	Generic	1	4	000100	1	2		110	10	110		1				30		90	2	30		90					29	31								20.00		60.00					15.00		45.00					15.00		37.50																	20.00			20.00			0.67	0.50	0.50			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5526	004	0	1	04	01	H5526_004_0	4	3	Preferred Brand	1	4	000001	1	2		110	10	110		1				30		90	2	30		90					29	31								47.00		141.00					42.00		126.00					42.00		105.00																	47.00			47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5526	004	0	1	04	01	H5526_004_0	4	4	Non-Preferred Brand	1	4	100000	1	2		110	10	110		1				30		90	2	30		90					29	31								100.00		300.00					94.00		282.00					94.00		235.00																	100.00			100.00			3.33	3.13	3.13			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5526	004	0	1	04	01	H5526_004_0	4	5	Specialty Tier	1	4	010010	1	1		110	10	110		1				30		90	2	30		90					29	31												33		33					33		33				33		33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5526	014	0	1	04	01	H5526_014_0	4	4	Non-Preferred Brand	1	4	100000	1	2		110	10	110		1				30		90	2	30		90					29	31								100.00		300.00					94.00		282.00					94.00		235.00																	100.00			100.00			3.33	3.13	3.13			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5526	014	0	1	04	01	H5526_014_0	4	3	Preferred Brand	1	4	000001	1	2		110	10	110		1				30		90	2	30		90					29	31								47.00		141.00					42.00		126.00					42.00		105.00																	47.00			47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5526	014	0	1	04	01	H5526_014_0	4	2	Generic	1	4	000100	1	2		110	10	110		1				30		90	2	30		90					29	31								20.00		60.00					15.00		45.00					15.00		37.50																	20.00			20.00			0.67	0.50	0.50			.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5526	014	0	1	04	01	H5526_014_0	4	1	Preferred Generic	1	4	001000	1	2		110	10	110		1				30		90	2	30		90					29	31								10.00		30.00					5.00		15.00					5.00		12.50																	10.00			10.00			0.33	0.17	0.17			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5526	014	0	1	04	01	H5526_014_0	4	5	Specialty Tier	1	4	010010	1	1		110	10	110		1				30		90	2	30		90					29	31												33		33					33		33				33		33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5526	016	0	1	04	01	H5526_016_0	4	1	Preferred Generic	1	4	001000	1	2		110	10	110		1				30		90	2	30		90					29	31								12.00		36.00					7.00		21.00					7.00		17.50																	12.00			12.00			0.40	0.23	0.23			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5526	016	0	1	04	01	H5526_016_0	4	2	Generic	1	4	000100	1	2		110	10	110		1				30		90	2	30		90					29	31								20.00		60.00					15.00		45.00					15.00		37.50																	20.00			20.00			0.67	0.50	.50			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5526	016	0	1	04	01	H5526_016_0	4	3	Preferred Brand	1	4	000001	1	2		110	10	110		1				30		90	2	30		90					29	31								47.00		141.00					42.00		126.00					42.00		105.00																	47.00			47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5526	016	0	1	04	01	H5526_016_0	4	4	Non-Preferred Brand	1	4	100000	1	2		110	10	110		1				30		90	2	30		90					29	31								100.00		300.00					94.00		282.00					94.00		235.00																	100.00			100.00			3.33	3.13	3.13			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5526	016	0	1	04	01	H5526_016_0	4	5	Specialty Tier	1	4	010010	1	1		110	10	110		1				30		90	2	30		90					29	31												33		33					33		33				33		33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5526	017	0	1	04	01	H5526_017_0	5	1	Preferred Generic	1	4	001000	1	2		110	10	110		1				30		90	2	30		90					29	31								12.00		36.00					7.00		21.00					7.00		17.50																	12.00			12.00			0.40	0.23	0.23			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5526	017	0	1	04	01	H5526_017_0	5	2	Generic	1	4	000100	1	2		110	10	110		1				30		90	2	30		90					29	31								20.00		60.00					15.00		45.00					15.00		37.50																	20.00			20.00			0.67	0.50	.50			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5526	017	0	1	04	01	H5526_017_0	5	3	Preferred Brand	1	4	000001	1	2		110	10	110		1				30		90	2	30		90					29	31								47.00		141.00					42.00		126.00					42.00		105.00																	47.00			47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5526	017	0	1	04	01	H5526_017_0	5	4	Non-Preferred Brand	1	4	100000	1	2		110	10	110		1				30		90	2	30		90					29	31								100.00		300.00					94.00		282.00					94.00		235.00																	100.00			100.00			3.33	3.13	3.13			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5526	017	0	1	04	01	H5526_017_0	5	5	Specialty Tier	1	4	010010	1	1		110	10	110		1				30		90	2	30		90					29	31												33		33					33		33				33		33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	018	0	1	04	01	H5528_018_0	5	4	Non-Preferred Brand	1	2	100000	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31				92.65	30	30	30																		30	30	30															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	018	0	1	04	01	H5528_018_0	5	3	Preferred Brand	1	2	000001	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31				55.70	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	018	0	1	04	01	H5528_018_0	5	2	Generic	1	2	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	9.00	18.00	27.00																			9.00	18.00	27.00																9.00				9.00		0.30			0.30			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	018	0	1	04	01	H5528_018_0	5	1	Preferred Generic	1	2	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	6.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	018	0	1	04	01	H5528_018_0	5	5	Specialty Tier	1	2	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31				774.45	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	022	0	1	04	01	H5528_022_0	6	1	Preferred Generic	1	3	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	022	0	1	04	01	H5528_022_0	6	2	Generic	1	3	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	45.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	022	0	1	04	01	H5528_022_0	6	3	Preferred Brand	1	3	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	022	0	1	04	01	H5528_022_0	6	4	Non-Preferred Brand	1	3	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	022	0	1	04	01	H5528_022_0	6	5	Specialty Tier	1	3	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31				709.81	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	023	0	1	04	01	H5528_023_0	5	2	Generic	1	3	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	45.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	023	0	1	04	01	H5528_023_0	5	1	Preferred Generic	1	3	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	023	0	1	04	01	H5528_023_0	5	3	Preferred Brand	1	3	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	023	0	1	04	01	H5528_023_0	5	5	Specialty Tier	1	3	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31				730.32	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	023	0	1	04	01	H5528_023_0	5	4	Non-Preferred Brand	1	3	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	024	0	1	04	01	H5528_024_0	5	1	Preferred Generic	1	3	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	024	0	1	04	01	H5528_024_0	5	2	Generic	1	3	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	45.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	024	0	1	04	01	H5528_024_0	5	3	Preferred Brand	1	3	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	024	0	1	04	01	H5528_024_0	5	4	Non-Preferred Brand	1	3	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	024	0	1	04	01	H5528_024_0	5	5	Specialty Tier	1	3	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31				777.12	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	025	0	1	04	01	H5528_025_0	6	5	Specialty Tier	1	3	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31				788.13	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	025	0	1	04	01	H5528_025_0	6	3	Preferred Brand	1	3	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	025	0	1	04	01	H5528_025_0	6	4	Non-Preferred Brand	1	3	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	025	0	1	04	01	H5528_025_0	6	2	Generic	1	3	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	45.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	025	0	1	04	01	H5528_025_0	6	1	Preferred Generic	1	3	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	026	0	1	04	01	H5528_026_0	5	2	Generic	1	3	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	45.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	026	0	1	04	01	H5528_026_0	5	1	Preferred Generic	1	3	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	026	0	1	04	01	H5528_026_0	5	3	Preferred Brand	1	3	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	026	0	1	04	01	H5528_026_0	5	5	Specialty Tier	1	3	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31				806.33	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5528	026	0	1	04	01	H5528_026_0	5	4	Non-Preferred Brand	1	3	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5530	006	1	1	04	01	H5530_006_1	10	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5530	006	1	1	04	01	H5530_006_1	10	2	Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5530	006	1	1	04	01	H5530_006_1	10	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5530	006	1	1	04	01	H5530_006_1	10	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								94.00	188.00	282.00					89.00	178.00	267.00					89.00	267.00	267.00																94.00				94.00			3.13	2.97	2.97			2.76	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5530	006	1	1	04	01	H5530_006_1	10	5	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34											1431.04	33						1431.04	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5530	006	1	1	04	01	H5530_006_1	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5530	006	2	1	04	01	H5530_006_2	10	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5530	006	2	1	04	01	H5530_006_2	10	2	Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5530	006	2	1	04	01	H5530_006_2	10	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5530	006	2	1	04	01	H5530_006_2	10	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								94.00	188.00	282.00					89.00	178.00	267.00					89.00	267.00	267.00																94.00				94.00			3.13	2.97	2.97			2.76	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5530	006	2	1	04	01	H5530_006_2	10	5	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34											1431.04	33						1431.04	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5530	006	2	1	04	01	H5530_006_2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5533	003	0	1	04	01	H5533_003_0	9	1	Generic	1	4	010000	1	2	110		01	100		1	30		90				1			90				30		31	14.00		42.00																					28.00																14.00				14.00		0.47						0.45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5533	003	0	1	04	01	H5533_003_0	9	2	Preferred Brand	1	4	010001	1	2	110		01	100		1	30		90				1			90				30		31	47.00		141.00																					117.50																47.00				47.00		1.57						1.52	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5533	003	0	1	04	01	H5533_003_0	9	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	003	0	1	04	01	H5533_003_0	9	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				604.68	33																				33																	33			33								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5533	003	0	1	04	01	H5533_003_0	9	3	Non-Preferred Brand	1	4	110000	1	2	110		01	100		1	30		90				1			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5533	005	0	1	04	01	H5533_005_0	9	1	Generic	1	4	010000	1	2	110		01	100		1	30		90				1			90				30		31	12.00		36.00																					24.00																12.00				12.00		0.40						0.39	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5533	005	0	1	04	01	H5533_005_0	9	2	Preferred Brand	1	4	010001	1	2	110		01	100		1	30		90				1			90				30		31	47.00		141.00																					117.50																47.00				47.00		1.57						1.52	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5533	005	0	1	04	01	H5533_005_0	9	3	Non-Preferred Brand	1	4	110000	1	2	110		01	100		1	30		90				1			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5533	005	0	1	04	01	H5533_005_0	9	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				800.87	33																				33																	33			33								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5533	005	0	1	04	01	H5533_005_0	9	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	006	0	1	04	01	H5533_006_0	9	1	Generic	1	4	010000	1	2	110		01	100		1	30		90				1			90				30		31	14.00		42.00																					28.00																14.00				14.00		0.47						0.45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5533	006	0	1	04	01	H5533_006_0	9	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				601.55	33																				33																	33			33								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5533	006	0	1	04	01	H5533_006_0	9	3	Non-Preferred Brand	1	4	110000	1	2	110		01	100		1	30		90				1			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5533	006	0	1	04	01	H5533_006_0	9	2	Preferred Brand	1	4	010001	1	2	110		01	100		1	30		90				1			90				30		31	47.00		141.00																					117.50																47.00				47.00		1.57						1.52	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5533	006	0	1	04	01	H5533_006_0	9	5	Select Care Drugs	1	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	8	5	Specialty Tier	1	4	100000	1	1	110		01	100		1	30		90				2			90				30		31				400.11	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5549	004	0	1	01	01	H5549_004_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5549	004	0	1	01	01	H5549_004_0	8	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	95.00		285.00																					285.00																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5549	004	0	1	01	01	H5549_004_0	8	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	45.00		135.00																					135.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5549	004	0	1	01	01	H5549_004_0	8	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	9.00		27.00																					27.00																9.00				9.00		.30						.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5549	009	0	1	02	01	H5549_009_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5549	009	0	1	02	01	H5549_009_0	10	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	9.00		27.00																					27.00																9.00				9.00		.30						.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5549	009	0	1	02	01	H5549_009_0	10	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	45.00		135.00																					135.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5549	009	0	1	02	01	H5549_009_0	10	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	95.00		285.00																					285.00																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5549	009	0	1	02	01	H5549_009_0	10	5	Specialty Tier	1	4	100000	1	1	110		01	100		1	30		90				2			90				30		31				400.11	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	012	0	1	02	01	H5576_012_0	9	2	Generic	1	4	000100	1	2	110		01		100	1	31		90				1						90	31		31	10.00		30.00																											30.00						30.00				10.00				10.00		0.32						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	012	0	1	02	01	H5576_012_0	9	5	Specialty Tier	1	4	100000	1	1	010		01		010	1	31										31			31		31				1263.62	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	012	0	1	02	01	H5576_012_0	9	4	Non-Preferred Brand	1	4	100000	1	2	110		01		100	1	31		90				1						90	31		31	100.00		300.00																											300.00						300.00				100.00				100.00		3.23						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	012	0	1	02	01	H5576_012_0	9	3	Preferred Brand	1	4	000001	1	2	110		01		100	1	31		90				1						90	31		31	47.00		141.00																											141.00						141.00				47.00				47.00		1.52						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	012	0	1	02	01	H5576_012_0	9	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	31		90				1						90	31		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	016	1	1	02	01	H5576_016_1	9	1	Preferred Generic	3	4	001000	1	2	110		01		100	1	31		90				1						90	31		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5576	016	1	1	02	01	H5576_016_1	9	5	Specialty Tier	1	4	100000	1	1	010		01		010	1	31										31			31		31				803.31	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	016	1	1	02	01	H5576_016_1	9	4	Non-Preferred Brand	1	4	100000	1	2	110		01		100	1	31		90				1						90	31		31	100.00		300.00																											300.00						300.00				100.00				100.00		3.23						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	016	1	1	02	01	H5576_016_1	9	3	Preferred Brand	1	4	000001	1	2	110		01		100	1	31		90				1						90	31		31	47.00		141.00																											141.00						141.00				47.00				47.00		1.52						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	016	1	1	02	01	H5576_016_1	9	2	Generic	1	4	000100	1	2	110		01		100	1	31		90				1						90	31		31	10.00		30.00																											30.00						30.00				10.00				10.00		0.32						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	016	1	1	02	01	H5576_016_1	9	2	Generic	3	4	000100	1	2	110		01		100	1	31		90				1						90	31		31	10.00		30.00																											30.00						30.00				10.00				10.00		0.32						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5576	016	1	1	02	01	H5576_016_1	9	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	31		90				1						90	31		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	016	2	1	02	01	H5576_016_2	9	2	Generic	1	4	000100	1	2	110		01		100	1	31		90				1						90	31		31	10.00		30.00																											30.00						30.00				10.00				10.00		0.32						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	016	2	1	02	01	H5576_016_2	9	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	31		90				1						90	31		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	016	2	1	02	01	H5576_016_2	9	2	Generic	3	4	000100	1	2	110		01		100	1	31		90				1						90	31		31	10.00		30.00																											30.00						30.00				10.00				10.00		0.32						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5576	016	2	1	02	01	H5576_016_2	9	1	Preferred Generic	3	4	001000	1	2	110		01		100	1	31		90				1						90	31		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5576	016	2	1	02	01	H5576_016_2	9	5	Specialty Tier	1	4	100000	1	1	010		01		010	1	31										31			31		31				803.31	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	016	2	1	02	01	H5576_016_2	9	4	Non-Preferred Brand	1	4	100000	1	2	110		01		100	1	31		90				1						90	31		31	100.00		300.00																											300.00						300.00				100.00				100.00		3.23						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	016	2	1	02	01	H5576_016_2	9	3	Preferred Brand	1	4	000001	1	2	110		01		100	1	31		90				1						90	31		31	47.00		141.00																											141.00						141.00				47.00				47.00		1.52						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	017	1	1	02	01	H5576_017_1	10	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	31		90				1						90	31		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	017	1	1	02	01	H5576_017_1	10	5	Specialty Tier	1	4	100000	1	1	010		01		010	1	31										31			31		31				991.19	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	017	1	1	02	01	H5576_017_1	10	4	Non-Preferred Brand	1	4	100000	1	2	110		01		100	1	31		90				1						90	31		31	100.00		300.00																											300.00						300.00				100.00				100.00		3.23						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	017	1	1	02	01	H5576_017_1	10	2	Generic	1	4	000100	1	2	110		01		100	1	31		90				1						90	31		31	10.00		30.00																											30.00						30.00				10.00				10.00		0.32						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	017	1	1	02	01	H5576_017_1	10	3	Preferred Brand	1	4	000001	1	2	110		01		100	1	31		90				1						90	31		31	47.00		141.00																											141.00						141.00				47.00				47.00		1.52						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	017	2	1	02	01	H5576_017_2	10	5	Specialty Tier	1	4	100000	1	1	010		01		010	1	31										31			31		31				991.19	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	017	2	1	02	01	H5576_017_2	10	4	Non-Preferred Brand	1	4	100000	1	2	110		01		100	1	31		90				1						90	31		31	100.00		300.00																											300.00						300.00				100.00				100.00		3.23						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	017	2	1	02	01	H5576_017_2	10	2	Generic	1	4	000100	1	2	110		01		100	1	31		90				1						90	31		31	10.00		30.00																											30.00						30.00				10.00				10.00		0.32						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	017	2	1	02	01	H5576_017_2	10	3	Preferred Brand	1	4	000001	1	2	110		01		100	1	31		90				1						90	31		31	47.00		141.00																											141.00						141.00				47.00				47.00		1.52						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	017	2	1	02	01	H5576_017_2	10	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	31		90				1						90	31		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	018	1	1	02	01	H5576_018_1	9	4	Non-Preferred Brand	1	4	100000	1	2	110		01		100	1	31		90				1						90	31		31	100.00		300.00																											300.00						300.00				100.00				100.00		3.23						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	018	1	1	02	01	H5576_018_1	9	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	31		90				1						90	31		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	018	1	1	02	01	H5576_018_1	9	3	Preferred Brand	1	4	000001	1	2	110		01		100	1	31		90				1						90	31		31	47.00		141.00																											141.00						141.00				47.00				47.00		1.52						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	018	1	1	02	01	H5576_018_1	9	2	Generic	1	4	000100	1	2	110		01		100	1	31		90				1						90	31		31	10.00		30.00																											30.00						30.00				10.00				10.00		0.32						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	018	1	1	02	01	H5576_018_1	9	1	Preferred Generic	3	4	001000	1	2	110		01		100	1	31		90				1						90	31		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5576	018	1	1	02	01	H5576_018_1	9	5	Specialty Tier	1	4	100000	1	1	010		01		010	1	31										31			31		31				1052.21	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	018	2	1	02	01	H5576_018_2	9	1	Preferred Generic	3	4	001000	1	2	110		01		100	1	31		90				1						90	31		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5576	018	2	1	02	01	H5576_018_2	9	5	Specialty Tier	1	4	100000	1	1	010		01		010	1	31										31			31		31				1052.21	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	018	2	1	02	01	H5576_018_2	9	4	Non-Preferred Brand	1	4	100000	1	2	110		01		100	1	31		90				1						90	31		31	100.00		300.00																											300.00						300.00				100.00				100.00		3.23						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	018	2	1	02	01	H5576_018_2	9	3	Preferred Brand	1	4	000001	1	2	110		01		100	1	31		90				1						90	31		31	47.00		141.00																											141.00						141.00				47.00				47.00		1.52						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	018	2	1	02	01	H5576_018_2	9	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	31		90				1						90	31		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	018	2	1	02	01	H5576_018_2	9	2	Generic	1	4	000100	1	2	110		01		100	1	31		90				1						90	31		31	10.00		30.00																											30.00						30.00				10.00				10.00		0.32						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5577	005	0	1	01	01	H5577_005_0	8	1	Generic	3	4	010000	1	2	110		01	110		1	30		90				1	30		90				30		31	4.00		12.00																			4.00		8.00																4.00				4.00		0.13			0.13			0.13	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5577	005	0	1	01	01	H5577_005_0	8	4	Specialty Tier	1	4	110001	1	1	010		01	010		1	30							30						30		31					33																				33																	33			33								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5577	005	0	1	01	01	H5577_005_0	8	3	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	50.00		150.00																			50.00		100.00																50.00				50.00		1.67			1.67			1.61	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5577	005	0	1	01	01	H5577_005_0	8	2	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				1	30		90				30		31	30.00		90.00																			30.00		60.00																30.00				30.00		1.00			1.00			0.97	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5577	005	0	1	01	01	H5577_005_0	8	1	Generic	1	4	010000	1	2	110		01	110		1	30		90				1	30		90				30		31	4.00		12.00																			4.00		8.00																4.00				4.00		0.13			0.13			0.13	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5577	008	0	1	02	01	H5577_008_0	10	1	Generic	3	4	010000	1	2	110		01	110		1	30		90				1	30		90				30		31	4.00		12.00																			4.00		8.00																4.00				4.00		0.13			0.13			0.13	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5577	008	0	1	02	01	H5577_008_0	10	4	Specialty Tier	1	4	110001	1	1	010		01	010		1	30							30						30		31					33																				33																	33			33								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5577	008	0	1	02	01	H5577_008_0	10	1	Generic	1	4	010000	1	2	110		01	110		1	30		90				1	30		90				30		31	4.00		12.00																			4.00		8.00																4.00				4.00		0.13			0.13			0.13	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5577	008	0	1	02	01	H5577_008_0	10	2	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				1	30		90				30		31	30.00		90.00																			30.00		60.00																30.00				30.00		1.00			1.00			0.97	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5577	008	0	1	02	01	H5577_008_0	10	3	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	55.00		165.00																			55.00		110.00																55.00				55.00		1.83			1.83			1.77	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5577	015	0	1	02	01	H5577_015_0	7	2	Generic	3	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5577	015	0	1	02	01	H5577_015_0	7	5	Specialty Tier	1	4	101101	1	1	010		01	010		1	30							30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5577	015	0	1	02	01	H5577_015_0	7	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	30.00		90.00																			30.00		60.00																30.00				30.00		1.00			1.00			0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5577	015	0	1	02	01	H5577_015_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				1	30		90				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5577	015	0	1	02	01	H5577_015_0	7	2	Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5577	015	0	1	02	01	H5577_015_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	3.00		9.00																			3.00		6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5577	015	0	1	02	01	H5577_015_0	7	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	3.00		9.00																			3.00		6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5591	001	0	1	02	01	H5591_001_0	8	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					47.00	94.00	117.50																47.00				47.00			1.50	1.33	1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5591	001	0	1	02	01	H5591_001_0	8	2	Generic	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								15.00	30.00	45.00					8.00	16.00	24.00					15.00	30.00	37.50																15.00				15.00			0.33	0.20	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5591	001	0	1	02	01	H5591_001_0	8	1	Preferred Generic	1	4	001001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					4.00	8.00	10.00																4.00				4.00			0.13	0.00	0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5591	001	0	1	02	01	H5591_001_0	8	5	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											600.00	33	33	33				600.00	33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5591	001	0	1	02	01	H5591_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								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	250.00																100.00				100.00			3.17	3.00	3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5591	005	0	1	02	01	H5591_005_0	8	1	Preferred Generic	1	4	001001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					4.00	8.00	10.00																4.00				4.00			0.13	0.00	0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5591	005	0	1	02	01	H5591_005_0	8	2	Generic	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								15.00	30.00	45.00					8.00	16.00	24.00					15.00	30.00	37.50																15.00				15.00			0.33	0.20	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5591	005	0	1	02	01	H5591_005_0	8	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					47.00	94.00	117.50																47.00				47.00			1.50	1.33	1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5591	005	0	1	02	01	H5591_005_0	8	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	250.00																100.00				100.00			3.17	3.00	3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5591	005	0	1	02	01	H5591_005_0	8	5	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											600.00	33	33	33				600.00	33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5591	006	1	1	02	01	H5591_006_1	8	5	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											600.00	33	33	33				600.00	33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5591	006	1	1	02	01	H5591_006_1	8	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					47.00	94.00	117.50																47.00				47.00			1.50	1.33	1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5591	006	1	1	02	01	H5591_006_1	8	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	250.00																100.00				100.00			3.17	3.00	3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5591	006	1	1	02	01	H5591_006_1	8	2	Generic	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								15.00	30.00	45.00					8.00	16.00	24.00					15.00	30.00	37.50																15.00				15.00			0.33	0.20	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5591	006	1	1	02	01	H5591_006_1	8	1	Preferred Generic	1	4	001001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					4.00	8.00	10.00																4.00				4.00			0.13	0.00	0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5591	006	2	1	02	01	H5591_006_2	8	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	250.00																100.00				100.00			3.17	3.00	3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5591	006	2	1	02	01	H5591_006_2	8	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					47.00	94.00	117.50																47.00				47.00			1.50	1.33	1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5591	006	2	1	02	01	H5591_006_2	8	2	Generic	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								15.00	30.00	45.00					8.00	16.00	24.00					15.00	30.00	37.50																15.00				15.00			0.33	0.20	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5591	006	2	1	02	01	H5591_006_2	8	1	Preferred Generic	1	4	001001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					4.00	8.00	10.00																4.00				4.00			0.13	0.00	0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5591	006	2	1	02	01	H5591_006_2	8	5	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											600.00	33	33	33				600.00	33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5591	007	0	1	01	01	H5591_007_0	10	1	Preferred Generic	3	4	001001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					4.00	8.00	10.00																4.00				4.00			0.13	0.00	0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5591	007	0	1	01	01	H5591_007_0	10	5	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											600.00	33	33	33				600.00	33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5591	007	0	1	01	01	H5591_007_0	10	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	250.00																100.00				100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5591	007	0	1	01	01	H5591_007_0	10	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					47.00	94.00	117.50																47.00				47.00			1.57	1.33	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5591	007	0	1	01	01	H5591_007_0	10	1	Preferred Generic	1	4	001001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					4.00	8.00	10.00																4.00				4.00			0.13	0.00	0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5591	007	0	1	01	01	H5591_007_0	10	2	Generic	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								15.00	30.00	45.00					8.00	16.00	24.00					15.00	30.00	37.50																15.00				15.00			0.50	0.27	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5591	007	0	1	01	01	H5591_007_0	10	2	Generic	3	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								15.00	30.00	45.00					8.00	16.00	24.00					15.00	30.00	37.50																15.00				15.00			0.50	0.27	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5591	008	0	1	01	01	H5591_008_0	9	1	Preferred Generic	1	4	001001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					4.00	8.00	10.00																4.00				4.00			0.13	0.00	0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5591	008	0	1	01	01	H5591_008_0	9	2	Generic	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								15.00	30.00	45.00					8.00	16.00	24.00					15.00	30.00	37.50																15.00				15.00			0.33	0.20	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5591	008	0	1	01	01	H5591_008_0	9	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					47.00	94.00	117.50																47.00				47.00			1.50	1.33	1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5591	008	0	1	01	01	H5591_008_0	9	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	250.00																100.00				100.00			3.17	3.00	3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5591	008	0	1	01	01	H5591_008_0	9	5	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											600.00	33	33	33				600.00	33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5591	009	0	1	01	01	H5591_009_0	9	1	Preferred Generic	1	4	001001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					4.00	8.00	10.00																4.00				4.00			0.13	0.00	0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5591	009	0	1	01	01	H5591_009_0	9	2	Generic	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								15.00	30.00	45.00					8.00	16.00	24.00					15.00	30.00	37.50																15.00				15.00			0.33	0.20	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5591	009	0	1	01	01	H5591_009_0	9	5	Specialty Tier	1	4	010010	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											600.00	33	33	33				600.00	33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5591	009	0	1	01	01	H5591_009_0	9	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	250.00																100.00				100.00			3.17	3.00	3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5591	009	0	1	01	01	H5591_009_0	9	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					47.00	94.00	117.50																47.00				47.00			1.50	1.33	1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	001	0	1	01	01	H5594_001_0	7	3	Non-Preferred Brand	1	4	100100	3	2	110		01	110		1	30		90				1	30		90				30		31	85.00		255.00																			85.00		170.00																85.00				85.00		2.83			2.83			2.74	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	001	0	1	01	01	H5594_001_0	7	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	35.00		105.00																			35.00		70.00																35.00				35.00		1.17			1.17			1.13	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	001	0	1	01	01	H5594_001_0	7	1	Generic	1	4	001000	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	001	0	1	01	01	H5594_001_0	7	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31				1125.02	33		33																		33		33															33			33								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	002	0	1	01	01	H5594_002_0	8	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	002	0	1	01	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	69.00		207.00																			69.00		138.00																69.00				69.00		2.30			2.30			2.23	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	002	0	1	01	01	H5594_002_0	8	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31				990.13	33		33																		33		33															33			33								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	002	0	1	01	01	H5594_002_0	8	1	Generic	3	4	001000	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5594	002	0	1	01	01	H5594_002_0	8	1	Generic	1	4	001000	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	016	0	1	01	01	H5594_016_0	7	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	45.00		135.00																			45.00		135.00																45.00				45.00		1.50			1.50			1.45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	016	0	1	01	01	H5594_016_0	7	3	Non-Preferred Brand	1	4	100100	3	2	110		01	110		1	30		90				1	30		90				30		31	95.00		285.00																			95.00		285.00																95.00				95.00		3.17			3.17			3.06	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	016	0	1	01	01	H5594_016_0	7	1	Generic	1	4	001000	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	016	0	1	01	01	H5594_016_0	7	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31				756.57	25		25																		25		25															25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	017	0	1	01	01	H5594_017_0	7	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	45.00		135.00																			45.00		135.00																45.00				45.00		1.50			1.50			1.45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	017	0	1	01	01	H5594_017_0	7	1	Generic	1	4	001000	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	017	0	1	01	01	H5594_017_0	7	3	Non-Preferred Brand	1	4	100100	3	2	110		01	110		1	30		90				1	30		90				30		31	95.00		285.00																			95.00		285.00																95.00				95.00		3.17			3.17			3.06	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	017	0	1	01	01	H5594_017_0	7	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31				554.24	25		25																		25		25															25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	019	0	1	01	01	H5594_019_0	8	1	Generic	1	4	001000	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	019	0	1	01	01	H5594_019_0	8	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	40.00		120.00																			40.00		80.00																40.00				40.00		1.33			1.33			1.29	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	019	0	1	01	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	85.00		255.00																			85.00		170.00																85.00				85.00		2.83			2.83			2.74	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	019	0	1	01	01	H5594_019_0	8	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31				989.03	33		33																		33		33															33			33								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	019	0	1	01	01	H5594_019_0	8	1	Generic	3	4	001000	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5594	022	0	1	01	01	H5594_022_0	8	1	Generic	1	4	001000	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	022	0	1	01	01	H5594_022_0	8	1	Generic	3	4	001000	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5594	022	0	1	01	01	H5594_022_0	8	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31				1571.23	33		33																		33		33															33			33								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	022	0	1	01	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	95.00		285.00																			95.00		190.00																95.00				95.00		3.17			3.17			3.06	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	022	0	1	01	01	H5594_022_0	8	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	40.00		120.00																			40.00		80.00																40.00				40.00		1.33			1.33			1.29	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	026	0	1	01	01	H5594_026_0	8	1	Generic	1	4	001000	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	026	0	1	01	01	H5594_026_0	8	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	40.00		120.00																			40.00		80.00																40.00				40.00		1.33			1.33			1.29	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	026	0	1	01	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	95.00		285.00																			95.00		190.00																95.00				95.00		3.17			3.17			3.06	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	026	0	1	01	01	H5594_026_0	8	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31				1081.50	33		33																		33		33															33			33								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	026	0	1	01	01	H5594_026_0	8	1	Generic	3	4	001000	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5594	028	0	1	01	01	H5594_028_0	8	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	20.00		60.00																			20.00		40.00																20.00				20.00		0.67			0.67			0.65	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	028	0	1	01	01	H5594_028_0	8	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31				1043.46	33		33																		33		33															33			33								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	028	0	1	01	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	60.00		180.00																			60.00		120.00																60.00				60.00		2.00			2.00			1.94	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	028	0	1	01	01	H5594_028_0	8	1	Generic	1	4	001000	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	028	0	1	01	01	H5594_028_0	8	1	Generic	3	4	001000	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5594	029	0	1	01	01	H5594_029_0	8	1	Generic	3	4	001000	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5594	029	0	1	01	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	69.00		207.00																			69.00		138.00																69.00				69.00		2.30			2.30			2.23	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	029	0	1	01	01	H5594_029_0	8	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31				1110.72	33		33																		33		33															33			33								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	029	0	1	01	01	H5594_029_0	8	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	25.00		75.00																			25.00		50.00																25.00				25.00		0.83			0.83			0.81	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	029	0	1	01	01	H5594_029_0	8	1	Generic	1	4	001000	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	030	0	1	01	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	80.00		240.00																			80.00		160.00																80.00				80.00		2.67			2.67			2.58	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	030	0	1	01	01	H5594_030_0	8	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	35.00		105.00																			35.00		70.00																35.00				35.00		1.17			1.17			1.13	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	030	0	1	01	01	H5594_030_0	8	1	Generic	1	4	001000	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	030	0	1	01	01	H5594_030_0	8	1	Generic	3	4	001000	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5594	030	0	1	01	01	H5594_030_0	8	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31				1257.36	33		33																		33		33															33			33								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	031	0	1	01	01	H5594_031_0	8	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31				1293.27	33		33																		33		33															33			33								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	031	0	1	01	01	H5594_031_0	8	3	Non-Preferred Brand	1	4	100100	3	2	110		01	110		1	30		90				1	30		90				30		31	80.00		240.00																			80.00		160.00																80.00				80.00		2.67			2.67			2.58	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	031	0	1	01	01	H5594_031_0	8	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	35.00		105.00																			35.00		70.00																35.00				35.00		1.17			1.17			1.13	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	031	0	1	01	01	H5594_031_0	8	1	Generic	1	4	001000	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	031	0	1	01	01	H5594_031_0	8	1	Generic	3	4	001000	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5594	032	0	1	01	01	H5594_032_0	8	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	25.00		75.00																			25.00		50.00																25.00				25.00		0.83			0.83			0.81	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	032	0	1	01	01	H5594_032_0	8	1	Generic	1	4	001000	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	032	0	1	01	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	60.00		180.00																			60.00		120.00																60.00				60.00		2.00			2.00			1.94	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	032	0	1	01	01	H5594_032_0	8	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31				1111.61	33		33																		33		33															33			33								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	032	0	1	01	01	H5594_032_0	8	1	Generic	3	4	001000	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5594	034	0	1	01	01	H5594_034_0	7	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	35.00		105.00																			35.00		70.00																35.00				35.00		1.17			1.17			1.13	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	034	0	1	01	01	H5594_034_0	7	1	Generic	1	4	001000	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	034	0	1	01	01	H5594_034_0	7	3	Non-Preferred Brand	1	4	100100	3	2	110		01	110		1	30		90				1	30		90				30		31	80.00		240.00																			80.00		160.00																80.00				80.00		2.67			2.67			2.58	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	034	0	1	01	01	H5594_034_0	7	1	Generic	3	4	001000	3	2	110		01	110		1	30		90				1	30		90				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.17			0.17			0.16	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5594	034	0	1	01	01	H5594_034_0	7	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31				816.00	33		33																		33		33															33			33								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	035	0	1	01	01	H5594_035_0	7	1	Generic	1	4	001000	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	035	0	1	01	01	H5594_035_0	7	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	35.00		105.00																			35.00		70.00																35.00				35.00		1.17			1.17			1.13	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	035	0	1	01	01	H5594_035_0	7	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31				1109.52	33		33																		33		33															33			33								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	035	0	1	01	01	H5594_035_0	7	3	Non-Preferred Brand	1	4	100100	3	2	110		01	110		1	30		90				1	30		90				30		31	80.00		240.00																			80.00		160.00																80.00				80.00		2.67			2.67			2.58	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5594	035	0	1	01	01	H5594_035_0	7	1	Generic	3	4	001000	3	2	110		01	110		1	30		90				1	30		90				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.17			0.17			0.16	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5608	002	0	1	01	01	H5608_002_0	8	4	Non-Preferred Brand	1	3	100000	1	2	111		10	100		1	30	60	90				1			90					10	31	95.00	190.00	190.00																					190.00																	95.00			95.00		3.16						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5608	002	0	1	01	01	H5608_002_0	8	3	Preferred Brand	1	3	000001	1	2	111		10	100		1	30	60	90				1			90					10	31	45.00	90.00	90.00																					90.00																	45.00			45.00		1.45						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5608	002	0	1	01	01	H5608_002_0	8	2	Generic	1	3	000100	1	2	111		10	100		1	30	60	90				1			90					10	31	8.00	16.00	16.00																					16.00																	8.00			8.00		0.26						.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5608	002	0	1	01	01	H5608_002_0	8	1	Preferred Generic	1	3	001000	1	2	111		10	100		1	30	60	90				1			90					10	31	3.00	6.00	6.00																					6.00																	3.00			3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5608	002	0	1	01	01	H5608_002_0	8	5	Specialty Tier	1	3	000010	1	1	111		10	100		1	30	60	90				1			90					10	31				223.02	28	28	28																				28																28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5609	001	0	1	01	01	H5609_001_0	8	4	Non-Preferred Brand	1	4	110000	1	2		111	01	100		1				30	60	90	1			90				30		31								95.00	190.00	285.00					95.00	190.00	190.00							190.00																95.00				95.00			3.17	3.17				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5609	001	0	1	01	01	H5609_001_0	8	3	Preferred Brand	1	4	010001	1	2		111	01	100		1				30	60	90	1			90				30		31								47.00	94.00	141.00					47.00	94.00	94.00							94.00																47.00				47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5609	001	0	1	01	01	H5609_001_0	8	2	Generic	1	4	000100	1	2		111	01	100		1				30	60	90	1			90				30		31								15.00	30.00	45.00					15.00	30.00	30.00							30.00																15.00				15.00			0.50	0.50				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5609	001	0	1	01	01	H5609_001_0	8	1	Preferred Generic	1	4	001000	1	2		111	01	100		1				30	60	90	1			90				30		31								5.00	10.00	15.00					5.00	10.00	10.00							10.00																5.00				5.00			0.17	0.17				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5609	001	0	1	01	01	H5609_001_0	8	5	Injectable Drugs	1	4	010010	1	1		111	01	100		1				30	60	90	1			90				30		31											55.36	25	25	25				55.36	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5609	001	0	1	01	01	H5609_001_0	8	1	Preferred Generic	3	4	001000	1	2		111	01	100		1				30	60	90	1			90				30		31								5.00	10.00	15.00					5.00	10.00	10.00							10.00																5.00				5.00			0.17	0.17				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
H5609	001	0	1	01	01	H5609_001_0	8	6	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5609	004	0	1	01	01	H5609_004_0	8	1	Preferred Generic	1	4	001000	1	2		111	01	100		1				30	60	90	1			90				30		31								5.00	10.00	15.00					5.00	10.00	10.00							10.00																5.00				5.00			0.17	0.17				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5609	004	0	1	01	01	H5609_004_0	8	2	Generic	1	4	000100	1	2		111	01	100		1				30	60	90	1			90				30		31								15.00	30.00	45.00					15.00	30.00	30.00							30.00																15.00				15.00			0.50	0.50				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5609	004	0	1	01	01	H5609_004_0	8	3	Preferred Brand	1	4	010001	1	2		111	01	100		1				30	60	90	1			90				30		31								47.00	94.00	141.00					47.00	94.00	94.00							94.00																47.00				47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5609	004	0	1	01	01	H5609_004_0	8	4	Non-Preferred Brand	1	4	110000	1	2		111	01	100		1				30	60	90	1			90				30		31								95.00	190.00	285.00					95.00	190.00	190.00							190.00																95.00				95.00			3.17	3.17				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5609	004	0	1	01	01	H5609_004_0	8	6	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5609	004	0	1	01	01	H5609_004_0	8	5	Injectable Drugs	1	4	010010	1	1		111	01	100		1				30	60	90	1			90				30		31											69.97	25	25	25				69.97	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5609	004	0	1	01	01	H5609_004_0	8	1	Preferred Generic	3	4	001000	1	2		111	01	100		1				30	60	90	1			90				30		31								5.00	10.00	15.00					5.00	10.00	10.00							10.00																5.00				5.00			0.17	0.17				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
H5619	001	0	1	01	01	H5619_001_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	18.00		54.00																									18.00		54.00				18.00		0.00				18.00				18.00		0.60				0.60	0.60	0.58	Preferred Generic, 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	8.00		24.00																									8.00		24.00				8.00		0.00				8.00				8.00		0.26				0.26	0.26	0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	8.00		24.00																									8.00		24.00				8.00		0.00				8.00				8.00		0.26				0.26	0.26	0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5619	001	0	1	01	01	H5619_001_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	18.00		54.00																									18.00		54.00				18.00		0.00				18.00				18.00		0.60				0.60	0.60	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	003	0	1	01	01	H5619_003_0	4	2	Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.66				0.66	0.66	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	003	0	1	01	01	H5619_003_0	4	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	003	0	1	01	01	H5619_003_0	4	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	003	0	1	01	01	H5619_003_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	003	0	1	01	01	H5619_003_0	4	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, 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	8.00		24.00																									8.00		24.00				8.00		0.00				8.00				8.00		0.26				0.26	0.26	0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	007	0	1	01	01	H5619_007_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	18.00		54.00																									18.00		54.00				18.00		0.00				18.00				18.00		0.60				0.60	0.60	0.58	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	8.00		24.00																									8.00		24.00				8.00		0.00				8.00				8.00		0.26				0.26	0.26	0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5619	007	0	1	01	01	H5619_007_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	18.00		54.00																									18.00		54.00				18.00		0.00				18.00				18.00		0.60				0.60	0.60	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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, 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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, 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, 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	8.00		24.00																									8.00		24.00				8.00		0.00				8.00				8.00		0.26				0.26	0.26	0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	011	0	1	01	01	H5619_011_0	3	2	Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	012	0	1	01	01	H5619_012_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5619	012	0	1	01	01	H5619_012_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5619	012	0	1	01	01	H5619_012_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	012	0	1	01	01	H5619_012_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	012	0	1	01	01	H5619_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	012	0	1	01	01	H5619_012_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	012	0	1	01	01	H5619_012_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	012	0	1	01	01	H5619_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	012	0	1	01	01	H5619_012_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	012	0	1	01	01	H5619_012_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	013	0	1	01	01	H5619_013_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5619	013	0	1	01	01	H5619_013_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5619	013	0	1	01	01	H5619_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	013	0	1	01	01	H5619_013_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	013	0	1	01	01	H5619_013_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	013	0	1	01	01	H5619_013_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	013	0	1	01	01	H5619_013_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	013	0	1	01	01	H5619_013_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	013	0	1	01	01	H5619_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	013	0	1	01	01	H5619_013_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	014	0	1	01	01	H5619_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	014	0	1	01	01	H5619_014_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	014	0	1	01	01	H5619_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	014	0	1	01	01	H5619_014_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	014	0	1	01	01	H5619_014_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	014	0	1	01	01	H5619_014_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5619	014	0	1	01	01	H5619_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5619	014	0	1	01	01	H5619_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	014	0	1	01	01	H5619_014_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	014	0	1	01	01	H5619_014_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	015	0	1	01	01	H5619_015_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	015	0	1	01	01	H5619_015_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	015	0	1	01	01	H5619_015_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	015	0	1	01	01	H5619_015_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5619	015	0	1	01	01	H5619_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	015	0	1	01	01	H5619_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	015	0	1	01	01	H5619_015_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	015	0	1	01	01	H5619_015_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	015	0	1	01	01	H5619_015_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	015	0	1	01	01	H5619_015_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5619	016	0	1	01	01	H5619_016_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	016	0	1	01	01	H5619_016_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5619	016	0	1	01	01	H5619_016_0	4	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5619	016	0	1	01	01	H5619_016_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	016	0	1	01	01	H5619_016_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	016	0	1	01	01	H5619_016_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	016	0	1	01	01	H5619_016_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	016	0	1	01	01	H5619_016_0	4	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	016	0	1	01	01	H5619_016_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	016	0	1	01	01	H5619_016_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	017	0	1	01	01	H5619_017_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	017	0	1	01	01	H5619_017_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	017	0	1	01	01	H5619_017_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5619	017	0	1	01	01	H5619_017_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5619	017	0	1	01	01	H5619_017_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	017	0	1	01	01	H5619_017_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	017	0	1	01	01	H5619_017_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	017	0	1	01	01	H5619_017_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	017	0	1	01	01	H5619_017_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	017	0	1	01	01	H5619_017_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	019	0	1	01	01	H5619_019_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	019	0	1	01	01	H5619_019_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	35.00		105.00																									35.00		105.00				35.00		70.00				35.00				35.00		1.16				1.16	1.16	1.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	019	0	1	01	01	H5619_019_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	019	0	1	01	01	H5619_019_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	019	0	1	01	01	H5619_019_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	35.00		105.00																									35.00		105.00				35.00		70.00				35.00				35.00		1.16				1.16	1.16	1.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	019	0	1	01	01	H5619_019_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	019	0	1	01	01	H5619_019_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	019	0	1	01	01	H5619_019_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5619	019	0	1	01	01	H5619_019_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	019	0	1	01	01	H5619_019_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5619	020	0	1	01	01	H5619_020_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	020	0	1	01	01	H5619_020_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	020	0	1	01	01	H5619_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	020	0	1	01	01	H5619_020_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	020	0	1	01	01	H5619_020_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	30.00		90.00																									30.00		90.00				30.00		60.00				30.00				30.00		1.00				1.00	1.00	0.96	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	020	0	1	01	01	H5619_020_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5619	020	0	1	01	01	H5619_020_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5619	020	0	1	01	01	H5619_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	020	0	1	01	01	H5619_020_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	020	0	1	01	01	H5619_020_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	30.00		90.00																									30.00		90.00				30.00		60.00				30.00				30.00		1.00				1.00	1.00	0.96	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	021	0	1	01	01	H5619_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	021	0	1	01	01	H5619_021_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	021	0	1	01	01	H5619_021_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	35.00		105.00																									35.00		105.00				35.00		70.00				35.00				35.00		1.16				1.16	1.16	1.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	021	0	1	01	01	H5619_021_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5619	021	0	1	01	01	H5619_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	021	0	1	01	01	H5619_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	021	0	1	01	01	H5619_021_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	021	0	1	01	01	H5619_021_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	35.00		105.00																									35.00		105.00				35.00		70.00				35.00				35.00		1.16				1.16	1.16	1.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	021	0	1	01	01	H5619_021_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	021	0	1	01	01	H5619_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5619	022	0	1	01	01	H5619_022_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	022	0	1	01	01	H5619_022_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	35.00		105.00																									35.00		105.00				35.00		70.00				35.00				35.00		1.16				1.16	1.16	1.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	022	0	1	01	01	H5619_022_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	80.00		240.00																									80.00		240.00				80.00		160.00				80.00				80.00		2.66				2.66	2.66	2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	022	0	1	01	01	H5619_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	022	0	1	01	01	H5619_022_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5619	022	0	1	01	01	H5619_022_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5619	022	0	1	01	01	H5619_022_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	35.00		105.00																									35.00		105.00				35.00		70.00				35.00				35.00		1.16				1.16	1.16	1.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	022	0	1	01	01	H5619_022_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	80.00		240.00																									80.00		240.00				80.00		160.00				80.00				80.00		2.66				2.66	2.66	2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	022	0	1	01	01	H5619_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	022	0	1	01	01	H5619_022_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	023	0	1	01	01	H5619_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	023	0	1	01	01	H5619_023_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	023	0	1	01	01	H5619_023_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5619	023	0	1	01	01	H5619_023_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5619	023	0	1	01	01	H5619_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	023	0	1	01	01	H5619_023_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	023	0	1	01	01	H5619_023_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	023	0	1	01	01	H5619_023_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	023	0	1	01	01	H5619_023_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	023	0	1	01	01	H5619_023_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	024	0	1	01	01	H5619_024_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	024	0	1	01	01	H5619_024_0	3	2	Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	024	0	1	01	01	H5619_024_0	3	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	40.00		120.00																									40.00		120.00				40.00		110.00				40.00				40.00		1.33				1.33	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	024	0	1	01	01	H5619_024_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	024	0	1	01	01	H5619_024_0	3	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	025	0	1	01	01	H5619_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	025	0	1	01	01	H5619_025_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	025	0	1	01	01	H5619_025_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	025	0	1	01	01	H5619_025_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	025	0	1	01	01	H5619_025_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5619	025	0	1	01	01	H5619_025_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5619	025	0	1	01	01	H5619_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	025	0	1	01	01	H5619_025_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	025	0	1	01	01	H5619_025_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	025	0	1	01	01	H5619_025_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	026	0	1	01	01	H5619_026_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	026	0	1	01	01	H5619_026_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	026	0	1	01	01	H5619_026_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	026	0	1	01	01	H5619_026_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	026	0	1	01	01	H5619_026_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	026	0	1	01	01	H5619_026_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	026	0	1	01	01	H5619_026_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	026	0	1	01	01	H5619_026_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5619	026	0	1	01	01	H5619_026_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5619	026	0	1	01	01	H5619_026_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	029	0	1	01	01	H5619_029_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	029	0	1	01	01	H5619_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	029	0	1	01	01	H5619_029_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	029	0	1	01	01	H5619_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	029	0	1	01	01	H5619_029_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5619	029	0	1	01	01	H5619_029_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	029	0	1	01	01	H5619_029_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	029	0	1	01	01	H5619_029_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	029	0	1	01	01	H5619_029_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5619	029	0	1	01	01	H5619_029_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	030	0	1	01	01	H5619_030_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	030	0	1	01	01	H5619_030_0	4	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.66				0.66	0.66	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	030	0	1	01	01	H5619_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	030	0	1	01	01	H5619_030_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	030	0	1	01	01	H5619_030_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	030	0	1	01	01	H5619_030_0	4	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.66				0.66	0.66	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5619	030	0	1	01	01	H5619_030_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	030	0	1	01	01	H5619_030_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	030	0	1	01	01	H5619_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	030	0	1	01	01	H5619_030_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5619	031	0	1	01	01	H5619_031_0	4	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	031	0	1	01	01	H5619_031_0	4	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	031	0	1	01	01	H5619_031_0	4	2	Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	18.00		54.00																									18.00		54.00				18.00		0.00				18.00				18.00		0.60				0.60	0.60	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	031	0	1	01	01	H5619_031_0	4	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	031	0	1	01	01	H5619_031_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	032	0	1	01	01	H5619_032_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00		9.00																									3.00		9.00				3.00		0.00				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	032	0	1	01	01	H5619_032_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	032	0	1	01	01	H5619_032_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	032	0	1	01	01	H5619_032_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	032	0	1	01	01	H5619_032_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	032	0	1	01	01	H5619_032_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00		9.00																									3.00		9.00				3.00		0.00				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5619	032	0	1	01	01	H5619_032_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5619	032	0	1	01	01	H5619_032_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	032	0	1	01	01	H5619_032_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	032	0	1	01	01	H5619_032_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	033	0	1	01	01	H5619_033_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	033	0	1	01	01	H5619_033_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5619	033	0	1	01	01	H5619_033_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	033	0	1	01	01	H5619_033_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	033	0	1	01	01	H5619_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	033	0	1	01	01	H5619_033_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	033	0	1	01	01	H5619_033_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5619	033	0	1	01	01	H5619_033_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	033	0	1	01	01	H5619_033_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	033	0	1	01	01	H5619_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	034	0	1	01	01	H5619_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	034	0	1	01	01	H5619_034_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	034	0	1	01	01	H5619_034_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	034	0	1	01	01	H5619_034_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	034	0	1	01	01	H5619_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	034	0	1	01	01	H5619_034_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5619	034	0	1	01	01	H5619_034_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5619	034	0	1	01	01	H5619_034_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	034	0	1	01	01	H5619_034_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	034	0	1	01	01	H5619_034_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	035	0	1	01	01	H5619_035_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	035	0	1	01	01	H5619_035_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	035	0	1	01	01	H5619_035_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	035	0	1	01	01	H5619_035_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	035	0	1	01	01	H5619_035_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5619	035	0	1	01	01	H5619_035_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5619	035	0	1	01	01	H5619_035_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	035	0	1	01	01	H5619_035_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	035	0	1	01	01	H5619_035_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	035	0	1	01	01	H5619_035_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	036	0	1	01	01	H5619_036_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	036	0	1	01	01	H5619_036_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	036	0	1	01	01	H5619_036_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	036	0	1	01	01	H5619_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	036	0	1	01	01	H5619_036_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5619	036	0	1	01	01	H5619_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	036	0	1	01	01	H5619_036_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	036	0	1	01	01	H5619_036_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5619	036	0	1	01	01	H5619_036_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5619	036	0	1	01	01	H5619_036_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	037	0	1	01	01	H5619_037_0	3	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	2.00		6.00																									2.00		6.00				2.00		0.00				2.00				2.00		0.06				0.06	0.06	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	037	0	1	01	01	H5619_037_0	3	2	Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	8.00		24.00																									8.00		24.00				8.00		0.00				8.00				8.00		0.26				0.26	0.26	0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	037	0	1	01	01	H5619_037_0	3	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	037	0	1	01	01	H5619_037_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	037	0	1	01	01	H5619_037_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	038	0	1	01	01	H5619_038_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	038	0	1	01	01	H5619_038_0	3	2	Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	038	0	1	01	01	H5619_038_0	3	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	038	0	1	01	01	H5619_038_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5619	038	0	1	01	01	H5619_038_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5628	001	0	1	01	01	H5628_001_0	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5628	001	0	1	01	01	H5628_001_0	7	2	Generic	1	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	15.00	30.00	45.00																			15.00	30.00	45.00																15.00				15.00		0.48			0.48			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5628	001	0	1	01	01	H5628_001_0	7	3	Preferred Brand	1	4	010001	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5628	001	0	1	01	01	H5628_001_0	7	4	Non-Preferred Brand	1	4	110000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.06			3.06			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5628	001	0	1	01	01	H5628_001_0	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5628	007	0	1	01	01	H5628_007_0	8	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	3.00	6.00	9.00																			3.00	6.00	9.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5628	007	0	1	01	01	H5628_007_0	8	2	Generic	1	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	10.00	20.00	30.00																			10.00	20.00	30.00																10.00				10.00		0.32			0.32			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5628	007	0	1	01	01	H5628_007_0	8	3	Preferred Brand	1	4	010001	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5628	007	0	1	01	01	H5628_007_0	8	4	Non-Preferred Brand	1	4	110000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.06			3.06			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5628	007	0	1	01	01	H5628_007_0	8	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5649	001	0	1	01	01	H5649_001_0	8	3	Preferred Brand	1	4	010001	3	2	110		01	100		1	30		90				1			90				30		31	35.00		105.00																					70.00																35.00				35.00		1.17						1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5649	001	0	1	01	01	H5649_001_0	8	2	Generic	1	4	000101	1	2	110		01	100		1	30		90				1			90				30		31	5.00		15.00																					10.00																5.00				5.00		.17						.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5649	001	0	1	01	01	H5649_001_0	8	1	Preferred Generic	1	4	001001	1	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5649	001	0	1	01	01	H5649_001_0	8	4	Non-Preferred Brand	1	4	110000	1	2	110		01	100		1	30		90				1			90				30		31	75.00		225.00																					150.00																75.00				75.00		2.50						2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5649	001	0	1	01	01	H5649_001_0	8	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31				506.12	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5649	001	0	1	01	01	H5649_001_0	8	6	Select Care Drugs	1	4	000010	1	2	110		01	100		1	30		90				1			90				30		31	10.00		30.00																					20.00																10.00				10.00		.33						.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5649	001	0	1	01	01	H5649_001_0	8	1	Preferred Generic	3	4	001001	1	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5649	001	0	1	01	01	H5649_001_0	8	2	Generic	3	4	000101	1	2	110		01	100		1	30		90				1			90				30		31	5.00		15.00																					10.00																5.00				5.00		.16						.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5649	002	0	1	01	01	H5649_002_0	10	3	Preferred Brand	1	4	010001	3	1	110		01	100		1	30		90				1			90				30		31				54.93	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5649	002	0	1	01	01	H5649_002_0	10	2	Generic	1	4	000101	1	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5649	002	0	1	01	01	H5649_002_0	10	1	Preferred Generic	1	4	001001	1	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5649	002	0	1	01	01	H5649_002_0	10	4	Non-Preferred Brand	1	4	110000	1	1	110		01	100		1	30		90				1			90				30		31				85.80	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5649	002	0	1	01	01	H5649_002_0	10	2	Generic	3	4	000101	1	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5649	002	0	1	01	01	H5649_002_0	10	1	Preferred Generic	3	4	001001	1	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5649	002	0	1	01	01	H5649_002_0	10	6	Select Care Drugs	1	4	000010	1	2	110		01	100		1	30		90				1			90				30		31	10.00		30.00																					30.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5649	002	0	1	01	01	H5649_002_0	10	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31				344.47	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5649	004	0	1	01	01	H5649_004_0	8	1	Preferred Generic	1	4	001001	1	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5649	004	0	1	01	01	H5649_004_0	8	2	Generic	1	4	000101	1	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5649	004	0	1	01	01	H5649_004_0	8	3	Preferred Brand	1	4	010001	3	1	110		01	100		1	30		90				1			90				30		31				62.27	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5649	004	0	1	01	01	H5649_004_0	8	1	Preferred Generic	3	4	001001	1	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5649	004	0	1	01	01	H5649_004_0	8	6	Select Care Drugs	1	4	000010	1	2	110		01	100		1	30		90				1			90				30		31	10.00		30.00																					30.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5649	004	0	1	01	01	H5649_004_0	8	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31				358.47	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5649	004	0	1	01	01	H5649_004_0	8	4	Non-Preferred Brand	1	4	110000	1	1	110		01	100		1	30		90				1			90				30		31				87.94	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5649	004	0	1	01	01	H5649_004_0	8	2	Generic	3	4	000101	1	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5649	006	0	1	01	01	H5649_006_0	10	3	Preferred Brand	1	4	010001	3	2	110		01	100		1	30		90				1			90				30		31	35.00		105.00																					70.00																35.00				35.00		1.17						1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5649	006	0	1	01	01	H5649_006_0	10	6	Select Care Drugs	1	4	000010	1	2	110		01	100		1	30		90				1			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5649	006	0	1	01	01	H5649_006_0	10	1	Preferred Generic	3	4	001001	1	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5649	006	0	1	01	01	H5649_006_0	10	2	Generic	3	4	000101	1	2	110		01	100		1	30		90				1			90				30		31	5.00		15.00																					10.00																5.00				5.00		.16						.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5649	006	0	1	01	01	H5649_006_0	10	6	Select Care Drugs	3	4	000010	1	2	110		01	100		1	30		90				1			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5649	006	0	1	01	01	H5649_006_0	10	4	Non-Preferred Brand	1	4	110000	1	2	110		01	100		1	30		90				1			90				30		31	75.00		225.00																					150.00																75.00				75.00		2.50						2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5649	006	0	1	01	01	H5649_006_0	10	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31				480.07	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5649	006	0	1	01	01	H5649_006_0	10	1	Preferred Generic	1	4	001001	1	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5649	006	0	1	01	01	H5649_006_0	10	2	Generic	1	4	000101	1	2	110		01	100		1	30		90				1			90				30		31	5.00		15.00																					10.00																5.00				5.00		.17						.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5649	007	0	1	01	01	H5649_007_0	9	1	Preferred Generic	3	4	001001	1	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5649	007	0	1	01	01	H5649_007_0	9	6	Select Care Drugs	1	4	000010	1	2	110		01	100		1	30		90				1			90				30		31	10.00		30.00																					20.00																10.00				10.00		.33						.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5649	007	0	1	01	01	H5649_007_0	9	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31				506.12	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5649	007	0	1	01	01	H5649_007_0	9	4	Non-Preferred Brand	1	4	110000	1	2	110		01	100		1	30		90				1			90				30		31	75.00		225.00																					150.00																75.00				75.00		2.50						2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5649	007	0	1	01	01	H5649_007_0	9	3	Preferred Brand	1	4	010001	1	2	110		01	100		1	30		90				1			90				30		31	35.00		105.00																					70.00																35.00				35.00		1.17						1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5649	007	0	1	01	01	H5649_007_0	9	2	Generic	1	4	000101	1	2	110		01	100		1	30		90				1			90				30		31	5.00		15.00																					10.00																5.00				5.00		.17						.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5649	007	0	1	01	01	H5649_007_0	9	1	Preferred Generic	1	4	001001	1	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5649	007	0	1	01	01	H5649_007_0	9	2	Generic	3	4	000101	1	2	110		01	100		1	30		90				1			90				30		31	5.00		15.00																					10.00																5.00				5.00		.16						.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5649	008	0	1	01	01	H5649_008_0	10	1	Preferred Generic	3	4	001001	1	2	110		01	100		1	30		90				1			90				30		31	4.00		12.00																					8.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5649	008	0	1	01	01	H5649_008_0	10	6	Select Care Drugs	1	4	000010	1	2	110		01	100		1	30		90				1			90				30		31	10.00		10.00																					20.00																10.00				10.00		.33						.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5649	008	0	1	01	01	H5649_008_0	10	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31				506.05	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5649	008	0	1	01	01	H5649_008_0	10	4	Non-Preferred Brand	1	4	110000	1	2	110		01	100		1	30		90				1			90				30		31	90.00		270.00																					180.00																90.00				90.00		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5649	008	0	1	01	01	H5649_008_0	10	3	Preferred Brand	1	4	010001	1	2	110		01	100		1	30		90				1			90				30		31	45.00		135.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5649	008	0	1	01	01	H5649_008_0	10	2	Generic	1	4	000101	1	2	110		01	100		1	30		90				1			90				30		31	9.00		27.00																					18.00																9.00				9.00		0.30						.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5649	008	0	1	01	01	H5649_008_0	10	1	Preferred Generic	1	4	001001	1	2	110		01	100		1	30		90				1			90				30		31	4.00		12.00																					8.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5649	008	0	1	01	01	H5649_008_0	10	2	Generic	3	4	000101	1	2	110		01	100		1	30		90				1			90				30		31	9.00		27.00																					18.00																9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5649	009	0	1	01	01	H5649_009_0	11	1	Preferred Generic	1	4	001001	1	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5649	009	0	1	01	01	H5649_009_0	11	2	Generic	1	4	000101	1	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5649	009	0	1	01	01	H5649_009_0	11	2	Generic	3	4	000101	1	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5649	009	0	1	01	01	H5649_009_0	11	1	Preferred Generic	3	4	001001	1	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5649	009	0	1	01	01	H5649_009_0	11	6	Select Care Drugs	1	4	000010	1	2	110		01	100		1	30		90				1			90				30		31	10.00		30.00																					30.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5649	009	0	1	01	01	H5649_009_0	11	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31				344.47	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5649	009	0	1	01	01	H5649_009_0	11	4	Non-Preferred Brand	1	4	110000	1	1	110		01	100		1	30		90				1			90				30		31				85.80	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5649	009	0	1	01	01	H5649_009_0	11	3	Preferred Brand	1	4	010001	1	1	110		01	100		1	30		90				1			90				30		31				54.93	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5649	010	0	1	01	01	H5649_010_0	9	1	Preferred Generic	1	4	001001	1	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5649	010	0	1	01	01	H5649_010_0	9	1	Preferred Generic	3	4	001001	1	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5649	010	0	1	01	01	H5649_010_0	9	6	Select Care Drugs	1	4	000010	1	2	110		01	100		1	30		90				1			90				30		31	10.00		30.00																					30.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5649	010	0	1	01	01	H5649_010_0	9	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31				344.47	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5649	010	0	1	01	01	H5649_010_0	9	4	Non-Preferred Brand	1	4	110000	1	1	110		01	100		1	30		90				1			90				30		31				85.80	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5649	010	0	1	01	01	H5649_010_0	9	3	Preferred Brand	1	4	010001	1	1	110		01	100		1	30		90				1			90				30		31				54.93	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5649	010	0	1	01	01	H5649_010_0	9	2	Generic	1	4	000101	1	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5649	010	0	1	01	01	H5649_010_0	9	2	Generic	3	4	000101	1	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5652	001	0	1	02	01	H5652_001_0	5	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5652	001	0	1	02	01	H5652_001_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	5.00		15.00																											15.00						0.00				5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5652	001	0	1	02	01	H5652_001_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5652	001	0	1	02	01	H5652_001_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	85.00		255.00																											255.00						245.00				85.00				85.00		2.83						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5652	001	0	1	02	01	H5652_001_0	5	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				522.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5652	003	0	1	02	01	H5652_003_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5652	003	0	1	02	01	H5652_003_0	5	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5652	003	0	1	02	01	H5652_003_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	28.00		84.00																											84.00						74.00				28.00				28.00		0.93						0.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5652	003	0	1	02	01	H5652_003_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	70.00		210.00																											210.00						200.00				70.00				70.00		2.33						2.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5652	003	0	1	02	01	H5652_003_0	5	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				248.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5652	004	0	1	02	01	H5652_004_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5652	004	0	1	02	01	H5652_004_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5652	004	0	1	02	01	H5652_004_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5652	004	0	1	02	01	H5652_004_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				480.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5652	004	0	1	02	01	H5652_004_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	85.00		255.00																											255.00						245.00				85.00				85.00		2.83						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5652	006	0	1	02	01	H5652_006_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	5.00		15.00																											15.00						0.00				5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5652	006	0	1	02	01	H5652_006_0	5	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5652	006	0	1	02	01	H5652_006_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5652	006	0	1	02	01	H5652_006_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	85.00		255.00																											255.00						245.00				85.00				85.00		2.83						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5652	006	0	1	02	01	H5652_006_0	5	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				561.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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								5.00		12.50					0.00		0.00											5.00		12.50				0.00		0.00				5.00				5.00			0.16	0.00		.16	0.00	.14	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5656	001	0	1	01	01	H5656_001_0	7	2	Generic	1	4	000100	1	2		110	01		110	1				30		90	2				30		90	30		34								10.00		25.00					5.00		12.50											10.00		25.00				5.00		5.00				10.00				10.00			0.33	0.16		.33	.16	.29	Preferred Generic, 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								85.00		212.50					75.00		187.50											85.00		212.50				75.00		150.00				85.00				85.00			2.83	2.50		2.83	2.50	2.50	Preferred Generic, 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								45.00		112.50					35.00		87.50											45.00		112.50				35.00		70.00				45.00				45.00			1.50	1.16		1.50	1.16	1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5685	001	0	1	01	01	H5685_001_0	6	1	Generic	1	3	010000	1	2	010		10			1	30														29	31	7.00																																								7.00			7.00		0.23						0.23	Generic, Brand												
H5685	001	0	1	01	01	H5685_001_0	6	2	Brand	1	3	000010	1	1	010		10			1	30														29	31				73.02	25																																						25		25								Generic, Brand												
H5698	028	0	1	01	01	H5698_028_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		110	1	30		90				1				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	028	0	1	01	01	H5698_028_0	5	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	028	0	1	01	01	H5698_028_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	028	0	1	01	01	H5698_028_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				1				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		247.50				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	028	0	1	01	01	H5698_028_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	062	0	1	01	01	H5698_062_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		110	1	30		90				1				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	062	0	1	01	01	H5698_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	062	0	1	01	01	H5698_062_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				1				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		247.50				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	062	0	1	01	01	H5698_062_0	5	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	062	0	1	01	01	H5698_062_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	063	0	1	01	01	H5698_063_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		110	1	30		90				1				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	063	0	1	01	01	H5698_063_0	5	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	063	0	1	01	01	H5698_063_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	063	0	1	01	01	H5698_063_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				1				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		247.50				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	063	0	1	01	01	H5698_063_0	5	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	128	0	1	01	01	H5698_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	128	0	1	01	01	H5698_128_0	4	3	Preferred Brand	1	3	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	128	0	1	01	01	H5698_128_0	4	4	Non-Preferred Brand	1	3	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				57.80	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	128	0	1	01	01	H5698_128_0	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	128	0	1	01	01	H5698_128_0	4	2	Generic	1	3	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	9.00		27.00																									9.00		27.00				9.00		22.50				9.00				9.00		0.30				0.30	0.30	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	134	0	1	01	01	H5698_134_0	4	4	Non-Preferred Brand	1	3	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				57.60	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	134	0	1	01	01	H5698_134_0	4	3	Preferred Brand	1	3	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	134	0	1	01	01	H5698_134_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	134	0	1	01	01	H5698_134_0	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	134	0	1	01	01	H5698_134_0	4	2	Generic	1	3	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	18.00		54.00																									18.00		54.00				18.00		45.00				18.00				18.00		0.60				0.60	0.60	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	140	0	1	01	01	H5698_140_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	140	0	1	01	01	H5698_140_0	4	3	Preferred Brand	1	3	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	140	0	1	01	01	H5698_140_0	4	4	Non-Preferred Brand	1	3	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				68.20	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	140	0	1	01	01	H5698_140_0	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	140	0	1	01	01	H5698_140_0	4	2	Generic	1	3	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	8.00		24.00																									8.00		24.00				8.00		20.00				8.00				8.00		0.27				0.27	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	158	0	1	01	01	H5698_158_0	4	2	Generic	1	3	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	9.00		27.00																									9.00		27.00				9.00		22.50				9.00				9.00		0.30				0.30	0.30	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	158	0	1	01	01	H5698_158_0	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	158	0	1	01	01	H5698_158_0	4	3	Preferred Brand	1	3	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	158	0	1	01	01	H5698_158_0	4	4	Non-Preferred Brand	1	3	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				75.00	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	158	0	1	01	01	H5698_158_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	159	0	1	01	01	H5698_159_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	159	0	1	01	01	H5698_159_0	4	4	Non-Preferred Brand	1	4	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				49.00	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	159	0	1	01	01	H5698_159_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	159	0	1	01	01	H5698_159_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	159	0	1	01	01	H5698_159_0	4	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	198	0	1	02	01	H5698_198_0	3	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	198	0	1	02	01	H5698_198_0	3	2	Generic	1	3	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	198	0	1	02	01	H5698_198_0	3	3	Preferred Brand	1	3	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	198	0	1	02	01	H5698_198_0	3	1	Preferred Generic	1	3	001000	1	2	110		01		110	1	30		90				1				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	198	0	1	02	01	H5698_198_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				1				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		247.50				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	199	0	1	02	01	H5698_199_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				1				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		247.50				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	199	0	1	02	01	H5698_199_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	199	0	1	02	01	H5698_199_0	4	1	Preferred Generic	1	4	001000	1	2	110		01		110	1	30		90				1				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	199	0	1	02	01	H5698_199_0	4	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	199	0	1	02	01	H5698_199_0	4	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	200	0	1	01	01	H5698_200_0	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	200	0	1	01	01	H5698_200_0	4	2	Generic	1	3	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		30.00				12.00				12.00		0.40				0.40	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	200	0	1	01	01	H5698_200_0	4	3	Preferred Brand	1	3	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	200	0	1	01	01	H5698_200_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	200	0	1	01	01	H5698_200_0	4	4	Non-Preferred Brand	1	3	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				49.50	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	203	0	1	01	01	H5698_203_0	5	4	Non-Preferred Brand	1	2	110000	1	2	110		01		110	1	30		90				1				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		247.50				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	203	0	1	01	01	H5698_203_0	5	3	Preferred Brand	1	2	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	35.00		105.00																									35.00		105.00				35.00		87.50				35.00				35.00		1.17				1.17	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	203	0	1	01	01	H5698_203_0	5	5	Specialty Tier	1	2	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	203	0	1	01	01	H5698_203_0	5	1	Preferred Generic	1	2	001000	1	2	110		01		110	1	30		90				1				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	203	0	1	01	01	H5698_203_0	5	2	Generic	1	2	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		25.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	204	0	1	01	01	H5698_204_0	5	3	Preferred Brand	1	2	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	35.00		105.00																									35.00		105.00				35.00		87.50				35.00				35.00		1.17				1.17	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	204	0	1	01	01	H5698_204_0	5	4	Non-Preferred Brand	1	2	110000	1	2	110		01		110	1	30		90				1				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		247.50				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	204	0	1	01	01	H5698_204_0	5	5	Specialty Tier	1	2	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	204	0	1	01	01	H5698_204_0	5	1	Preferred Generic	1	2	001000	1	2	110		01		110	1	30		90				1				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5698	204	0	1	01	01	H5698_204_0	5	2	Generic	1	2	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		25.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5746	016	0	1	01	01	H5746_016_0	10	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								19.00	38.00	57.00					14.00	28.00	42.00					14.00	42.00	42.00																19.00				19.00			0.63	0.47	0.47			0.56	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5746	016	0	1	01	01	H5746_016_0	10	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5746	016	0	1	01	01	H5746_016_0	10	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34											1117.30	33						1117.30	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5746	016	0	1	01	01	H5746_016_0	10	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5746	016	0	1	01	01	H5746_016_0	10	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5746	016	0	1	01	01	H5746_016_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5746	016	0	1	01	01	H5746_016_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	005	0	1	01	01	H5774_005_0	10	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								10.00		20.00					5.00		10.00							10.00																10.00				5.00			0.33	0.17				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5774	005	0	1	01	01	H5774_005_0	10	2	Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								20.00		40.00					10.00		20.00							20.00																20.00				10.00			0.67	0.33				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5774	005	0	1	01	01	H5774_005_0	10	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31								75.00		150.00					50.00		100.00							100.00																75.00				50.00			2.50	1.67				1.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	005	0	1	01	01	H5774_005_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	005	0	1	01	01	H5774_005_0	10	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31								45.00		90.00					35.00		70.00							70.00																45.00				35.00			1.50	1.17				1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	005	0	1	01	01	H5774_005_0	10	2	Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								20.00		40.00					10.00		20.00							20.00																20.00				10.00			.67	.33				.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	005	0	1	01	01	H5774_005_0	10	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								10.00		20.00					5.00		10.00							10.00																10.00				5.00			.33	.17				.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	008	0	1	01	01	H5774_008_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	008	0	1	01	01	H5774_008_0	9	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		190.00					50.00		100.00							100.00																95.00				50.00			3.17	1.67				1.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	008	0	1	01	01	H5774_008_0	9	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31								45.00		90.00					40.00		80.00							80.00																45.00				40.00			1.50	1.33				1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	008	0	1	01	01	H5774_008_0	9	2	Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								20.00		40.00					15.00		30.00							30.00																20.00				15.00			.67	.50				.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	008	0	1	01	01	H5774_008_0	9	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								10.00		20.00					6.00		12.00							12.00																10.00				6.00			.33	.20				.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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								10.00		20.00					5.00		10.00							10.00																10.00				5.00			.33	.17				.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5774	022	0	1	01	01	H5774_022_0	8	2	Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								20.00		40.00					10.00		20.00							20.00																20.00				10.00			.67	.33				.32	Preferred Generic, 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, 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								75.00		150.00					50.00		100.00							100.00																75.00				50.00			2.50	1.67				1.61	Preferred Generic, 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								45.00		90.00					35.00		70.00							70.00																45.00				35.00			1.50	1.17				1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	022	0	1	01	01	H5774_022_0	8	2	Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								20.00		40.00					10.00		20.00							20.00																20.00				10.00			.67	.33				.32	Preferred Generic, 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								10.00		20.00					5.00		10.00							10.00																10.00				5.00			.33	.17				.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	023	0	1	01	01	H5774_023_0	8	2	Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								20.00		40.00					10.00		20.00							20.00																20.00				10.00			.67	.33				.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	023	0	1	01	01	H5774_023_0	8	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								10.00		20.00					5.00		10.00							10.00																10.00				5.00			.33	.17				.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	023	0	1	01	01	H5774_023_0	8	2	Generic	3	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								20.00		40.00					10.00		20.00							20.00																20.00				10.00			.67	.33				.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5774	023	0	1	01	01	H5774_023_0	8	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								10.00		20.00					5.00		10.00							10.00																10.00				5.00			.33	.17				.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5774	023	0	1	01	01	H5774_023_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	023	0	1	01	01	H5774_023_0	8	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	1			90				30		31								75.00		150.00					50.00		100.00							100.00																75.00				50.00			2.50	1.67				1.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	023	0	1	01	01	H5774_023_0	8	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31								45.00		90.00					35.00		70.00							70.00																45.00				35.00			1.50	1.17				1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	024	0	1	01	01	H5774_024_0	11	3	Preferred Brand	1	2	000001	1	2		110	01	100		1				30		90	1			90				30		31								45.00		90.00					35.00		70.00							70.00																45.00				35.00			1.50	1.17				1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	024	0	1	01	01	H5774_024_0	11	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	024	0	1	01	01	H5774_024_0	11	4	Non-Preferred Brand	1	2	100000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		190.00					50.00		100.00							100.00																95.00				50.00			3.17	1.67				1.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	024	0	1	01	01	H5774_024_0	11	2	Generic	1	2	000100	1	2		110	01	100		1				30		90	1			90				30		31								20.00		40.00					13.00		26.00							26.00																20.00				13.00			.67	.43				.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	024	0	1	01	01	H5774_024_0	11	1	Preferred Generic	1	2	001000	1	2		110	01	100		1				30		90	1			90				30		31								10.00		20.00					4.00		8.00							8.00																10.00				4.00			.33	.13				.13	Preferred Generic, 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	100.00		300.00																					200.00																100.00				100.00		3.23						3.23	Preferred Generic, 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				198.00	33		33																				33															33			33								Preferred Generic, 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	47.00		141.00																					94.00																47.00				47.00		1.52						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5779	002	0	1	01	01	H5779_002_0	6	2	Generic	1	4	000100	1	2	110		01	100		1	31		90				2			90				31		31	5.00		15.00																					10.00																5.00				5.00		0.16						0.16	Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5793	001	0	1	01	01	H5793_001_0	5	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5793	001	0	1	01	01	H5793_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5793	001	0	1	01	01	H5793_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											48.22	50	50	50				44.96	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5793	001	0	1	01	01	H5793_001_0	5	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					12.00	24.00	36.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.40	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5793	001	0	1	01	01	H5793_001_0	5	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								15.00	30.00	45.00					4.00	8.00	12.00					15.00	30.00	45.00																	15.00			15.00			0.50	0.13	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5793	008	0	1	01	01	H5793_008_0	5	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											46.10	50	50	50				43.11	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5793	008	0	1	01	01	H5793_008_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5793	008	0	1	01	01	H5793_008_0	5	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5793	008	0	1	01	01	H5793_008_0	5	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					14.00	28.00	42.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.47	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5793	008	0	1	01	01	H5793_008_0	5	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								15.00	30.00	45.00					6.00	12.00	18.00					15.00	30.00	45.00																	15.00			15.00			0.50	0.20	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5793	010	0	1	01	01	H5793_010_0	5	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5793	010	0	1	01	01	H5793_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											49.24	50	50	50				46.97	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5793	010	0	1	01	01	H5793_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5793	010	0	1	01	01	H5793_010_0	5	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					13.00	26.00	39.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.43	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5793	010	0	1	01	01	H5793_010_0	5	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								14.00	28.00	42.00					5.00	10.00	15.00					14.00	28.00	42.00																	14.00			14.00			0.47	0.17	0.47			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5793	011	0	1	01	01	H5793_011_0	5	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					13.00	26.00	39.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.43	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5793	011	0	1	01	01	H5793_011_0	5	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								14.00	28.00	42.00					5.00	10.00	15.00					14.00	28.00	42.00																	14.00			14.00			0.47	0.17	0.47			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5793	011	0	1	01	01	H5793_011_0	5	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5793	011	0	1	01	01	H5793_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											47.60	50	50	50				45.43	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5793	011	0	1	01	01	H5793_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5810	001	0	1	01	01	H5810_001_0	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5810	001	0	1	01	01	H5810_001_0	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5810	001	0	1	01	01	H5810_001_0	7	4	Non-Preferred Brand	1	4	110000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.06			3.06			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5810	001	0	1	01	01	H5810_001_0	7	3	Preferred Brand	1	4	010001	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5810	001	0	1	01	01	H5810_001_0	7	2	Generic	1	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	15.00	30.00	45.00																			15.00	30.00	45.00																15.00				15.00		0.48			0.48			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5810	011	0	1	01	01	H5810_011_0	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5810	011	0	1	01	01	H5810_011_0	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5810	011	0	1	01	01	H5810_011_0	7	4	Non-Preferred Brand	1	4	110000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.06			3.06			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5810	011	0	1	01	01	H5810_011_0	7	3	Preferred Brand	1	4	010001	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5810	011	0	1	01	01	H5810_011_0	7	2	Generic	1	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	15.00	30.00	45.00																			15.00	30.00	45.00																15.00				15.00		0.48			0.48			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5817	018	0	1	01	01	H5817_018_0	9	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	018	0	1	01	01	H5817_018_0	9	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								13.00	26.00	39.00					8.00	16.00	24.00					8.00	24.00	24.00																13.00				13.00			0.43	0.27	0.27			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	018	0	1	01	01	H5817_018_0	9	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00	6.00	6.00																7.00				7.00			0.23	0.07	0.07			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	018	0	1	01	01	H5817_018_0	9	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34											1114.89	33						1114.89	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	018	0	1	01	01	H5817_018_0	9	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5817	018	0	1	01	01	H5817_018_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	018	0	1	01	01	H5817_018_0	9	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	019	0	1	01	01	H5817_019_0	9	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34											1226.88	33						1226.88	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	019	0	1	01	01	H5817_019_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	019	0	1	01	01	H5817_019_0	9	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5817	019	0	1	01	01	H5817_019_0	9	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00	6.00	6.00																7.00				7.00			0.23	0.07	0.07			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	019	0	1	01	01	H5817_019_0	9	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								13.00	26.00	39.00					8.00	16.00	24.00					8.00	24.00	24.00																13.00				13.00			0.43	0.27	0.27			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	019	0	1	01	01	H5817_019_0	9	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	019	0	1	01	01	H5817_019_0	9	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	020	1	1	01	01	H5817_020_1	10	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00	36.00	36.00																17.00				17.00			0.57	0.40	0.40			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	020	1	1	01	01	H5817_020_1	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5817	020	1	1	01	01	H5817_020_1	10	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	020	1	1	01	01	H5817_020_1	10	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	020	1	1	01	01	H5817_020_1	10	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34											1255.92	33						1255.92	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	020	1	1	01	01	H5817_020_1	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	020	1	1	01	01	H5817_020_1	10	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	.13	.13			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	020	2	1	01	01	H5817_020_2	10	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	.13	.13			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	020	2	1	01	01	H5817_020_2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5817	020	2	1	01	01	H5817_020_2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	020	2	1	01	01	H5817_020_2	10	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34											1255.92	33						1255.92	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	020	2	1	01	01	H5817_020_2	10	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	020	2	1	01	01	H5817_020_2	10	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00	36.00	36.00																17.00				17.00			0.57	0.40	0.40			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	020	2	1	01	01	H5817_020_2	10	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	020	3	1	01	01	H5817_020_3	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	020	3	1	01	01	H5817_020_3	10	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34											1255.92	33						1255.92	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	020	3	1	01	01	H5817_020_3	10	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	020	3	1	01	01	H5817_020_3	10	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	.13	.13			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	020	3	1	01	01	H5817_020_3	10	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00	36.00	36.00																17.00				17.00			0.57	0.40	0.40			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	020	3	1	01	01	H5817_020_3	10	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	020	3	1	01	01	H5817_020_3	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5817	020	4	1	01	01	H5817_020_4	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	020	4	1	01	01	H5817_020_4	11	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34											1255.92	33						1255.92	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	020	4	1	01	01	H5817_020_4	11	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	020	4	1	01	01	H5817_020_4	11	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	020	4	1	01	01	H5817_020_4	11	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00	36.00	36.00																17.00				17.00			0.57	0.40	0.40			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	020	4	1	01	01	H5817_020_4	11	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	.13	.13			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	020	4	1	01	01	H5817_020_4	11	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5817	020	5	1	01	01	H5817_020_5	10	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	.13	.13			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	020	5	1	01	01	H5817_020_5	10	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00	36.00	36.00																17.00				17.00			0.57	0.40	0.40			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	020	5	1	01	01	H5817_020_5	10	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	020	5	1	01	01	H5817_020_5	10	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	020	5	1	01	01	H5817_020_5	10	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34											1255.92	33						1255.92	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	020	5	1	01	01	H5817_020_5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	020	5	1	01	01	H5817_020_5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5817	020	6	1	01	01	H5817_020_6	10	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	.13	.13			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	020	6	1	01	01	H5817_020_6	10	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00	36.00	36.00																17.00				17.00			0.57	0.40	0.40			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	020	6	1	01	01	H5817_020_6	10	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	020	6	1	01	01	H5817_020_6	10	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	020	6	1	01	01	H5817_020_6	10	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34											1255.92	33						1255.92	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	020	6	1	01	01	H5817_020_6	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	020	6	1	01	01	H5817_020_6	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5817	022	0	1	01	01	H5817_022_0	9	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	022	0	1	01	01	H5817_022_0	9	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	022	0	1	01	01	H5817_022_0	9	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34											1275.88	33						1275.88	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	022	0	1	01	01	H5817_022_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	022	0	1	01	01	H5817_022_0	9	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5817	022	0	1	01	01	H5817_022_0	9	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00	6.00	6.00																7.00				7.00			0.23	0.07	0.07			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	022	0	1	01	01	H5817_022_0	9	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								13.00	26.00	39.00					8.00	16.00	24.00					8.00	24.00	24.00																13.00				13.00			0.43	0.27	0.27			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	023	0	1	01	01	H5817_023_0	9	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	023	0	1	01	01	H5817_023_0	9	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	023	0	1	01	01	H5817_023_0	9	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								13.00	26.00	39.00					8.00	16.00	24.00					8.00	24.00	24.00																13.00				13.00			0.43	0.27	0.27			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	023	0	1	01	01	H5817_023_0	9	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00	6.00	6.00																7.00				7.00			0.23	0.07	0.07			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	023	0	1	01	01	H5817_023_0	9	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34											1243.61	33						1243.61	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	023	0	1	01	01	H5817_023_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	023	0	1	01	01	H5817_023_0	9	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5817	024	1	1	01	01	H5817_024_1	10	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								93.00	186.00	279.00					88.00	176.00	264.00					88.00	264.00	264.00																93.00				93.00			3.10	2.93	2.93			2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	024	1	1	01	01	H5817_024_1	10	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	024	1	1	01	01	H5817_024_1	10	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								13.00	26.00	39.00					13.00	26.00	39.00					13.00	39.00	39.00																13.00				13.00			0.43	0.43	0.43			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	024	1	1	01	01	H5817_024_1	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	024	1	1	01	01	H5817_024_1	10	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34											922.54	25						922.54	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	024	1	1	01	01	H5817_024_1	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5817	024	1	1	01	01	H5817_024_1	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5817	024	1	1	01	01	H5817_024_1	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	024	2	1	01	01	H5817_024_2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	024	2	1	01	01	H5817_024_2	10	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								13.00	26.00	39.00					13.00	26.00	39.00					13.00	39.00	39.00																13.00				13.00			0.43	0.43	0.43			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	024	2	1	01	01	H5817_024_2	10	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	024	2	1	01	01	H5817_024_2	10	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								93.00	186.00	279.00					88.00	176.00	264.00					88.00	264.00	264.00																93.00				93.00			3.10	2.93	2.93			2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	024	2	1	01	01	H5817_024_2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5817	024	2	1	01	01	H5817_024_2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	024	2	1	01	01	H5817_024_2	10	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34											922.54	25						922.54	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	024	2	1	01	01	H5817_024_2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5817	024	3	1	01	01	H5817_024_3	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5817	024	3	1	01	01	H5817_024_3	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5817	024	3	1	01	01	H5817_024_3	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	024	3	1	01	01	H5817_024_3	10	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								13.00	26.00	39.00					13.00	26.00	39.00					13.00	39.00	39.00																13.00				13.00			0.43	0.43	0.43			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	024	3	1	01	01	H5817_024_3	10	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	024	3	1	01	01	H5817_024_3	10	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								93.00	186.00	279.00					88.00	176.00	264.00					88.00	264.00	264.00																93.00				93.00			3.10	2.93	2.93			2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	024	3	1	01	01	H5817_024_3	10	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34											922.54	25						922.54	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5817	024	3	1	01	01	H5817_024_3	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5826	008	0	1	01	01	H5826_008_0	5	2	Generic	1	4	000100	1	2	110		01	100		1	34		90				1			90				34		34	20.00		50.00																					50.00																20.00				20.00		0.59						0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5826	008	0	1	01	01	H5826_008_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	34		90				1			90				34		34	4.00		10.00																					10.00																4.00				4.00		.12						.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5826	008	0	1	01	01	H5826_008_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	34		90				1			90				34		34	47.00		135.00																					135.00																47.00				47.00		1.38						1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5826	008	0	1	01	01	H5826_008_0	5	4	Non-Preferred Brand	1	4	100000	1	1	110		01	100		1	34		90				1			90				34		34				100.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5826	008	0	1	01	01	H5826_008_0	5	5	Specialty Tier	1	4	100101	1	1	110		01	100		1	34		90				1			90				34		34				100.00	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5826	009	0	1	01	01	H5826_009_0	5	2	Generic	1	4	000100	1	2	110		01	100		1	34		90				1			90				34		34	20.00		50.00																					50.00																20.00				20.00		0.59						0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5826	009	0	1	01	01	H5826_009_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	34		90				1			90				34		34	4.00		10.00																					10.00																4.00				4.00		.12						.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5826	009	0	1	01	01	H5826_009_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	34		90				1			90				34		34	47.00		135.00																					135.00																47.00				47.00		1.38						1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5826	009	0	1	01	01	H5826_009_0	5	5	Specialty Tier	1	4	100101	1	1	110		01	100		1	34		90				1			90				34		34				100.00	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5826	009	0	1	01	01	H5826_009_0	5	4	Non-Preferred Brand	1	4	100000	1	1	110		01	100		1	34		90				1			90				34		34				100.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5826	010	0	1	01	01	H5826_010_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	34		90				1			90				34		34	4.00		10.00																					10.00																4.00				4.00		.12						.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5826	010	0	1	01	01	H5826_010_0	5	2	Generic	1	4	000100	1	2	110		01	100		1	34		90				1			90				34		34	20.00		50.00																					50.00																20.00				20.00		0.59						0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5826	010	0	1	01	01	H5826_010_0	5	4	Non-Preferred Brand	1	4	100000	1	1	110		01	100		1	34		90				1			90				34		34				100.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5826	010	0	1	01	01	H5826_010_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	34		90				1			90				34		34	47.00		135.00																					135.00																47.00				47.00		1.38						1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5826	010	0	1	01	01	H5826_010_0	5	5	Specialty Tier	1	4	100101	1	1	110		01	100		1	34		90				1			90				34		34				100.00	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5852	001	0	1	01	01	H5852_001_0	10	3	Non-Preferred Brand	1	2	100000	1	1	010		01			1	30													30		34				96.18	25																																					25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5852	001	0	1	01	01	H5852_001_0	10	4	Specialty Tier	1	2	100000	1	1	010		01			1	30													30		34				341.62	25																																					25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5852	001	0	1	01	01	H5852_001_0	10	1	Generic	1	2	010000	1	1	110		01			1	30		90				2							30		34				8.93	25		25																																			25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5852	001	0	1	01	01	H5852_001_0	10	2	Preferred Brand	1	2	000101	1	1	110		01			1	30		90				2							30		34				80.51	25		25																																			25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5854	007	0	1	01	01	H5854_007_0	8	5	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34											957.15	28						957.15	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5854	007	0	1	01	01	H5854_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								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5854	007	0	1	01	01	H5854_007_0	8	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5854	007	0	1	01	01	H5854_007_0	8	2	Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5854	007	0	1	01	01	H5854_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5854	007	0	1	01	01	H5854_007_0	8	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5854	008	0	1	01	01	H5854_008_0	7	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								46.00	92.00	138.00					46.00	92.00	138.00					46.00	138.00	138.00																46.00				46.00			1.53	1.53	1.53			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5854	008	0	1	01	01	H5854_008_0	7	2	Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								4.00	8.00	12.00					4.00	8.00	12.00					4.00	12.00	12.00																4.00				4.00			0.13	0.13	0.13			0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5854	008	0	1	01	01	H5854_008_0	7	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5854	008	0	1	01	01	H5854_008_0	7	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5854	008	0	1	01	01	H5854_008_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5854	008	0	1	01	01	H5854_008_0	7	5	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34											827.00	25						827.00	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5854	009	0	1	01	01	H5854_009_0	9	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00	9.00	9.00																8.00				8.00			0.27	0.10	0.10			0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5854	009	0	1	01	01	H5854_009_0	9	2	Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5854	009	0	1	01	01	H5854_009_0	9	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5854	009	0	1	01	01	H5854_009_0	9	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5854	009	0	1	01	01	H5854_009_0	9	5	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34											1015.97	27						1015.97	27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5854	009	0	1	01	01	H5854_009_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5859	003	0	1	02	01	H5859_003_0	4	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	12.00																4.00				4.00		0.13			0.13			0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5859	003	0	1	02	01	H5859_003_0	4	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.66			0.66			0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5859	003	0	1	02	01	H5859_003_0	4	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5859	003	0	1	02	01	H5859_003_0	4	5	Injectable Drugs	1	4	010010	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5859	003	0	1	02	01	H5859_003_0	4	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.16			3.16			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5859	003	0	1	02	01	H5859_003_0	4	6	Specialty Tier	1	4	010010	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31				366.06	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5883	002	1	1	02	01	H5883_002_1	6	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				34		90	1	34		90				34		34								3.00		9.00					3.00		7.50					3.00		7.50																3.00				3.00			.09	.09	.09			.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	002	1	1	02	01	H5883_002_1	6	2	Generic	1	4	000100	1	2		110	01	110		1				34		90	1	34		90				34		34								10.00		30.00					10.00		25.00					10.00		25.00																10.00				10.00			.29	.29	.29			.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	002	1	1	02	01	H5883_002_1	6	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				34				34						34		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	002	1	1	02	01	H5883_002_1	6	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				34		90	1	34		90				34		34								80.00		240.00					80.00		200.00					80.00		200.00																80.00				80.00			2.35	2.35	2.35			2.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	002	1	1	02	01	H5883_002_1	6	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				34		90	1	34		90				34		34								40.00		120.00					40.00		100.00					40.00		100.00																40.00				40.00			1.18	1.18	1.18			1.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	002	2	1	02	01	H5883_002_2	6	2	Generic	1	4	000100	1	2		110	01	110		1				34		90	1	34		90				34		34								10.00		30.00					10.00		25.00					10.00		25.00																10.00				10.00			.29	.29	.29			.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	002	2	1	02	01	H5883_002_2	6	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				34		90	1	34		90				34		34								40.00		120.00					40.00		100.00					40.00		100.00																40.00				40.00			1.18	1.18	1.18			1.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	002	2	1	02	01	H5883_002_2	6	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				34		90	1	34		90				34		34								80.00		240.00					80.00		200.00					80.00		200.00																80.00				80.00			2.35	2.35	2.35			2.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	002	2	1	02	01	H5883_002_2	6	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				34				34						34		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	002	2	1	02	01	H5883_002_2	6	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				34		90	1	34		90				34		34								3.00		9.00					3.00		7.50					3.00		7.50																3.00				3.00			.09	.09	.09			.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	002	3	1	02	01	H5883_002_3	6	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				34		90	1	34		90				34		34								40.00		120.00					40.00		100.00					40.00		100.00																40.00				40.00			1.18	1.18	1.18			1.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	002	3	1	02	01	H5883_002_3	6	2	Generic	1	4	000100	1	2		110	01	110		1				34		90	1	34		90				34		34								10.00		30.00					10.00		25.00					10.00		25.00																10.00				10.00			.29	.29	.29			.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	002	3	1	02	01	H5883_002_3	6	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				34		90	1	34		90				34		34								3.00		9.00					3.00		7.50					3.00		7.50																3.00				3.00			.09	.09	.09			.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	002	3	1	02	01	H5883_002_3	6	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				34		90	1	34		90				34		34								80.00		240.00					80.00		200.00					80.00		200.00																80.00				80.00			2.35	2.35	2.35			2.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	002	3	1	02	01	H5883_002_3	6	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				34				34						34		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	002	4	1	02	01	H5883_002_4	6	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				34		90	1	34		90				34		34								3.00		9.00					3.00		7.50					3.00		7.50																3.00				3.00			.09	.09	.09			.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	002	4	1	02	01	H5883_002_4	6	2	Generic	1	4	000100	1	2		110	01	110		1				34		90	1	34		90				34		34								10.00		30.00					10.00		25.00					10.00		25.00																10.00				10.00			.29	.29	.29			.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	002	4	1	02	01	H5883_002_4	6	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				34		90	1	34		90				34		34								40.00		120.00					40.00		100.00					40.00		100.00																40.00				40.00			1.18	1.18	1.18			1.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	002	4	1	02	01	H5883_002_4	6	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				34		90	1	34		90				34		34								80.00		240.00					80.00		200.00					80.00		200.00																80.00				80.00			2.35	2.35	2.35			2.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	002	4	1	02	01	H5883_002_4	6	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				34				34						34		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	002	7	1	02	01	H5883_002_7	6	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				34		90	1	34		90				34		34								40.00		120.00					40.00		100.00					40.00		100.00																40.00				40.00			1.18	1.18	1.18			1.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	002	7	1	02	01	H5883_002_7	6	2	Generic	1	4	000100	1	2		110	01	110		1				34		90	1	34		90				34		34								10.00		30.00					10.00		25.00					10.00		25.00																10.00				10.00			.29	.29	.29			.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	002	7	1	02	01	H5883_002_7	6	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				34		90	1	34		90				34		34								3.00		9.00					3.00		7.50					3.00		7.50																3.00				3.00			.09	.09	.09			.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	002	7	1	02	01	H5883_002_7	6	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				34		90	1	34		90				34		34								80.00		240.00					80.00		200.00					80.00		200.00																80.00				80.00			2.35	2.35	2.35			2.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	002	7	1	02	01	H5883_002_7	6	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				34				34						34		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	003	1	1	02	01	H5883_003_1	6	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				34		90	1	34		90				34		34								3.00		9.00					3.00		7.50					3.00		7.50																3.00				3.00			.09	.09	.09			.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	003	1	1	02	01	H5883_003_1	6	2	Generic	1	4	000100	1	2		110	01	110		1				34		90	1	34		90				34		34								10.00		30.00					10.00		25.00					10.00		25.00																10.00				10.00			.29	.29	.29			.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	003	1	1	02	01	H5883_003_1	6	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				34		90	1	34		90				34		34								35.00		105.00					35.00		87.50					35.00		87.50																35.00				35.00			1.03	1.03	1.03			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	003	1	1	02	01	H5883_003_1	6	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				34		90	1	34		90				34		34								75.00		225.00					75.00		187.50					75.00		187.50																75.00				75.00			2.21	2.21	2.21			2.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	003	1	1	02	01	H5883_003_1	6	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				34				34						34		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	003	1	1	02	01	H5883_003_1	6	1	Preferred Generic	3	4	001000	1	2		110	01	110		1				34		90	1	34		90				34		34								5.00		15.00					5.00		12.50					5.00		12.50																5.00				5.00			.15	.15	.15			.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5883	003	2	1	02	01	H5883_003_2	6	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				34		90	1	34		90				34		34								3.00		9.00					3.00		7.50					3.00		7.50																3.00				3.00			.09	.09	.09			.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	003	2	1	02	01	H5883_003_2	6	2	Generic	1	4	000100	1	2		110	01	110		1				34		90	1	34		90				34		34								10.00		30.00					10.00		25.00					10.00		25.00																10.00				10.00			.29	.29	.29			.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	003	2	1	02	01	H5883_003_2	6	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				34		90	1	34		90				34		34								35.00		105.00					35.00		87.50					35.00		87.50																35.00				35.00			1.03	1.03	1.03			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	003	2	1	02	01	H5883_003_2	6	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				34		90	1	34		90				34		34								75.00		225.00					75.00		187.50					75.00		187.50																75.00				75.00			2.21	2.21	2.21			2.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	003	2	1	02	01	H5883_003_2	6	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				34				34						34		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	003	2	1	02	01	H5883_003_2	6	1	Preferred Generic	3	4	001000	1	2		110	01	110		1				34		90	1	34		90				34		34								5.00		15.00					5.00		12.50					5.00		12.50																5.00				5.00			.15	.15	.15			.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5883	003	3	1	02	01	H5883_003_3	6	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				34		90	1	34		90				34		34								3.00		9.00					3.00		7.50					3.00		7.50																3.00				3.00			.09	.09	.09			.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	003	3	1	02	01	H5883_003_3	6	1	Preferred Generic	3	4	001000	1	2		110	01	110		1				34		90	1	34		90				34		34								5.00		15.00					5.00		12.50					5.00		12.50																5.00				5.00			.15	.15	.15			.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5883	003	3	1	02	01	H5883_003_3	6	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				34				34						34		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	003	3	1	02	01	H5883_003_3	6	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				34		90	1	34		90				34		34								75.00		225.00					75.00		187.50					75.00		187.50																75.00				75.00			2.21	2.21	2.21			2.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	003	3	1	02	01	H5883_003_3	6	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				34		90	1	34		90				34		34								35.00		105.00					35.00		87.50					35.00		87.50																35.00				35.00			1.03	1.03	1.03			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	003	3	1	02	01	H5883_003_3	6	2	Generic	1	4	000100	1	2		110	01	110		1				34		90	1	34		90				34		34								10.00		30.00					10.00		25.00					10.00		25.00																10.00				10.00			.29	.29	.29			.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	003	4	1	02	01	H5883_003_4	6	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				34		90	1	34		90				34		34								75.00		225.00					75.00		187.50					75.00		187.50																75.00				75.00			2.21	2.21	2.21			2.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	003	4	1	02	01	H5883_003_4	6	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				34		90	1	34		90				34		34								35.00		105.00					35.00		87.50					35.00		87.50																35.00				35.00			1.03	1.03	1.03			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	003	4	1	02	01	H5883_003_4	6	2	Generic	1	4	000100	1	2		110	01	110		1				34		90	1	34		90				34		34								10.00		30.00					10.00		25.00					10.00		25.00																10.00				10.00			.29	.29	.29			.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	003	4	1	02	01	H5883_003_4	6	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				34		90	1	34		90				34		34								3.00		9.00					3.00		7.50					3.00		7.50																3.00				3.00			.09	.09	.09			.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	003	4	1	02	01	H5883_003_4	6	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				34				34						34		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	003	4	1	02	01	H5883_003_4	6	1	Preferred Generic	3	4	001000	1	2		110	01	110		1				34		90	1	34		90				34		34								5.00		15.00					5.00		12.50					5.00		12.50																5.00				5.00			.15	.15	.15			.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5883	003	5	1	02	01	H5883_003_5	7	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				34		90	1	34		90				34		34								75.00		225.00					75.00		187.50					75.00		187.50																75.00				75.00			2.21	2.21	2.21			2.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	003	5	1	02	01	H5883_003_5	7	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				34		90	1	34		90				34		34								35.00		105.00					35.00		87.50					35.00		87.50																35.00				35.00			1.03	1.03	1.03			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	003	5	1	02	01	H5883_003_5	7	2	Generic	1	4	000100	1	2		110	01	110		1				34		90	1	34		90				34		34								10.00		30.00					10.00		25.00					10.00		25.00																10.00				10.00			.29	.29	.29			.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	003	5	1	02	01	H5883_003_5	7	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				34		90	1	34		90				34		34								3.00		9.00					3.00		7.50					3.00		7.50																3.00				3.00			.09	.09	.09			.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	003	5	1	02	01	H5883_003_5	7	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				34				34						34		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	003	5	1	02	01	H5883_003_5	7	1	Preferred Generic	3	4	001000	1	2		110	01	110		1				34		90	1	34		90				34		34								5.00		15.00					5.00		12.50					5.00		12.50																5.00				5.00			.15	.15	.15			.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5883	006	0	1	01	01	H5883_006_0	7	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				34				34						34		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	006	0	1	01	01	H5883_006_0	7	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				34		90	1	34		90				34		34								100.00		300.00					100.00		250.00					100.00		250.00																100.00				100.00			2.94	2.94	2.94			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	006	0	1	01	01	H5883_006_0	7	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				34		90	1	34		90				34		34								47.00		141.00					47.00		117.50					47.00		117.50																47.00				47.00			1.38	1.38	1.38			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	006	0	1	01	01	H5883_006_0	7	2	Generic	1	4	000100	1	2		110	01	110		1				34		90	1	34		90				34		34								15.00		45.00					15.00		37.50					15.00		37.50																15.00				15.00			.44	.44	.44			.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	006	0	1	01	01	H5883_006_0	7	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				34		90	1	34		90				34		34								5.00		15.00					5.00		12.50					5.00		12.50																5.00				5.00			.15	.15	.15			.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	007	0	1	01	01	H5883_007_0	8	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				34		90	1	34		90				34		34								5.00		15.00					5.00		12.50					5.00		12.50																5.00				5.00			.15	.15	.15			.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	007	0	1	01	01	H5883_007_0	8	2	Generic	1	4	000100	1	2		110	01	110		1				34		90	1	34		90				34		34								15.00		45.00					15.00		37.50					15.00		37.50																15.00				15.00			.44	.44	.44			.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	007	0	1	01	01	H5883_007_0	8	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				34		90	1	34		90				34		34								47.00		141.00					47.00		117.50					47.00		117.50																47.00				47.00			1.38	1.38	1.38			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	007	0	1	01	01	H5883_007_0	8	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				34				34						34		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5883	007	0	1	01	01	H5883_007_0	8	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				34		90	1	34		90				34		34								100.00		300.00					100.00		250.00					100.00		250.00																100.00				100.00			2.94	2.94	2.94			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5926	001	0	1	01	01	H5926_001_0	6	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5926	001	0	1	01	01	H5926_001_0	6	2	Generic	1	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	15.00	30.00	45.00																			15.00	30.00	45.00																15.00				15.00		0.48			0.48			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5926	001	0	1	01	01	H5926_001_0	6	3	Preferred Brand	1	4	010001	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5926	001	0	1	01	01	H5926_001_0	6	4	Non-Preferred Brand	1	4	110000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.06			3.06			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5926	001	0	1	01	01	H5926_001_0	6	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	001	0	1	01	01	H5928_001_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5928	001	0	1	01	01	H5928_001_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	001	0	1	01	01	H5928_001_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	001	0	1	01	01	H5928_001_0	8	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	001	0	1	01	01	H5928_001_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	001	0	1	01	01	H5928_001_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	004	0	1	01	01	H5928_004_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5928	004	0	1	01	01	H5928_004_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	004	0	1	01	01	H5928_004_0	8	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	5.00		12.50																					12.50																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	004	0	1	01	01	H5928_004_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	004	0	1	01	01	H5928_004_0	8	2	Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	5.00		12.50																					12.50																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5928	004	0	1	01	01	H5928_004_0	8	4	Non-Preferred Brand	1	4	100100	1	2	110		01	100		1	30		90				2			90				30		31	75.00		187.50																					187.50																75.00				75.00		2.50						2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	004	0	1	01	01	H5928_004_0	8	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	35.00		87.50																					87.50																35.00				35.00		1.17						1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	005	0	1	01	01	H5928_005_0	12	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	005	0	1	01	01	H5928_005_0	12	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	005	0	1	01	01	H5928_005_0	12	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	005	0	1	01	01	H5928_005_0	12	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	005	0	1	01	01	H5928_005_0	12	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5928	005	0	1	01	01	H5928_005_0	12	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	010	0	1	01	01	H5928_010_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	010	0	1	01	01	H5928_010_0	8	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	7.00		17.50																					17.50																7.00				7.00		0.23						0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	010	0	1	01	01	H5928_010_0	8	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	35.00		87.50																					87.50																35.00				35.00		1.17						1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	010	0	1	01	01	H5928_010_0	8	4	Non-Preferred Brand	1	4	100100	1	2	110		01	100		1	30		90				2			90				30		31	80.00		200.00																					200.00																80.00				80.00		2.67						2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	010	0	1	01	01	H5928_010_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	010	0	1	01	01	H5928_010_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5928	010	0	1	01	01	H5928_010_0	8	2	Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	7.00		17.50																					17.50																7.00				7.00		0.23						0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	012	0	1	01	01	H5928_012_0	8	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	5.00		12.50																					12.50																5.00				5.00		0.17						0.16	Preferred Generic, 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	40.00		100.00																					100.00																40.00				40.00		1.33						1.29	Preferred Generic, 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	80.00		200.00																					200.00																80.00				80.00		2.67						2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	012	0	1	01	01	H5928_012_0	8	2	Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	5.00		12.50																					12.50																5.00				5.00		0.17						0.16	Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5928	016	0	1	01	01	H5928_016_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	016	0	1	01	01	H5928_016_0	9	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	5.00		12.50																					12.50																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	016	0	1	01	01	H5928_016_0	9	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	30.00		75.00																					75.00																30.00				30.00		1.00						0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	016	0	1	01	01	H5928_016_0	9	4	Non-Preferred Brand	1	4	100100	1	2	110		01	100		1	30		90				2			90				30		31	75.00		187.50																					187.50																75.00				75.00		2.50						2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	016	0	1	01	01	H5928_016_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	016	0	1	01	01	H5928_016_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5928	016	0	1	01	01	H5928_016_0	9	2	Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	5.00		12.50																					12.50																5.00				5.00		0.17						0.16	Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	020	0	1	01	01	H5928_020_0	7	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	5.00		12.50																					12.50																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	30.00		75.00																					75.00																30.00				30.00		1.00						0.97	Preferred Generic, 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	50.00		125.00																					125.00																50.00				50.00		1.67						1.61	Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	020	0	1	01	01	H5928_020_0	7	2	Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	5.00		12.50																					12.50																5.00				5.00		0.17						0.16	Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5928	022	0	1	01	01	H5928_022_0	7	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	5.00		12.50																					12.50																5.00				5.00		0.17						0.16	Preferred Generic, 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, 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	40.00		100.00																					100.00																40.00				40.00		1.33						1.29	Preferred Generic, 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	80.00		200.00																					200.00																80.00				80.00		2.67						2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5928	022	0	1	01	01	H5928_022_0	7	2	Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	5.00		12.50																					12.50																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5928	024	0	1	01	01	H5928_024_0	9	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	5.00		12.50																					12.50																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	024	0	1	01	01	H5928_024_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	024	0	1	01	01	H5928_024_0	9	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	40.00		100.00																					100.00																40.00				40.00		1.33						1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	024	0	1	01	01	H5928_024_0	9	2	Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	5.00		12.50																					12.50																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5928	024	0	1	01	01	H5928_024_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5928	024	0	1	01	01	H5928_024_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	024	0	1	01	01	H5928_024_0	9	4	Non-Preferred Brand	1	4	100100	1	2	110		01	100		1	30		90				2			90				30		31	80.00		200.00																					200.00																80.00				80.00		2.67						2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	037	0	1	01	01	H5928_037_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	037	0	1	01	01	H5928_037_0	10	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	037	0	1	01	01	H5928_037_0	10	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	037	0	1	01	01	H5928_037_0	10	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	037	0	1	01	01	H5928_037_0	10	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	037	0	1	01	01	H5928_037_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5928	038	0	1	01	01	H5928_038_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	038	0	1	01	01	H5928_038_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5928	038	0	1	01	01	H5928_038_0	8	2	Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	8.00		20.00																					20.00																8.00				8.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5928	038	0	1	01	01	H5928_038_0	8	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	30.00		75.00																					75.00																30.00				30.00		1.00						0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	038	0	1	01	01	H5928_038_0	8	4	Non-Preferred Brand	1	4	100100	1	2	110		01	100		1	30		90				2			90				30		31	75.00		187.50																					187.50																75.00				75.00		2.50						2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	038	0	1	01	01	H5928_038_0	8	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	8.00		20.00																					20.00																8.00				8.00		0.27						0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	038	0	1	01	01	H5928_038_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	042	0	1	01	01	H5928_042_0	7	4	Non-Preferred Brand	1	4	100100	1	2	110		01	100		1	30		90				2			90				30		31	80.00		200.00																					200.00																80.00				80.00		2.67						2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	042	0	1	01	01	H5928_042_0	7	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	5.00		12.50																					12.50																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	042	0	1	01	01	H5928_042_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	40.00		100.00																					100.00																40.00				40.00		1.33						1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	042	0	1	01	01	H5928_042_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	042	0	1	01	01	H5928_042_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5928	042	0	1	01	01	H5928_042_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	042	0	1	01	01	H5928_042_0	7	2	Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	5.00		12.50																					12.50																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5928	044	0	1	01	01	H5928_044_0	7	2	Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	5.00		12.50																					12.50																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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, 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	80.00		200.00																					200.00																80.00				80.00		2.67						2.58	Preferred Generic, 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	40.00		100.00																					100.00																40.00				40.00		1.33						1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	044	0	1	01	01	H5928_044_0	7	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	5.00		12.50																					12.50																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5928	046	0	1	01	01	H5928_046_0	7	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	5.00		12.50																					12.50																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	046	0	1	01	01	H5928_046_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	046	0	1	01	01	H5928_046_0	7	2	Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	5.00		12.50																					12.50																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5928	046	0	1	01	01	H5928_046_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	30.00		75.00																					75.00																30.00				30.00		1.00						0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	046	0	1	01	01	H5928_046_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5928	046	0	1	01	01	H5928_046_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	046	0	1	01	01	H5928_046_0	7	4	Non-Preferred Brand	1	4	100100	1	2	110		01	100		1	30		90				2			90				30		31	50.00		125.00																					125.00																50.00				50.00		1.67						1.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	047	0	1	01	01	H5928_047_0	11	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	047	0	1	01	01	H5928_047_0	11	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	047	0	1	01	01	H5928_047_0	11	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	047	0	1	01	01	H5928_047_0	11	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	047	0	1	01	01	H5928_047_0	11	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5928	047	0	1	01	01	H5928_047_0	11	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5932	007	0	1	01	01	H5932_007_0	13	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	30	60	90				1			90				30		31	4.00	8.00	12.00																					12.00																4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5932	007	0	1	01	01	H5932_007_0	13	2	Generic	1	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	10.00	20.00	30.00																					30.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5932	007	0	1	01	01	H5932_007_0	13	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	30	60	90				1			90				30		31	45.00	90.00	135.00																					135.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5932	007	0	1	01	01	H5932_007_0	13	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	30	60	90				1			90				30		31	95.00	190.00	285.00																					285.00																95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5932	007	0	1	01	01	H5932_007_0	13	5	Specialty Tier	1	4	010010	1	1	111		01			1	30	60	90				1							30		31				1.00	25	25	25																																			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5932	007	0	1	01	01	H5932_007_0	13	6	Select Care Drugs	1	4	000010	1	2	111		01	100		1	30	60	90				1			90				30		31	11.00	22.00	33.00																					33.00																11.00				11.00		0.37						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5932	008	0	1	01	01	H5932_008_0	11	2	Generic	1	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	10.00	20.00	30.00																					30.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5932	008	0	1	01	01	H5932_008_0	11	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	30	60	90				1			90				30		31	4.00	8.00	12.00																					12.00																4.00				4.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5932	008	0	1	01	01	H5932_008_0	11	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	30	60	90				1			90				30		31	45.00	90.00	135.00																					135.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5932	008	0	1	01	01	H5932_008_0	11	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	30	60	90				1			90				30		31	95.00	190.00	285.00																					285.00																95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5932	008	0	1	01	01	H5932_008_0	11	5	Specialty Tier	1	4	010010	1	1	111		01			1	30	60	90				1							30		31				1.00	27	27	27																																			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5932	008	0	1	01	01	H5932_008_0	11	6	Select Care Drugs	1	4	000010	1	2	111		01	100		1	30	60	90				1			90				30		31	11.00	22.00	33.00																					33.00																11.00				11.00		0.37						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5938	001	0	1	01	01	H5938_001_0	9	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	7.00	14.00	21.00																			7.00	14.00	17.50																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	3.00	6.00	9.00																			3.00	6.00	7.50																3.00				3.00		0.10			0.10			0.10	Preferred Generic, 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	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, 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	250.00				25																																			250.00		25		250.00	25	8.33						8.06	Preferred Generic, 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	95.00	190.00	285.00																			95.00	190.00	237.50																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5938	006	0	1	01	01	H5938_006_0	9	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	7.50																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5938	006	0	1	01	01	H5938_006_0	9	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	7.00	14.00	21.00																			7.00	14.00	17.50																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5938	006	0	1	01	01	H5938_006_0	9	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5938	006	0	1	01	01	H5938_006_0	9	4	Non-Preferred Brand	1	4	110000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	237.50																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5938	006	0	1	01	01	H5938_006_0	9	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	7.50																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5938	006	0	1	01	01	H5938_006_0	9	5	Specialty Tier	1	4	010010	1	4	010		01			1	30													30		31	250.00				25																																			250.00		25		250.00	25	8.33						8.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5938	006	0	1	01	01	H5938_006_0	9	2	Generic	3	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	7.00	14.00	21.00																			7.00	14.00	17.50																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5943	001	0	1	02	01	H5943_001_0	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				1.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5943	001	0	1	02	01	H5943_001_0	5	4	Non-Preferred Brand	1	4	100000	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31				86.87	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5943	001	0	1	02	01	H5943_001_0	5	6	Select Care Drugs	1	4	000010	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	11.00	22.00	33.00																			11.00	22.00	33.00																11.00				11.00		0.37			0.37			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5943	001	0	1	02	01	H5943_001_0	5	3	Preferred Brand	1	4	010001	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31				177.38	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5943	001	0	1	02	01	H5943_001_0	5	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	16.00	32.00	48.00																			16.00	32.00	48.00																16.00				16.00		0.53			0.53			0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5943	001	0	1	02	01	H5943_001_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	9.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5945	001	0	1	01	01	H5945_001_0	7	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5945	001	0	1	01	01	H5945_001_0	7	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5945	001	0	1	01	01	H5945_001_0	7	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5945	001	0	1	01	01	H5945_001_0	7	2	Generic	3	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5945	001	0	1	01	01	H5945_001_0	7	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5945	001	0	1	01	01	H5945_001_0	7	5	Specialty Tier	1	4	000010	1	1	010		10	010		1	30							30							10	31				600.00	33																				33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5945	001	0	1	01	01	H5945_001_0	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5945	002	0	1	01	01	H5945_002_0	7	2	Generic	3	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5945	002	0	1	01	01	H5945_002_0	7	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5945	002	0	1	01	01	H5945_002_0	7	5	Specialty Tier	1	4	000010	1	1	010		10	010		1	30							30							10	31				600.00	33																				33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5945	002	0	1	01	01	H5945_002_0	7	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5945	002	0	1	01	01	H5945_002_0	7	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5945	002	0	1	01	01	H5945_002_0	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5945	002	0	1	01	01	H5945_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	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5970	001	0	1	04	01	H5970_001_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	8.00		24.00																									8.00		24.00				8.00		0.00				8.00				8.00		0.26				0.26	0.26	0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5970	001	0	1	04	01	H5970_001_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.66				0.66	0.66	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5970	001	0	1	04	01	H5970_001_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5970	001	0	1	04	01	H5970_001_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5970	001	0	1	04	01	H5970_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5970	001	0	1	04	01	H5970_001_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	8.00		24.00																									8.00		24.00				8.00		0.00				8.00				8.00		0.26				0.26	0.26	0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5970	001	0	1	04	01	H5970_001_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.66				0.66	0.66	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5970	001	0	1	04	01	H5970_001_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5970	001	0	1	04	01	H5970_001_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5970	001	0	1	04	01	H5970_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, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5970	002	0	1	04	01	H5970_002_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.66				0.66	0.66	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5970	002	0	1	04	01	H5970_002_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.66				0.66	0.66	0.64	Preferred Generic, 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	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5970	004	0	1	04	01	H5970_004_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.66				0.66	0.66	0.64	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, 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	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H5970	004	0	1	04	01	H5970_004_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.66				0.66	0.66	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, 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, 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, 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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H5970	008	0	1	04	01	H5970_008_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	18.00		54.00																									18.00		54.00				18.00		0.00				18.00				18.00		0.60				0.60	0.60	0.58	Preferred Generic, 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	8.00		24.00																									8.00		24.00				8.00		0.00				8.00				8.00		0.26				0.26	0.26	0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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, 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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	8.00		24.00																									8.00		24.00				8.00		0.00				8.00				8.00		0.26				0.26	0.26	0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5970	008	0	1	04	01	H5970_008_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	18.00		54.00																									18.00		54.00				18.00		0.00				18.00				18.00		0.60				0.60	0.60	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5985	001	0	1	01	01	H5985_001_0	8	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	7.50																3.00				3.00		0.10			0.10			.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5985	001	0	1	01	01	H5985_001_0	8	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	25.00																10.00				10.00		.33			.33			.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5985	001	0	1	01	01	H5985_001_0	8	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		0.83			.83			.81	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5985	001	0	1	01	01	H5985_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	95.00	190.00	285.00																			95.00	190.00	237.50																95.00				95.00		2.50			2.50			2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5985	001	0	1	01	01	H5985_001_0	8	5	Specialty Tier	1	4	100100	1	1	010		01	010		1	30							30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5985	001	0	1	01	01	H5985_001_0	8	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	7.50																3.00				3.00		.10			.10			.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5985	005	0	1	01	01	H5985_005_0	9	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	7.50																3.00				3.00		0.10			0.10			.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5985	005	0	1	01	01	H5985_005_0	9	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	7.50																3.00				3.00		.10			.10			.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5985	005	0	1	01	01	H5985_005_0	9	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	25.00																10.00				10.00		.33			.33			.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5985	005	0	1	01	01	H5985_005_0	9	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	25.00	50.00	75.00																			25.00	50.00	62.50																25.00				25.00		0.83			.83			.81	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5985	005	0	1	01	01	H5985_005_0	9	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	75.00	150.00	225.00																			75.00	150.00	187.50																75.00				75.00		2.50			2.50			2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5985	005	0	1	01	01	H5985_005_0	9	5	Specialty Tier	1	4	100101	1	1	010		01	010		1	30							30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5989	002	0	1	01	01	H5989_002_0	4	1	Generic	1	3	010000	1	2	110		01	100		1	30		90				1			90				30		31	9.50		28.50																					28.50																9.50				9.50		0.32						0.31	Generic, Brand												
H5989	002	0	1	01	01	H5989_002_0	4	2	Brand	1	3	000010	1	1	110		01	100		1	30		90				2			90				30		31				60.36	25		25																				25															25			25								Generic, Brand												
H5991	001	0	1	01	01	H5991_001_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5991	001	0	1	01	01	H5991_001_0	6	2	Generic	1	3	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	6.00	12.00	15.00																					15.00																6.00				6.00		0.20						0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5991	001	0	1	01	01	H5991_001_0	6	3	Preferred Brand	1	3	000001	1	2	111		01	100		1	30	60	90				1			90				30		31	47.00	94.00	117.50																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5991	001	0	1	01	01	H5991_001_0	6	4	Non-Preferred Brand	1	3	100100	1	2	111		01	100		1	30	60	90				1			90				30		31	90.00	180.00	225.00																					225.00																90.00				90.00		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5991	001	0	1	01	01	H5991_001_0	6	5	Specialty Tier	1	3	010010	1	1	010		01			1	30													30		31				562.50	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5991	002	0	1	01	01	H5991_002_0	6	5	Specialty Tier	1	3	010010	1	1	010		01			1	30													30		31				562.50	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5991	002	0	1	01	01	H5991_002_0	6	4	Non-Preferred Brand	1	3	100100	1	2	111		01	100		1	30	60	90				1			90				30		31	100.00	200.00	250.00																					250.00																100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5991	002	0	1	01	01	H5991_002_0	6	3	Preferred Brand	1	3	000001	1	2	111		01	100		1	30	60	90				1			90				30		31	47.00	94.00	117.50																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5991	002	0	1	01	01	H5991_002_0	6	2	Generic	1	3	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	11.00	22.00	27.50																					27.50																11.00				11.00		0.37						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5991	002	0	1	01	01	H5991_002_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5991	003	0	1	01	01	H5991_003_0	6	5	Specialty Tier	1	4	000010	1	1	010		01	010		1	30							30						30		31				585.00	26																				26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5991	003	0	1	01	01	H5991_003_0	6	4	Non-Preferred Brand	1	4	100100	1	2	111		01	100		1	30	60	90				1			90				30		31	100.00	200.00	250.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5991	003	0	1	01	01	H5991_003_0	6	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5991	003	0	1	01	01	H5991_003_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5991	003	0	1	01	01	H5991_003_0	6	2	Generic	1	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	10.00	20.00	25.00																					25.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5991	003	0	1	01	01	H5991_003_0	6	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	30	60	90				1			90				30		31	47.00	94.00	117.50																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5991	004	0	1	01	01	H5991_004_0	6	2	Generic	1	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	8.00	16.00	20.00																					20.00																8.00				8.00		0.27						0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5991	004	0	1	01	01	H5991_004_0	6	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	30	60	90				1			90				30		31	42.00	84.00	105.00																					105.00																42.00				42.00		1.40						1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5991	004	0	1	01	01	H5991_004_0	6	4	Non-Preferred Brand	1	4	100100	1	2	111		01	100		1	30	60	90				1			90				30		31	95.00	190.00	237.50																					237.50																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5991	004	0	1	01	01	H5991_004_0	6	5	Specialty Tier	1	4	000010	1	1	010		01	010		1	30							30						30		31				742.50	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5991	004	0	1	01	01	H5991_004_0	6	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5991	004	0	1	01	01	H5991_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5991	006	0	1	01	01	H5991_006_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5991	006	0	1	01	01	H5991_006_0	5	5	Specialty Tier	1	4	000010	1	1	010		01	010		1	30							30						30		31				652.50	29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5991	006	0	1	01	01	H5991_006_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	30	60	90				1			90				30		31	47.00	94.00	117.50																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5991	006	0	1	01	01	H5991_006_0	5	2	Generic	1	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	10.00	20.00	25.00																					25.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5991	006	0	1	01	01	H5991_006_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5991	006	0	1	01	01	H5991_006_0	5	4	Non-Preferred Brand	1	4	100100	1	2	111		01	100		1	30	60	90				1			90				30		31	100.00	200.00	250.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6080	001	0	1	48	05	H6080_001_0	6	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	2.95	0.00	2.95			0.00	2.95			
H6080	001	0	1	48	05	H6080_001_0	6	3	Non-Medicare Rx/OTC Drugs	1	4	010010			110		01	100		1	31		90				2			90				31		31																																														0.00						0.00	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	6	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	7.40	0.00	7.40			0.00	7.40			
H6229	005	0	1	48	05	H6229_005_0	5	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	5	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	5	1	Generic Drugs	1	4	010000			111		10	111		1	31	62	93				2	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			
H6229	005	0	1	48	05	H6229_005_0	5	2	Brand Drugs	1	4	000010			111		10	111		1	31	62	93				2	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			
H6229	006	0	1	48	05	H6229_006_0	5	1	Generic Drugs	1	4	010010			111		10	111		1	31	62	93				2	31	62	93					10	31																																														0.00			0.00			0.00	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			
H6229	006	0	1	48	05	H6229_006_0	5	2	Brand Drugs	1	4	010010			111		10	111		1	31	62	93				2	31	62	93					10	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	7.40			0.00	7.40	0.00	7.40			
H6229	006	0	1	48	05	H6229_006_0	5	3	Non-Medicare Rx Drugs	1	4	010010			010		10			1	31														10	31																																														0.00						0.00	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	5	4	Non-Medicare OTC Drugs	1	4	010010			010		10			1	31														10	31																																														0.00						0.00	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			
H6237	003	1	1	01	01	H6237_003_1	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	5.00	10.00	10.00																			5.00	10.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6237	003	1	1	01	01	H6237_003_1	7	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	45.00	90.00	112.50																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6237	003	1	1	01	01	H6237_003_1	7	6	Select Care Drugs	1	4	010010	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6237	003	1	1	01	01	H6237_003_1	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6237	003	1	1	01	01	H6237_003_1	7	4	Non-Preferred Brand	1	4	110000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	95.00	190.00	237.50																			95.00	190.00	237.50																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6237	003	1	1	01	01	H6237_003_1	7	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	12.00	24.00	24.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6237	003	2	1	01	01	H6237_003_2	7	6	Select Care Drugs	1	4	010010	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6237	003	2	1	01	01	H6237_003_2	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6237	003	2	1	01	01	H6237_003_2	7	4	Non-Preferred Brand	1	4	110000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	95.00	190.00	237.50																			95.00	190.00	237.50																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6237	003	2	1	01	01	H6237_003_2	7	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	45.00	90.00	112.50																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6237	003	2	1	01	01	H6237_003_2	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	5.00	10.00	10.00																			5.00	10.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6237	003	2	1	01	01	H6237_003_2	7	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	12.00	24.00	24.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6298	001	0	1	01	01	H6298_001_0	5	6	Vaccines	3	4	010010	1	2	010		01			1	30													30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H6298	001	0	1	01	01	H6298_001_0	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H6298	001	0	1	01	01	H6298_001_0	5	6	Vaccines	1	4	010010	1	2	010		01			1	30													30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6298	001	0	1	01	01	H6298_001_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				2	30		90				30		31	95.00		285.00																			95.00		190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6298	001	0	1	01	01	H6298_001_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				2	30		90				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6298	001	0	1	01	01	H6298_001_0	5	2	Generic	1	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	14.00		42.00																			14.00		28.00																14.00				14.00		0.47			0.47			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6298	001	0	1	01	01	H6298_001_0	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6298	001	0	1	01	01	H6298_001_0	5	5	Specialty Tier	1	4	010010	1	1	110		01	110		1	30		90				2	30		90				30		31				3003.49	33		33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6298	002	0	1	01	01	H6298_002_0	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				2	30		90				30		31	95.00		285.00																			95.00		190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6298	002	0	1	01	01	H6298_002_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				2	30		90				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6298	002	0	1	01	01	H6298_002_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6298	002	0	1	01	01	H6298_002_0	6	6	Vaccines	3	4	000001	1	2	010		01			1	30													30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H6298	002	0	1	01	01	H6298_002_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H6298	002	0	1	01	01	H6298_002_0	6	6	Vaccines	1	4	000001	1	2	010		01			1	30													30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6298	002	0	1	01	01	H6298_002_0	6	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		90				2	30		90				30		31				3003.49	33		33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6298	002	0	1	01	01	H6298_002_0	6	2	Generic	1	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	14.00		42.00																			14.00		28.00																14.00				14.00		0.47			0.47			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6298	009	0	1	01	01	H6298_009_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				2	30		90				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6298	009	0	1	01	01	H6298_009_0	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				2	30		90				30		31	95.00		285.00																			95.00		190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6298	009	0	1	01	01	H6298_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H6298	009	0	1	01	01	H6298_009_0	6	2	Generic	3	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	14.00		42.00																			14.00		28.00																14.00				14.00		0.47			0.47			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H6298	009	0	1	01	01	H6298_009_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H6298	009	0	1	01	01	H6298_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6298	009	0	1	01	01	H6298_009_0	6	2	Generic	1	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	14.00		42.00																			14.00		28.00																14.00				14.00		0.47			0.47			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6298	009	0	1	01	01	H6298_009_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6298	009	0	1	01	01	H6298_009_0	6	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		90				2	30		90				30		31				3003.49	33		33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6306	002	0	1	01	01	H6306_002_0	7	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6306	002	0	1	01	01	H6306_002_0	7	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.00	6.00	9.00																			3.00	0.00	0.00																3.00				3.00		0.10			.10			.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H6306	002	0	1	01	01	H6306_002_0	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				750.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6306	002	0	1	01	01	H6306_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	90.00	180.00	270.00																			90.00	180.00	225.00																90.00				90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6306	002	0	1	01	01	H6306_002_0	7	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	50.00																20.00				20.00		.67			.67			.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6306	002	0	1	01	01	H6306_002_0	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.00	6.00	9.00																			3.00	0.00	0.00																3.00				3.00		.10			.10			.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6306	003	0	1	01	01	H6306_003_0	8	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6306	003	0	1	01	01	H6306_003_0	8	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	7.00	14.00	21.00																			7.00	0.00	0.00																7.00				7.00		.23			.23			.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6306	003	0	1	01	01	H6306_003_0	8	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	50.00																20.00				20.00		.67			.67			.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6306	003	0	1	01	01	H6306_003_0	8	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	7.00	14.00	21.00																			7.00	0.00	0.00																7.00				7.00		0.23			.23			.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H6306	003	0	1	01	01	H6306_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	90.00	180.00	270.00																			90.00	180.00	225.00																90.00				90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6306	003	0	1	01	01	H6306_003_0	8	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				612.50	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6308	001	0	1	48	05	H6308_001_0	10	3	Non-Medicare Rx/OTC Drugs	1	4	010010			111		01	100		1	30	60	90				2			90				30		31																																														0.00						0.00	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	10	1	Generic Drugs	1	4	010000			111		01	100		1	30	60	90				2			90				30		31																																														0.00						0.00	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	10	2	Brand Drugs	1	4	000010			111		01	100		1	30	60	90				2			90				30		31																																														0.00						0.00	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			
H6320	001	0	1	01	01	H6320_001_0	6	1	Preferred Generic	1	4	001000	1	2	110		10	100		1	31		90				1			90					10	31	0.00		0.00																					0.00																	0.00			0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6320	001	0	1	01	01	H6320_001_0	6	2	Generic	1	4	000100	1	1	110		10	100		1	31		90				1			90					10	31				14.90	25		25																				25																25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6320	001	0	1	01	01	H6320_001_0	6	3	Preferred Brand	1	4	000001	1	1	110		10	100		1	31		90				1			90					10	31				67.40	25		25																				25																25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6320	001	0	1	01	01	H6320_001_0	6	4	Non-Preferred Brand	1	4	100000	1	1	110		10	100		1	31		90				1			90					10	31				188.71	25		25																				25																25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6320	001	0	1	01	01	H6320_001_0	6	5	Specialty Tier	1	4	010010	1	1	010		10	010		1	31							30							10	31					25																				25																		25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6328	001	0	1	04	01	H6328_001_0	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H6328	001	0	1	04	01	H6328_001_0	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6328	001	0	1	04	01	H6328_001_0	5	2	Generic	1	4	000100	1	2	111		10	111		1	30	60	90				1	30	60	90					29	31	8.00	16.00	16.00																			8.00	16.00	16.00																	8.00			8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6328	001	0	1	04	01	H6328_001_0	5	3	Preferred Brand	1	4	000001	1	2	111		10	111		1	30	60	90				1	30	60	90					29	31	36.00	72.00	72.00																			36.00	72.00	72.00																	36.00			36.00		1.20			1.20			1.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6328	001	0	1	04	01	H6328_001_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		10	111		1	30	60	90				1	30	60	90					29	31	68.00	136.00	136.00																			68.00	136.00	136.00																	68.00			68.00		2.27			2.27			2.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6328	001	0	1	04	01	H6328_001_0	5	5	Specialty Tier	1	4	010010	1	1	111		10	111		1	30	60	90				2	30	60	90					29	31				1179.57	33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6328	002	0	1	04	01	H6328_002_0	7	1	Preferred Generic	1	4	001000	1	2	111		10	111		1	30	60	90				1	30	60	90					29	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6328	002	0	1	04	01	H6328_002_0	7	2	Generic	1	4	000100	1	2	111		10	111		1	30	60	90				1	30	60	90					29	31	12.00	24.00	24.00																			12.00	24.00	24.00																	12.00			12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6328	002	0	1	04	01	H6328_002_0	7	3	Preferred Brand	1	4	000001	1	2	111		10	111		1	30	60	90				1	30	60	90					29	31	40.00	80.00	80.00																			40.00	80.00	80.00																	40.00			40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6328	002	0	1	04	01	H6328_002_0	7	4	Non-Preferred Brand	1	4	100000	1	2	111		10	111		1	30	60	90				1	30	60	90					29	31	75.00	150.00	150.00																			75.00	150.00	150.00																	75.00			75.00		2.50			2.50			2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6328	002	0	1	04	01	H6328_002_0	7	5	Specialty Tier	1	4	010010	1	1	111		10	111		1	30	60	90				2	30	60	90					29	31				1197.39	33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6328	002	0	1	04	01	H6328_002_0	7	1	Preferred Generic	3	4	001000	1	2	111		10	111		1	30	60	90				1	30	60	90					29	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H6328	003	0	1	04	01	H6328_003_0	6	1	Preferred Generic	1	4	001000	1	2	111		10	111		1	30	60	90				1	30	60	90					29	31	4.00	8.00	8.00																			4.00	8.00	8.00																	4.00			4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6328	003	0	1	04	01	H6328_003_0	6	2	Generic	1	4	000100	1	2	111		10	111		1	30	60	90				1	30	60	90					29	31	15.00	30.00	30.00																			15.00	30.00	30.00																	15.00			15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6328	003	0	1	04	01	H6328_003_0	6	3	Preferred Brand	1	4	000001	1	2	111		10	111		1	30	60	90				1	30	60	90					29	31	45.00	90.00	90.00																			45.00	90.00	90.00																	45.00			45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6328	003	0	1	04	01	H6328_003_0	6	4	Non-Preferred Brand	1	4	100000	1	2	111		10	111		1	30	60	90				1	30	60	90					29	31	85.00	170.00	170.00																			85.00	170.00	170.00																	85.00			85.00		2.83			2.83			2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6328	003	0	1	04	01	H6328_003_0	6	5	Specialty Tier	1	4	010010	1	1	111		10	111		1	30	60	90				2	30	60	90					29	31				1004.77	33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6328	003	0	1	04	01	H6328_003_0	6	1	Preferred Generic	3	4	001000	1	2	111		10	111		1	30	60	90				1	30	60	90					29	31	4.00	8.00	8.00																			4.00	8.00	8.00																	4.00			4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H6360	001	0	1	18	06	H6360_001_0	7	6	Vaccines	3	4	000001	1	2	010		01			1	30													30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H6360	001	0	1	18	06	H6360_001_0	7	2	Generic	3	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	16.00		48.00																			16.00		32.00																16.00				16.00		0.53			0.53			0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H6360	001	0	1	18	06	H6360_001_0	7	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	2.00		6.00																			2.00		4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H6360	001	0	1	18	06	H6360_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6360	001	0	1	18	06	H6360_001_0	7	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		90				2	30		90				30		31				2925.51	33		33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6360	001	0	1	18	06	H6360_001_0	7	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				2	30		90				30		31	95.00		285.00																			95.00		190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6360	001	0	1	18	06	H6360_001_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				2	30		90				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6360	001	0	1	18	06	H6360_001_0	7	2	Generic	1	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	16.00		48.00																			16.00		32.00																16.00				16.00		.53			.53			.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6360	001	0	1	18	06	H6360_001_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	2.00		6.00																			2.00		4.00																2.00				2.00		.07			.07			.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6360	002	0	1	18	06	H6360_002_0	6	6	Vaccines	3	4	000001	1	2	010		01			1	30													30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H6360	002	0	1	18	06	H6360_002_0	6	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	2.00		6.00																			2.00		4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H6360	002	0	1	18	06	H6360_002_0	6	6	Vaccines	1	4	000001	1	2	010		01			1	30													30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6360	002	0	1	18	06	H6360_002_0	6	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		90				2	30		90				30		31				2695.65	33		33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6360	002	0	1	18	06	H6360_002_0	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				2	30		90				30		31	95.00		285.00																			95.00		190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6360	002	0	1	18	06	H6360_002_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				2	30		90				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6360	002	0	1	18	06	H6360_002_0	6	2	Generic	3	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	16.00		48.00																			16.00		32.00																16.00				16.00		0.53			0.53			0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H6360	002	0	1	18	06	H6360_002_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	2.00		6.00																			2.00		4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6360	002	0	1	18	06	H6360_002_0	6	2	Generic	1	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	16.00		48.00																			16.00		32.00																16.00				16.00		0.53			0.53			0.52	Preferred Generic, 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				2	30		90				30		31	47.00		141.00																			47.00		94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
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				2	30		90				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, 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				2	30		90				30		31				1762.96	33		33																		33		33															33			33								Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6360	006	0	1	18	06	H6360_006_0	5	2	Generic	1	3	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	18.00		54.00																			18.00		36.00																18.00				18.00		0.60			0.60			0.58	Preferred Generic, 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				2	30		90				30		31	3.00		9.00																			3.00		6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6360	009	0	2	18	06	H6360_009_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H6360	009	0	2	18	06	H6360_009_0	5	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	2.00		6.00																			2.00		4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H6360	009	0	2	18	06	H6360_009_0	5	2	Generic	3	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	16.00		48.00																			16.00		32.00																16.00				16.00		0.53			0.53			0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H6360	009	0	2	18	06	H6360_009_0	5	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		90				2	30		90				30		31				2925.51	33		33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6360	009	0	2	18	06	H6360_009_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6360	009	0	2	18	06	H6360_009_0	5	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				2	30		90				30		31	95.00		285.00																			95.00		190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6360	009	0	2	18	06	H6360_009_0	5	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				2	30		90				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6360	009	0	2	18	06	H6360_009_0	5	2	Generic	1	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	16.00		48.00																			16.00		32.00																16.00				16.00		0.53			0.53			0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6360	009	0	2	18	06	H6360_009_0	5	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	2.00		6.00																			2.00		4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6360	010	0	1	18	06	H6360_010_0	6	6	Vaccines	1	3	000001	1	2	010		01			1	30													30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6360	010	0	1	18	06	H6360_010_0	6	3	Preferred Brand	1	3	000001	1	2	110		01	110		1	30		90				2	30		90				30		31	47.00		141.00																			47.00		94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6360	010	0	1	18	06	H6360_010_0	6	2	Generic	1	3	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	20.00		60.00																			20.00		40.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6360	010	0	1	18	06	H6360_010_0	6	1	Preferred Generic	1	3	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	9.00		27.00																			9.00		18.00																9.00				9.00		0.30			0.30			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6360	010	0	1	18	06	H6360_010_0	6	4	Non-Preferred Brand	1	3	100000	1	2	110		01	110		1	30		90				2	30		90				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6360	010	0	1	18	06	H6360_010_0	6	5	Specialty Tier	1	3	100001	1	1	110		01	110		1	30		90				2	30		90				30		31				2082.31	33		33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6361	001	0	1	01	01	H6361_001_0	6	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	2				30		90	30		34								5.00		12.50					0.00		0.00											5.00		12.50				0.00		0.00				5.00				5.00			0.16	0.00		.16	0.00	.14	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6361	001	0	1	01	01	H6361_001_0	6	2	Generic	1	4	000100	1	2		110	01		110	1				30		90	2				30		90	30		34								10.00		25.00					5.00		12.50											10.00		25.00				5.00		5.00				10.00				10.00			0.33	0.16		.33	.16	.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6361	001	0	1	01	01	H6361_001_0	6	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		34								45.00		112.50					35.00		87.50											45.00		112.50				35.00		70.00				45.00				45.00			1.50	1.16		1.50	1.16	1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6361	001	0	1	01	01	H6361_001_0	6	4	Non-Preferred Brand	1	4	100100	1	2		110	01		110	1				30		90	2				30		90	30		34								85.00		212.50					75.00		187.50											85.00		212.50				75.00		150.00				85.00				85.00			2.83	2.50		2.83	2.50	2.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6361	001	0	1	01	01	H6361_001_0	6	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6435	001	0	1	48	05	H6435_001_0	9	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	9	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			
H6435	001	0	1	48	05	H6435_001_0	9	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			
H6453	001	0	1	01	01	H6453_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	85.00	170.00	255.00																			85.00	170.00	255.00																85.00				85.00		2.83			2.83			2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6453	001	0	1	01	01	H6453_001_0	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				1.00	31																				31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6453	001	0	1	01	01	H6453_001_0	5	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	9.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H6453	001	0	1	01	01	H6453_001_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	40.00	80.00	120.00																			40.00	80.00	120.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6453	001	0	1	01	01	H6453_001_0	5	2	Generic	3	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	30.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H6453	001	0	1	01	01	H6453_001_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	9.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6453	001	0	1	01	01	H6453_001_0	5	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	30.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6453	002	0	1	01	01	H6453_002_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	9.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6453	002	0	1	01	01	H6453_002_0	5	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	30.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6453	002	0	1	01	01	H6453_002_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	40.00	80.00	120.00																			40.00	80.00	120.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6453	002	0	1	01	01	H6453_002_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	85.00	170.00	255.00																			85.00	170.00	255.00																85.00				85.00		2.83			2.83			2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6453	002	0	1	01	01	H6453_002_0	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				1.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6453	002	0	1	01	01	H6453_002_0	5	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	9.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H6453	002	0	1	01	01	H6453_002_0	5	2	Generic	3	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	30.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H6453	003	0	1	01	01	H6453_003_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6453	003	0	1	01	01	H6453_003_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	9.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6453	003	0	1	01	01	H6453_003_0	5	2	Generic	3	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	30.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H6453	003	0	1	01	01	H6453_003_0	5	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	9.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H6453	003	0	1	01	01	H6453_003_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6453	003	0	1	01	01	H6453_003_0	5	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	30.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6453	003	0	1	01	01	H6453_003_0	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				1.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6453	004	0	1	01	01	H6453_004_0	5	2	Generic	3	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	30.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H6453	004	0	1	01	01	H6453_004_0	5	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	9.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H6453	004	0	1	01	01	H6453_004_0	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				1.00	28																				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6453	004	0	1	01	01	H6453_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	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6453	004	0	1	01	01	H6453_004_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6453	004	0	1	01	01	H6453_004_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	9.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6453	004	0	1	01	01	H6453_004_0	5	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	30.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6528	006	0	1	04	01	H6528_006_0	2	4	Non-Preferred Brand	1	3	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6528	006	0	1	04	01	H6528_006_0	2	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6528	006	0	1	04	01	H6528_006_0	2	2	Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		.40						.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6528	006	0	1	04	01	H6528_006_0	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		.06						.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6528	006	0	1	04	01	H6528_006_0	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31				488.00	30		30																										30						30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6528	016	0	1	04	01	H6528_016_0	2	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6528	016	0	1	04	01	H6528_016_0	2	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6528	016	0	1	04	01	H6528_016_0	2	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		.40						.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6528	016	0	1	04	01	H6528_016_0	2	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		.13						.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6528	016	0	1	04	01	H6528_016_0	2	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				487.00	26		26																										26						26			26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6528	029	0	1	04	01	H6528_029_0	2	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		.13						.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6528	029	0	1	04	01	H6528_029_0	2	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		.40						.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6528	029	0	1	04	01	H6528_029_0	2	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6528	029	0	1	04	01	H6528_029_0	2	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6528	029	0	1	04	01	H6528_029_0	2	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				491.00	26		26																										26						26			26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6528	030	0	1	04	01	H6528_030_0	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		.06						.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6528	030	0	1	04	01	H6528_030_0	2	2	Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		.40						.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6528	030	0	1	04	01	H6528_030_0	2	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6528	030	0	1	04	01	H6528_030_0	2	4	Non-Preferred Brand	1	3	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6528	030	0	1	04	01	H6528_030_0	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31				414.00	26		26																										26						26			26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	001	0	1	04	01	H6609_001_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	001	0	1	04	01	H6609_001_0	4	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.66				0.66	0.66	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	001	0	1	04	01	H6609_001_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	001	0	1	04	01	H6609_001_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	001	0	1	04	01	H6609_001_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	001	0	1	04	01	H6609_001_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	001	0	1	04	01	H6609_001_0	4	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.66				0.66	0.66	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	001	0	1	04	01	H6609_001_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	001	0	1	04	01	H6609_001_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	001	0	1	04	01	H6609_001_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	003	0	1	04	01	H6609_003_0	3	2	Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, 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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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, 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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, 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	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	009	0	1	04	01	H6609_009_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, 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	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, 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	95.00		285.00																									95.00		285.00				95.00		275.00				95.00				95.00		3.16				3.16	3.16	3.06	Preferred Generic, 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, 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	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	009	0	1	04	01	H6609_009_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, 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	95.00		285.00																									95.00		285.00				95.00		275.00				95.00				95.00		3.16				3.16	3.16	3.06	Preferred Generic, 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	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	013	0	1	04	01	H6609_013_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, 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	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, 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	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	95.00		285.00																									95.00		285.00				95.00		275.00				95.00				95.00		3.16				3.16	3.16	3.06	Preferred Generic, 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	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	013	0	1	04	01	H6609_013_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, 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	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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, 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	95.00		285.00																									95.00		285.00				95.00		275.00				95.00				95.00		3.16				3.16	3.16	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	017	0	1	04	01	H6609_017_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	017	0	1	04	01	H6609_017_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.66				0.66	0.66	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	017	0	1	04	01	H6609_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	017	0	1	04	01	H6609_017_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	017	0	1	04	01	H6609_017_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	017	0	1	04	01	H6609_017_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.66				0.66	0.66	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	017	0	1	04	01	H6609_017_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	017	0	1	04	01	H6609_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	017	0	1	04	01	H6609_017_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	017	0	1	04	01	H6609_017_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	019	0	1	04	01	H6609_019_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	019	0	1	04	01	H6609_019_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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, 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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	029	0	1	04	01	H6609_029_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	18.00		54.00																									18.00		54.00				18.00		0.00				18.00				18.00		0.60				0.60	0.60	0.58	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, 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, 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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	029	0	1	04	01	H6609_029_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	18.00		54.00																									18.00		54.00				18.00		0.00				18.00				18.00		0.60				0.60	0.60	0.58	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	075	0	1	04	01	H6609_075_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	18.00		54.00																									18.00		54.00				18.00		0.00				18.00				18.00		0.60				0.60	0.60	0.58	Preferred Generic, 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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	075	0	1	04	01	H6609_075_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	18.00		54.00																									18.00		54.00				18.00		0.00				18.00				18.00		0.60				0.60	0.60	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, 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, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	077	0	1	04	01	H6609_077_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, 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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	077	0	1	04	01	H6609_077_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, 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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	078	0	1	04	01	H6609_078_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	078	0	1	04	01	H6609_078_0	4	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	078	0	1	04	01	H6609_078_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	078	0	1	04	01	H6609_078_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	078	0	1	04	01	H6609_078_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	078	0	1	04	01	H6609_078_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	078	0	1	04	01	H6609_078_0	4	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	078	0	1	04	01	H6609_078_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	078	0	1	04	01	H6609_078_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	078	0	1	04	01	H6609_078_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	080	0	1	04	01	H6609_080_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	080	0	1	04	01	H6609_080_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	080	0	1	04	01	H6609_080_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	080	0	1	04	01	H6609_080_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	080	0	1	04	01	H6609_080_0	4	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		0.00				12.00				12.00		0.40				0.40	0.40	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	080	0	1	04	01	H6609_080_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	080	0	1	04	01	H6609_080_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	080	0	1	04	01	H6609_080_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	080	0	1	04	01	H6609_080_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	080	0	1	04	01	H6609_080_0	4	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		0.00				12.00				12.00		0.40				0.40	0.40	0.38	Preferred Generic, 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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	081	0	1	04	01	H6609_081_0	4	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, 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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	081	0	1	04	01	H6609_081_0	4	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	081	0	1	04	01	H6609_081_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	082	0	1	04	01	H6609_082_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	082	0	1	04	01	H6609_082_0	4	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	082	0	1	04	01	H6609_082_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	082	0	1	04	01	H6609_082_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	082	0	1	04	01	H6609_082_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	082	0	1	04	01	H6609_082_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	082	0	1	04	01	H6609_082_0	4	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	082	0	1	04	01	H6609_082_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	082	0	1	04	01	H6609_082_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	082	0	1	04	01	H6609_082_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	083	0	1	04	01	H6609_083_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	083	0	1	04	01	H6609_083_0	4	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	083	0	1	04	01	H6609_083_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	083	0	1	04	01	H6609_083_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	083	0	1	04	01	H6609_083_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	083	0	1	04	01	H6609_083_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	083	0	1	04	01	H6609_083_0	4	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	083	0	1	04	01	H6609_083_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	083	0	1	04	01	H6609_083_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	083	0	1	04	01	H6609_083_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	084	0	1	04	01	H6609_084_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	084	0	1	04	01	H6609_084_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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, 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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	085	0	1	04	01	H6609_085_0	4	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	085	0	1	04	01	H6609_085_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	085	0	1	04	01	H6609_085_0	4	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	086	0	1	04	01	H6609_086_0	4	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	086	0	1	04	01	H6609_086_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	086	0	1	04	01	H6609_086_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	086	0	1	04	01	H6609_086_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	086	0	1	04	01	H6609_086_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	086	0	1	04	01	H6609_086_0	4	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	086	0	1	04	01	H6609_086_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	086	0	1	04	01	H6609_086_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	086	0	1	04	01	H6609_086_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	086	0	1	04	01	H6609_086_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	088	0	1	04	01	H6609_088_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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					26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	088	0	1	04	01	H6609_088_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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					26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	089	0	1	04	01	H6609_089_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	089	0	1	04	01	H6609_089_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	089	0	1	04	01	H6609_089_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	089	0	1	04	01	H6609_089_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	089	0	1	04	01	H6609_089_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	089	0	1	04	01	H6609_089_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	089	0	1	04	01	H6609_089_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	089	0	1	04	01	H6609_089_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	089	0	1	04	01	H6609_089_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	089	0	1	04	01	H6609_089_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	090	0	1	04	01	H6609_090_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	090	0	1	04	01	H6609_090_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	090	0	1	04	01	H6609_090_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	090	0	1	04	01	H6609_090_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	090	0	1	04	01	H6609_090_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	090	0	1	04	01	H6609_090_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	090	0	1	04	01	H6609_090_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	090	0	1	04	01	H6609_090_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	090	0	1	04	01	H6609_090_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	090	0	1	04	01	H6609_090_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	091	0	1	04	01	H6609_091_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	091	0	1	04	01	H6609_091_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	091	0	1	04	01	H6609_091_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	091	0	1	04	01	H6609_091_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	091	0	1	04	01	H6609_091_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	091	0	1	04	01	H6609_091_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	091	0	1	04	01	H6609_091_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	091	0	1	04	01	H6609_091_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	091	0	1	04	01	H6609_091_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	091	0	1	04	01	H6609_091_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	092	0	1	04	01	H6609_092_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	092	0	1	04	01	H6609_092_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	095	0	1	04	01	H6609_095_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	095	0	1	04	01	H6609_095_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	095	0	1	04	01	H6609_095_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	095	0	1	04	01	H6609_095_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	095	0	1	04	01	H6609_095_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	095	0	1	04	01	H6609_095_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	095	0	1	04	01	H6609_095_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	095	0	1	04	01	H6609_095_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	095	0	1	04	01	H6609_095_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	095	0	1	04	01	H6609_095_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	096	0	1	04	01	H6609_096_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	096	0	1	04	01	H6609_096_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	096	0	1	04	01	H6609_096_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	096	0	1	04	01	H6609_096_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	096	0	1	04	01	H6609_096_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	096	0	1	04	01	H6609_096_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	096	0	1	04	01	H6609_096_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	096	0	1	04	01	H6609_096_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	096	0	1	04	01	H6609_096_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	096	0	1	04	01	H6609_096_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	097	0	1	04	01	H6609_097_0	4	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	097	0	1	04	01	H6609_097_0	4	2	Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	097	0	1	04	01	H6609_097_0	4	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	097	0	1	04	01	H6609_097_0	4	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	097	0	1	04	01	H6609_097_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, 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, 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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	098	0	1	04	01	H6609_098_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	098	0	1	04	01	H6609_098_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, 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, 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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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					27																										27						27					27			27								Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	099	0	1	04	01	H6609_099_0	3	2	Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, 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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	100	0	1	04	01	H6609_100_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, 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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	100	0	1	04	01	H6609_100_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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, 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, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	102	0	1	04	01	H6609_102_0	3	2	Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.66				0.66	0.66	0.64	Preferred Generic, 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	8.00		24.00																									8.00		24.00				8.00		0.00				8.00				8.00		0.26				0.26	0.26	0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	103	0	1	04	01	H6609_103_0	3	2	Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, 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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	104	0	1	04	01	H6609_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	104	0	1	04	01	H6609_104_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	11.00		33.00																									11.00		33.00				11.00		0.00				11.00				11.00		0.36				0.36	0.36	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	104	0	1	04	01	H6609_104_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	104	0	1	04	01	H6609_104_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	104	0	1	04	01	H6609_104_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	104	0	1	04	01	H6609_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	104	0	1	04	01	H6609_104_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	104	0	1	04	01	H6609_104_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	104	0	1	04	01	H6609_104_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	11.00		33.00																									11.00		33.00				11.00		0.00				11.00				11.00		0.36				0.36	0.36	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	104	0	1	04	01	H6609_104_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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, 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	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	105	0	1	04	01	H6609_105_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		0.00				12.00				12.00		0.40				0.40	0.40	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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, 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	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	105	0	1	04	01	H6609_105_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		0.00				12.00				12.00		0.40				0.40	0.40	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	106	0	1	04	01	H6609_106_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	106	0	1	04	01	H6609_106_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	106	0	1	04	01	H6609_106_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	106	0	1	04	01	H6609_106_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	106	0	1	04	01	H6609_106_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	106	0	1	04	01	H6609_106_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	106	0	1	04	01	H6609_106_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	106	0	1	04	01	H6609_106_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	106	0	1	04	01	H6609_106_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	106	0	1	04	01	H6609_106_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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, 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	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	107	0	1	04	01	H6609_107_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	107	0	1	04	01	H6609_107_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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					28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	108	0	1	04	01	H6609_108_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		0.00				12.00				12.00		0.40				0.40	0.40	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, 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					28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	108	0	1	04	01	H6609_108_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		0.00				12.00				12.00		0.40				0.40	0.40	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, 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, 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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, 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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	110	0	1	04	01	H6609_110_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	110	0	1	04	01	H6609_110_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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								Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	112	0	1	04	01	H6609_112_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	112	0	1	04	01	H6609_112_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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								Preferred Generic, 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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	112	0	1	04	01	H6609_112_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, 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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	113	0	1	04	01	H6609_113_0	3	2	Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		0.00				12.00				12.00		0.40				0.40	0.40	0.38	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, 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					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	115	0	1	04	01	H6609_115_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	115	0	1	04	01	H6609_115_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	115	0	1	04	01	H6609_115_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	115	0	1	04	01	H6609_115_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	115	0	1	04	01	H6609_115_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	115	0	1	04	01	H6609_115_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	115	0	1	04	01	H6609_115_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	115	0	1	04	01	H6609_115_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	115	0	1	04	01	H6609_115_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	115	0	1	04	01	H6609_115_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	116	0	1	04	01	H6609_116_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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, 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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	116	0	1	04	01	H6609_116_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	117	0	1	04	01	H6609_117_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	117	0	1	04	01	H6609_117_0	4	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	117	0	1	04	01	H6609_117_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	117	0	1	04	01	H6609_117_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	117	0	1	04	01	H6609_117_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	117	0	1	04	01	H6609_117_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	117	0	1	04	01	H6609_117_0	4	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	117	0	1	04	01	H6609_117_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	117	0	1	04	01	H6609_117_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	117	0	1	04	01	H6609_117_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	118	0	1	04	01	H6609_118_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	118	0	1	04	01	H6609_118_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	118	0	1	04	01	H6609_118_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	118	0	1	04	01	H6609_118_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	118	0	1	04	01	H6609_118_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	118	0	1	04	01	H6609_118_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	118	0	1	04	01	H6609_118_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	118	0	1	04	01	H6609_118_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	118	0	1	04	01	H6609_118_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	118	0	1	04	01	H6609_118_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	119	0	1	04	01	H6609_119_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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, 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, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	119	0	1	04	01	H6609_119_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	120	0	1	04	01	H6609_120_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	95.00		285.00																									95.00		285.00				95.00		275.00				95.00				95.00		3.16				3.16	3.16	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	120	0	1	04	01	H6609_120_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	120	0	1	04	01	H6609_120_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	120	0	1	04	01	H6609_120_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	120	0	1	04	01	H6609_120_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	120	0	1	04	01	H6609_120_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	120	0	1	04	01	H6609_120_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	95.00		285.00																									95.00		285.00				95.00		275.00				95.00				95.00		3.16				3.16	3.16	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	120	0	1	04	01	H6609_120_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	120	0	1	04	01	H6609_120_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	120	0	1	04	01	H6609_120_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	121	0	1	04	01	H6609_121_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		0.00				12.00				12.00		0.40				0.40	0.40	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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					29																										29						29					29			29								Preferred Generic, 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					29																										29						29					29			29								Preferred Generic, 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	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	121	0	1	04	01	H6609_121_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		0.00				12.00				12.00		0.40				0.40	0.40	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	122	0	1	04	01	H6609_122_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	122	0	1	04	01	H6609_122_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	122	0	1	04	01	H6609_122_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	122	0	1	04	01	H6609_122_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	122	0	1	04	01	H6609_122_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	122	0	1	04	01	H6609_122_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	122	0	1	04	01	H6609_122_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	122	0	1	04	01	H6609_122_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	122	0	1	04	01	H6609_122_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	122	0	1	04	01	H6609_122_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	123	0	1	04	01	H6609_123_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	8.00		24.00																									8.00		24.00				8.00		0.00				8.00				8.00		0.26				0.26	0.26	0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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					26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	8.00		24.00																									8.00		24.00				8.00		0.00				8.00				8.00		0.26				0.26	0.26	0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	123	0	1	04	01	H6609_123_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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					26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	124	0	1	04	01	H6609_124_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	124	0	1	04	01	H6609_124_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	124	0	1	04	01	H6609_124_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	124	0	1	04	01	H6609_124_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	124	0	1	04	01	H6609_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	124	0	1	04	01	H6609_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	124	0	1	04	01	H6609_124_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	124	0	1	04	01	H6609_124_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	124	0	1	04	01	H6609_124_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	124	0	1	04	01	H6609_124_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	125	0	1	04	01	H6609_125_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	125	0	1	04	01	H6609_125_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	18.00		54.00																									18.00		54.00				18.00		0.00				18.00				18.00		0.60				0.60	0.60	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	125	0	1	04	01	H6609_125_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	125	0	1	04	01	H6609_125_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	125	0	1	04	01	H6609_125_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	125	0	1	04	01	H6609_125_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	125	0	1	04	01	H6609_125_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	18.00		54.00																									18.00		54.00				18.00		0.00				18.00				18.00		0.60				0.60	0.60	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	125	0	1	04	01	H6609_125_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	125	0	1	04	01	H6609_125_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	125	0	1	04	01	H6609_125_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	8.00		24.00																									8.00		24.00				8.00		0.00				8.00				8.00		0.26				0.26	0.26	0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	126	0	1	04	01	H6609_126_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	126	0	1	04	01	H6609_126_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	8.00		24.00																									8.00		24.00				8.00		0.00				8.00				8.00		0.26				0.26	0.26	0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	126	0	1	04	01	H6609_126_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	127	0	1	04	01	H6609_127_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	127	0	1	04	01	H6609_127_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	127	0	1	04	01	H6609_127_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	127	0	1	04	01	H6609_127_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	127	0	1	04	01	H6609_127_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	127	0	1	04	01	H6609_127_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	127	0	1	04	01	H6609_127_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	127	0	1	04	01	H6609_127_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	127	0	1	04	01	H6609_127_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	127	0	1	04	01	H6609_127_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	128	0	1	04	01	H6609_128_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	128	0	1	04	01	H6609_128_0	3	2	Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	128	0	1	04	01	H6609_128_0	3	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	128	0	1	04	01	H6609_128_0	3	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	128	0	1	04	01	H6609_128_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	129	0	1	04	01	H6609_129_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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					28																										28						28					28			28								Preferred Generic, 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	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	129	0	1	04	01	H6609_129_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, 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					28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	130	0	1	04	01	H6609_130_0	3	2	Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, 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					26																										26						26					26			26								Preferred Generic, 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	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	131	0	1	04	01	H6609_131_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	9.00		27.00																									9.00		27.00				9.00		0.00				9.00				9.00		0.30				0.30	0.30	0.29	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, 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					28																										28						28					28			28								Preferred Generic, 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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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					28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	131	0	1	04	01	H6609_131_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	9.00		27.00																									9.00		27.00				9.00		0.00				9.00				9.00		0.30				0.30	0.30	0.29	Preferred Generic, 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	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	132	0	1	04	01	H6609_132_0	3	2	Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		0.00				12.00				12.00		0.40				0.40	0.40	0.38	Preferred Generic, 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	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, 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, 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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	133	0	1	04	01	H6609_133_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, 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					28																										28						28					28			28								Preferred Generic, 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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	133	0	1	04	01	H6609_133_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, 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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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					28																										28						28					28			28								Preferred Generic, 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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	135	0	1	04	01	H6609_135_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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					28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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					28																										28						28					28			28								Preferred Generic, 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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	135	0	1	04	01	H6609_135_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	137	0	1	04	01	H6609_137_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	137	0	1	04	01	H6609_137_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	138	0	1	04	01	H6609_138_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	18.00		54.00																									18.00		54.00				18.00		0.00				18.00				18.00		0.60				0.60	0.60	0.58	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	138	0	1	04	01	H6609_138_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	18.00		54.00																									18.00		54.00				18.00		0.00				18.00				18.00		0.60				0.60	0.60	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	140	0	1	04	01	H6609_140_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	140	0	1	04	01	H6609_140_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	140	0	1	04	01	H6609_140_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	18.00		54.00																									18.00		54.00				18.00		0.00				18.00				18.00		0.60				0.60	0.60	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	140	0	1	04	01	H6609_140_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	140	0	1	04	01	H6609_140_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	140	0	1	04	01	H6609_140_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	140	0	1	04	01	H6609_140_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	140	0	1	04	01	H6609_140_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	18.00		54.00																									18.00		54.00				18.00		0.00				18.00				18.00		0.60				0.60	0.60	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	140	0	1	04	01	H6609_140_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	140	0	1	04	01	H6609_140_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	142	1	1	04	01	H6609_142_1	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	142	1	1	04	01	H6609_142_1	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	142	1	1	04	01	H6609_142_1	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	142	1	1	04	01	H6609_142_1	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	142	1	1	04	01	H6609_142_1	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	142	1	1	04	01	H6609_142_1	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	142	1	1	04	01	H6609_142_1	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	142	1	1	04	01	H6609_142_1	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	142	1	1	04	01	H6609_142_1	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	142	1	1	04	01	H6609_142_1	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	142	2	1	04	01	H6609_142_2	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	142	2	1	04	01	H6609_142_2	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	142	2	1	04	01	H6609_142_2	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	142	2	1	04	01	H6609_142_2	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	142	2	1	04	01	H6609_142_2	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	142	2	1	04	01	H6609_142_2	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	142	2	1	04	01	H6609_142_2	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	142	2	1	04	01	H6609_142_2	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	142	2	1	04	01	H6609_142_2	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	142	2	1	04	01	H6609_142_2	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	143	0	1	04	01	H6609_143_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	143	0	1	04	01	H6609_143_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	143	0	1	04	01	H6609_143_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	143	0	1	04	01	H6609_143_0	4	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	143	0	1	04	01	H6609_143_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	143	0	1	04	01	H6609_143_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	143	0	1	04	01	H6609_143_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	143	0	1	04	01	H6609_143_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	143	0	1	04	01	H6609_143_0	4	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	143	0	1	04	01	H6609_143_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	144	1	1	04	01	H6609_144_1	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	144	1	1	04	01	H6609_144_1	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	144	1	1	04	01	H6609_144_1	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	144	1	1	04	01	H6609_144_1	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	144	1	1	04	01	H6609_144_1	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	144	1	1	04	01	H6609_144_1	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	144	1	1	04	01	H6609_144_1	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	144	1	1	04	01	H6609_144_1	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	144	1	1	04	01	H6609_144_1	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	144	1	1	04	01	H6609_144_1	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	144	2	1	04	01	H6609_144_2	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	144	2	1	04	01	H6609_144_2	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	144	2	1	04	01	H6609_144_2	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	144	2	1	04	01	H6609_144_2	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	144	2	1	04	01	H6609_144_2	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	144	2	1	04	01	H6609_144_2	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	144	2	1	04	01	H6609_144_2	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	144	2	1	04	01	H6609_144_2	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	144	2	1	04	01	H6609_144_2	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	144	2	1	04	01	H6609_144_2	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	145	0	1	04	01	H6609_145_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00		9.00																									3.00		9.00				3.00		0.00				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	145	0	1	04	01	H6609_145_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	145	0	1	04	01	H6609_145_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	145	0	1	04	01	H6609_145_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		0.00				12.00				12.00		0.40				0.40	0.40	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	145	0	1	04	01	H6609_145_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	145	0	1	04	01	H6609_145_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	145	0	1	04	01	H6609_145_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	145	0	1	04	01	H6609_145_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	145	0	1	04	01	H6609_145_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		0.00				12.00				12.00		0.40				0.40	0.40	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	145	0	1	04	01	H6609_145_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00		9.00																									3.00		9.00				3.00		0.00				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	146	0	1	04	01	H6609_146_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	146	0	1	04	01	H6609_146_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	95.00		285.00																									95.00		285.00				95.00		275.00				95.00				95.00		3.16				3.16	3.16	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	146	0	1	04	01	H6609_146_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	146	0	1	04	01	H6609_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	146	0	1	04	01	H6609_146_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6609	146	0	1	04	01	H6609_146_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	146	0	1	04	01	H6609_146_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	95.00		285.00																									95.00		285.00				95.00		275.00				95.00				95.00		3.16				3.16	3.16	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6609	146	0	1	04	01	H6609_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	146	0	1	04	01	H6609_146_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6609	146	0	1	04	01	H6609_146_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6622	001	0	1	01	01	H6622_001_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, 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	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6622	001	0	1	01	01	H6622_001_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6622	002	0	1	01	01	H6622_002_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, 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, 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	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6622	002	0	1	01	01	H6622_002_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6622	004	0	1	01	01	H6622_004_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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					27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6622	004	0	1	01	01	H6622_004_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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					27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6622	005	0	1	01	01	H6622_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6622	005	0	1	01	01	H6622_005_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6622	005	0	1	01	01	H6622_005_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6622	005	0	1	01	01	H6622_005_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6622	005	0	1	01	01	H6622_005_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6622	005	0	1	01	01	H6622_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6622	005	0	1	01	01	H6622_005_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6622	005	0	1	01	01	H6622_005_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6622	005	0	1	01	01	H6622_005_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6622	005	0	1	01	01	H6622_005_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6622	007	0	1	01	01	H6622_007_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6622	007	0	1	01	01	H6622_007_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6622	007	0	1	01	01	H6622_007_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6622	007	0	1	01	01	H6622_007_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6622	007	0	1	01	01	H6622_007_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6622	007	0	1	01	01	H6622_007_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6622	007	0	1	01	01	H6622_007_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6622	007	0	1	01	01	H6622_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6622	007	0	1	01	01	H6622_007_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6622	007	0	1	01	01	H6622_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6622	009	0	1	01	01	H6622_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6622	009	0	1	01	01	H6622_009_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6622	009	0	1	01	01	H6622_009_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6622	009	0	1	01	01	H6622_009_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6622	009	0	1	01	01	H6622_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6622	009	0	1	01	01	H6622_009_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6622	009	0	1	01	01	H6622_009_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6622	009	0	1	01	01	H6622_009_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6622	009	0	1	01	01	H6622_009_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6622	009	0	1	01	01	H6622_009_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6622	010	0	1	01	01	H6622_010_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6622	010	0	1	01	01	H6622_010_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6622	010	0	1	01	01	H6622_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6622	010	0	1	01	01	H6622_010_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6622	010	0	1	01	01	H6622_010_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6622	010	0	1	01	01	H6622_010_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6622	010	0	1	01	01	H6622_010_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6622	010	0	1	01	01	H6622_010_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6622	010	0	1	01	01	H6622_010_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6622	010	0	1	01	01	H6622_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6723	001	1	1	01	01	H6723_001_1	5	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	4.00	6.00	8.00																			4.00	6.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H6723	001	1	1	01	01	H6723_001_1	5	5	Specialty Tier	1	4	100101	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31				198.00	29	29	29																		29	29	29															29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6723	001	1	1	01	01	H6723_001_1	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	100.00	150.00	200.00																			100.00	150.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6723	001	1	1	01	01	H6723_001_1	5	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	71.00	94.00																			47.00	71.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6723	001	1	1	01	01	H6723_001_1	5	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	17.00	26.00	34.00																			17.00	26.00	34.00																17.00				17.00		0.57			0.57			0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6723	001	1	1	01	01	H6723_001_1	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	4.00	6.00	8.00																			4.00	6.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6723	001	1	1	01	01	H6723_001_1	5	2	Generic	3	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	17.00	26.00	34.00																			17.00	26.00	34.00																17.00				17.00		0.57			0.57			0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H6723	001	2	1	01	01	H6723_001_2	5	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	4.00	6.00	8.00																			4.00	6.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H6723	001	2	1	01	01	H6723_001_2	5	5	Specialty Tier	1	4	100101	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31				198.00	29	29	29																		29	29	29															29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6723	001	2	1	01	01	H6723_001_2	5	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	100.00	150.00	200.00																			100.00	150.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6723	001	2	1	01	01	H6723_001_2	5	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	71.00	94.00																			47.00	71.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6723	001	2	1	01	01	H6723_001_2	5	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	17.00	26.00	34.00																			17.00	26.00	34.00																17.00				17.00		0.57			0.57			0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6723	001	2	1	01	01	H6723_001_2	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	4.00	6.00	8.00																			4.00	6.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6723	001	2	1	01	01	H6723_001_2	5	2	Generic	3	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	17.00	26.00	34.00																			17.00	26.00	34.00																17.00				17.00		0.57			0.57			0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H6723	002	1	1	01	01	H6723_002_1	7	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6723	002	1	1	01	01	H6723_002_1	7	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	12.00	18.00	24.00																			12.00	18.00	24.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6723	002	1	1	01	01	H6723_002_1	7	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	71.00	94.00																			47.00	71.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6723	002	1	1	01	01	H6723_002_1	7	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	100.00	150.00	200.00																			100.00	150.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6723	002	1	1	01	01	H6723_002_1	7	5	Specialty Tier	1	4	100101	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31				198.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6723	002	1	1	01	01	H6723_002_1	7	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H6723	002	1	1	01	01	H6723_002_1	7	2	Generic	3	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	12.00	18.00	24.00																			12.00	18.00	24.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H6723	002	2	1	01	01	H6723_002_2	7	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6723	002	2	1	01	01	H6723_002_2	7	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	12.00	18.00	24.00																			12.00	18.00	24.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6723	002	2	1	01	01	H6723_002_2	7	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	71.00	94.00																			47.00	71.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6723	002	2	1	01	01	H6723_002_2	7	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	100.00	150.00	200.00																			100.00	150.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6723	002	2	1	01	01	H6723_002_2	7	5	Specialty Tier	1	4	100101	1	1	111		01	111		1	30	60	90				1	30	60	90				30		31				198.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6723	002	2	1	01	01	H6723_002_2	7	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H6723	002	2	1	01	01	H6723_002_2	7	2	Generic	3	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	12.00	18.00	24.00																			12.00	18.00	24.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H6743	001	0	1	04	01	H6743_001_0	7	5	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31				563.07	33		33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6743	001	0	1	04	01	H6743_001_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6743	001	0	1	04	01	H6743_001_0	7	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	95.00		190.00																			95.00		190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6743	001	0	1	04	01	H6743_001_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				1	30		90				30		31	45.00		90.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6743	001	0	1	04	01	H6743_001_0	7	2	Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	20.00		40.00																			20.00		40.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6743	001	0	1	04	01	H6743_001_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	10.00		20.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6743	003	0	1	04	01	H6743_003_0	7	5	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31				650.18	29		29																		29		29															29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6743	003	0	1	04	01	H6743_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6743	003	0	1	04	01	H6743_003_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	6.00		12.00																			6.00		12.00																6.00				6.00		0.20			0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6743	003	0	1	04	01	H6743_003_0	7	2	Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	15.00		30.00																			15.00		30.00																15.00				15.00		.50			.50			.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6743	003	0	1	04	01	H6743_003_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				1	30		90				30		31	40.00		80.00																			40.00		80.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6743	003	0	1	04	01	H6743_003_0	7	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	85.00		170.00																			85.00		170.00																85.00				85.00		2.83			2.83			2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6743	004	0	1	04	01	H6743_004_0	7	5	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31				813.56	33		33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6743	004	0	1	04	01	H6743_004_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6743	004	0	1	04	01	H6743_004_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	4.00		8.00																			4.00		8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6743	004	0	1	04	01	H6743_004_0	7	2	Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	10.00		20.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6743	004	0	1	04	01	H6743_004_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				1	30		90				30		31	35.00		70.00																			35.00		70.00																35.00				35.00		1.17			1.17			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6743	004	0	1	04	01	H6743_004_0	7	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	75.00		150.00																			75.00		150.00																75.00				75.00		2.50			2.50			2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6743	007	0	1	04	01	H6743_007_0	7	5	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31				912.25	33		33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6743	007	0	1	04	01	H6743_007_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6743	007	0	1	04	01	H6743_007_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	10.00		20.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6743	007	0	1	04	01	H6743_007_0	7	2	Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	20.00		40.00																			20.00		40.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6743	007	0	1	04	01	H6743_007_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				1	30		90				30		31	45.00		90.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6743	007	0	1	04	01	H6743_007_0	7	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	95.00		190.00																			95.00		190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6743	014	0	1	04	01	H6743_014_0	6	5	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31				789.83	29		29																		29		29															29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6743	014	0	1	04	01	H6743_014_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	10.00		20.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6743	014	0	1	04	01	H6743_014_0	6	2	Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	20.00		40.00																			20.00		40.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6743	014	0	1	04	01	H6743_014_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				1	30		90				30		31	45.00		90.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6743	014	0	1	04	01	H6743_014_0	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	95.00		190.00																			95.00		190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6743	014	0	1	04	01	H6743_014_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, 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	6.00		12.00																			6.00		12.00																6.00				6.00		.20			.20			.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6743	016	0	1	04	01	H6743_016_0	6	2	Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	15.00		30.00																			15.00		30.00																15.00				15.00		.50			.50			.48	Preferred Generic, 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	40.00		80.00																			40.00		80.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, 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	85.00		170.00																			85.00		170.00																85.00				85.00		2.83			2.83			2.74	Preferred Generic, 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				996.45	33		33																		33		33															33			33								Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6743	017	0	1	04	01	H6743_017_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	4.00		8.00																			4.00		8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6743	017	0	1	04	01	H6743_017_0	7	2	Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	10.00		20.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6743	017	0	1	04	01	H6743_017_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6743	017	0	1	04	01	H6743_017_0	7	5	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31				785.99	33		33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6743	017	0	1	04	01	H6743_017_0	7	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	75.00		150.00																			75.00		150.00																75.00				75.00		2.50			2.50			2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6743	017	0	1	04	01	H6743_017_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				1	30		90				30		31	35.00		70.00																			35.00		70.00																35.00				35.00		1.17			1.17			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H6745	001	0	1	01	01	H6745_001_0	7	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								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6745	001	0	1	01	01	H6745_001_0	7	3	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6745	001	0	1	01	01	H6745_001_0	7	2	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	33.00	66.00	99.00																			33.00	66.00	99.00																33.00				33.00		1.10			1.10			1.06	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6745	001	0	1	01	01	H6745_001_0	7	1	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6745	003	0	1	01	01	H6745_003_0	6	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6745	003	0	1	01	01	H6745_003_0	6	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6745	003	0	1	01	01	H6745_003_0	6	2	Generic	1	2	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6745	003	0	1	01	01	H6745_003_0	6	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6745	003	0	1	01	01	H6745_003_0	6	1	Preferred Generic	1	2	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, 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	0.00		0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	001	0	1	01	01	H6750_001_0	8	2	Generic	1	4	000100	3	2	110		01	111		1	30		90				1	30	60	90				30		31	10.00		30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, 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	47.00		141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	001	0	1	01	01	H6750_001_0	8	2	Generic	3	4	000100	3	2	110		01	111		1	30		90				1	30	60	90				30		31	10.00		30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, 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				300.00	33		33																		33	33	33															33			33								Preferred Generic, 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	0.00		0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
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	100.00		300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	002	0	1	01	01	H6750_002_0	8	2	Generic	1	4	000100	3	2	110		01	111		1	30		90				1	30	60	90				30		31	10.00		30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, 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	47.00		141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, 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	100.00		300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, 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				300.00	33		33																		33	33	33															33			33								Preferred Generic, 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	0.00		0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6751	001	0	1	48	05	H6751_001_0	6	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			
H6751	001	0	1	48	05	H6751_001_0	6	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			
H6786	002	0	1	04	01	H6786_002_0	8	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6786	002	0	1	04	01	H6786_002_0	8	5	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34											1321.97	26						1321.97	26						26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6786	002	0	1	04	01	H6786_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6786	002	0	1	04	01	H6786_002_0	8	2	Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6786	002	0	1	04	01	H6786_002_0	8	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00	9.00	9.00																8.00				8.00			0.27	0.10	0.10			0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6786	002	0	1	04	01	H6786_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								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6801	002	0	1	01	01	H6801_002_0	7	3	Preferred Brand	1	4	010001	1	2	110		01	100		1	30		90				1			90				30		31	39.00		117.00																					117.00																39.00				39.00		1.30						1.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6801	002	0	1	01	01	H6801_002_0	7	4	Non-Preferred Brand	1	4	110000	1	2	110		01	100		1	30		90				1			90				30		31	95.00		285.00																					285.00																95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6801	002	0	1	01	01	H6801_002_0	7	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31				1330.00	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6801	002	0	1	01	01	H6801_002_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H6801	002	0	1	01	01	H6801_002_0	7	2	Generic	3	4	000110	1	2	110		01	100		1	30		90				1			90				30		31	11.00		33.00																					33.00																11.00				11.00		0.37						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H6801	002	0	1	01	01	H6801_002_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6801	002	0	1	01	01	H6801_002_0	7	2	Generic	1	4	000110	1	2	110		01	100		1	30		90				1			90				30		31	11.00		33.00																					33.00																11.00				11.00		0.37						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6801	006	0	1	02	01	H6801_006_0	8	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6801	006	0	1	02	01	H6801_006_0	8	2	Generic	1	4	000110	1	2	110		01	100		1	30		90				1			90				30		31	11.00		33.00																					33.00																11.00				11.00		0.37						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6801	006	0	1	02	01	H6801_006_0	8	3	Preferred Brand	1	4	010001	1	2	110		01	100		1	30		90				1			90				30		31	39.00		117.00																					117.00																39.00				39.00		1.30						1.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6801	006	0	1	02	01	H6801_006_0	8	2	Generic	3	4	000110	1	2	110		01	100		1	30		90				1			90				30		31	11.00		33.00																					33.00																11.00				11.00		0.37						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H6801	006	0	1	02	01	H6801_006_0	8	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				1			90				30		31				1330.00	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6801	006	0	1	02	01	H6801_006_0	8	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H6801	006	0	1	02	01	H6801_006_0	8	4	Non-Preferred Brand	1	4	110000	1	2	110		01	100		1	30		90				1			90				30		31	95.00		285.00																					285.00																95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6815	003	1	1	01	01	H6815_003_1	5	5	Specialty Tier	1	4	010010	1	1		111	01		111	1				30	60	90	1				30	60	90	30		31												30	30	30					30	30	30										30	30	30				30	30	30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6815	003	1	1	01	01	H6815_003_1	5	4	Non-Preferred Brand	1	4	100100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	225.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6815	003	1	1	01	01	H6815_003_1	5	3	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6815	003	1	1	01	01	H6815_003_1	5	2	Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								15.00	30.00	45.00					8.00	16.00	24.00											15.00	30.00	45.00				8.00	16.00	16.00				15.00				15.00			0.50	0.27		0.50	0.27	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6815	003	1	1	01	01	H6815_003_1	5	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	6.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6815	003	1	1	01	01	H6815_003_1	5	6	Select Care Drugs	1	4	010010	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	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6815	003	2	1	01	01	H6815_003_2	5	5	Specialty Tier	1	4	010010	1	1		111	01		111	1				30	60	90	1				30	60	90	30		31												30	30	30					30	30	30										30	30	30				30	30	30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6815	003	2	1	01	01	H6815_003_2	5	4	Non-Preferred Brand	1	4	100100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	225.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6815	003	2	1	01	01	H6815_003_2	5	3	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6815	003	2	1	01	01	H6815_003_2	5	2	Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								15.00	30.00	45.00					8.00	16.00	24.00											15.00	30.00	45.00				8.00	16.00	16.00				15.00				15.00			0.50	0.27		0.50	0.27	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6815	003	2	1	01	01	H6815_003_2	5	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	6.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6815	003	2	1	01	01	H6815_003_2	5	6	Select Care Drugs	1	4	010010	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	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6815	004	1	1	01	01	H6815_004_1	3	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	6.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6815	004	1	1	01	01	H6815_004_1	3	2	Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								15.00	30.00	45.00					8.00	16.00	24.00											15.00	30.00	45.00				8.00	16.00	16.00				15.00				15.00			0.50	0.27		0.50	0.27	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6815	004	1	1	01	01	H6815_004_1	3	3	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6815	004	1	1	01	01	H6815_004_1	3	4	Non-Preferred Brand	1	4	100100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	225.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6815	004	1	1	01	01	H6815_004_1	3	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	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6815	004	1	1	01	01	H6815_004_1	3	6	Select Care Drugs	1	4	010010	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	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6815	004	2	1	01	01	H6815_004_2	3	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	6.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6815	004	2	1	01	01	H6815_004_2	3	2	Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								15.00	30.00	45.00					8.00	16.00	24.00											15.00	30.00	45.00				8.00	16.00	16.00				15.00				15.00			0.50	0.27		0.50	0.27	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6815	004	2	1	01	01	H6815_004_2	3	3	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6815	004	2	1	01	01	H6815_004_2	3	4	Non-Preferred Brand	1	4	100100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	225.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6815	004	2	1	01	01	H6815_004_2	3	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	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6815	004	2	1	01	01	H6815_004_2	3	6	Select Care Drugs	1	4	010010	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	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6859	001	0	1	01	01	H6859_001_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6859	001	0	1	01	01	H6859_001_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6859	003	0	1	01	01	H6859_003_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6859	003	0	1	01	01	H6859_003_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6859	004	0	1	01	01	H6859_004_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, 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					25																										25						25					25			25								Preferred Generic, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6859	004	0	1	01	01	H6859_004_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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					25																										25						25					25			25								Preferred Generic, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H6859	007	0	1	01	01	H6859_007_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6859	007	0	1	01	01	H6859_007_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, 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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H6864	001	0	1	01	01	H6864_001_0	9	1	Preferred Generic	1	2	001000	1	2	111		01	100		1	30	60	90				2			90				30		31	1.00	2.00	3.00																					2.00																1.00				1.00		0.03						0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6864	001	0	1	01	01	H6864_001_0	9	2	Generic	1	2	000100	1	2	111		01	100		1	30	60	90				2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6864	001	0	1	01	01	H6864_001_0	9	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6864	001	0	1	01	01	H6864_001_0	9	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6864	001	0	1	01	01	H6864_001_0	9	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6870	001	0	1	48	05	H6870_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			
H6870	001	0	1	48	05	H6870_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			
H6870	001	0	1	48	05	H6870_001_0	4	2	Brand Drugs	1	4	000010			110		01	100		1	30		90				2			90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H6947	001	0	1	01	01	H6947_001_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	2.00	4.00	5.00																			2.00	4.00	6.00																2.00				2.00		0.06			0.06			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6947	001	0	1	01	01	H6947_001_0	5	4	Non-Preferred Brand	1	4	100000	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31				90.31	35	35	35																		35	35	35															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6947	001	0	1	01	01	H6947_001_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	38.00	76.00	95.00																			38.00	76.00	114.00																38.00				38.00		1.23			1.23			1.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6947	001	0	1	01	01	H6947_001_0	5	2	Generic	1	4	000100	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	10.00	20.00	25.00																			10.00	20.00	30.00																10.00				10.00		0.32			0.32			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6947	001	0	1	01	01	H6947_001_0	5	5	Specialty Tier	1	4	000010	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31					33	33	33																		33	33	33															33			33								Preferred Generic, 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	30																				30																	30			30								Preferred Generic, 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	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.45			1.45			1.45	Preferred Generic, 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	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.06			3.06			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6951	002	0	1	04	01	H6951_002_0	6	2	Generic	1	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	12.00	24.00	36.00																			12.00	24.00	36.00																12.00				12.00		0.39			0.39			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	3.00	6.00	9.00																			2.00	4.00	6.00																3.00				3.00		0.10			0.06			0.10	Preferred Generic, 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	95.00	190.00	285.00																			95.00		285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6972	001	0	1	01	01	H6972_001_0	4	3	Preferred Brand	1	4	000101	1	2	111		01	110		1	30	60	90				2	30		90				30		31	45.00	90.00	135.00																			45.00		135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6972	001	0	1	01	01	H6972_001_0	4	2	Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	11.00	22.00	27.50																			11.00		27.50																11.00				11.00		0.37			0.37			0.35	Preferred Generic, 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	2.00	4.00	5.00																			2.00		5.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, 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				478.23	33	33	33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6974	001	0	1	48	05	H6974_001_0	5	6	Non-Medicare OTC  Drugs	1	4	010010			110		01	100		1	30		90				1			90				30		31																																																					Preferred Generic Drugs, Generic Drugs, Preferred Brand Drugs, Non-Preferred 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			
H6974	001	0	1	48	05	H6974_001_0	5	5	Non-Medicare Rx Drugs	1	4	010010			110		01	100		1	30		90				1			90				30		31																																																					Preferred Generic Drugs, Generic Drugs, Preferred Brand Drugs, Non-Preferred 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			
H6974	001	0	1	48	05	H6974_001_0	5	4	Non-Preferred Brand Drugs	1	4	100000			110		01	100		1	30		90				1			90				30		31																																																					Preferred Generic Drugs, Generic Drugs, Preferred Brand Drugs, Non-Preferred 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			
H6974	001	0	1	48	05	H6974_001_0	5	3	Preferred Brand Drugs	1	4	000001			110		01	100		1	30		90				1			90				30		31																																																					Preferred Generic Drugs, Generic Drugs, Preferred Brand Drugs, Non-Preferred 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			
H6974	001	0	1	48	05	H6974_001_0	5	1	Preferred Generic Drugs	1	4	001000			110		01	100		1	30		90				1			90				30		31																																																					Preferred Generic Drugs, Generic Drugs, Preferred Brand Drugs, Non-Preferred 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			
H6974	001	0	1	48	05	H6974_001_0	5	2	Generic Drugs	1	4	000100			110		01	100		1	30		90				1			90				30		31																																																					Preferred Generic Drugs, Generic Drugs, Preferred Brand Drugs, Non-Preferred 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			
H6988	001	0	1	01	01	H6988_001_0	9	1	Generic	1	4	010000	1	2	110		01	100		1	30		90				1			90				30		31	2.00		6.00																					5.00																2.00				2.00		0.07						0.06	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6988	001	0	1	01	01	H6988_001_0	9	2	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	35.00		105.00																					87.50																35.00				35.00		1.17						1.13	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6988	001	0	1	01	01	H6988_001_0	9	3	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	85.00		255.00																					212.50																85.00				85.00		2.83						2.74	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6988	001	0	1	01	01	H6988_001_0	9	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	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				1	30		90				30		31	35.00		70.00																			35.00		70.00																35.00				35.00		1.17			1.17			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H7006	001	0	1	04	01	H7006_001_0	6	2	Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	10.00		20.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, 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	4.00		8.00																			4.00		8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, 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				917.56	33		33																		33		33															33			33								Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
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	75.00		150.00																			75.00		150.00																75.00				75.00		2.50			2.50			2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H7006	003	0	1	04	01	H7006_003_0	6	2	Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	15.00		30.00																			15.00		30.00																15.00				15.00		.50			.50			.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H7006	003	0	1	04	01	H7006_003_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				1	30		90				30		31	40.00		80.00																			40.00		80.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H7006	003	0	1	04	01	H7006_003_0	6	5	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31				540.35	33		33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H7006	003	0	1	04	01	H7006_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H7006	003	0	1	04	01	H7006_003_0	6	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	6.00		12.00																			6.00		12.00																6.00				6.00		.20			.20			.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H7006	003	0	1	04	01	H7006_003_0	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	85.00		170.00																			85.00		170.00																85.00				85.00		2.83			2.83			2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H7006	005	0	1	04	01	H7006_005_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H7006	005	0	1	04	01	H7006_005_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				1	30		90				30		31	45.00		90.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H7006	005	0	1	04	01	H7006_005_0	7	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				1	30		90				30		31	95.00		190.00																			95.00		190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H7006	005	0	1	04	01	H7006_005_0	7	5	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31				626.99	33		33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H7006	005	0	1	04	01	H7006_005_0	7	2	Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	20.00		40.00																			20.00		40.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H7006	005	0	1	04	01	H7006_005_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	10.00		20.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H7020	001	0	1	01	01	H7020_001_0	4	2	Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	15.00	30.00	45.00																			15.00		45.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	3.00	6.00	9.00																			3.00		9.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7020	001	0	1	01	01	H7020_001_0	4	3	Preferred Brand	1	4	000101	1	2	111		01	110		1	30	60	90				2	30		90				30		31	47.00	94.00	141.00																			47.00		141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, 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	95.00	190.00	285.00																			95.00		285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, 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				590.08	28	28	28																		28		28															28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7115	001	0	1	01	01	H7115_001_0	7	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	30	60	90				1			90				30		31	95.00	190.00	237.50																					190.00																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7115	001	0	1	01	01	H7115_001_0	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7115	001	0	1	01	01	H7115_001_0	7	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H7115	001	0	1	01	01	H7115_001_0	7	2	Generic	3	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	5.00	10.00	12.50																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H7115	001	0	1	01	01	H7115_001_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7115	001	0	1	01	01	H7115_001_0	7	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	30	60	90				1			90				30		31	47.00	94.00	117.50																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7115	001	0	1	01	01	H7115_001_0	7	2	Generic	1	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	5.00	10.00	12.50																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7149	001	0	1	01	01	H7149_001_0	5	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					3.00	6.00	9.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.10	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7149	001	0	1	01	01	H7149_001_0	5	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7149	001	0	1	01	01	H7149_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											53.19	50	50	50				49.67	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7149	001	0	1	01	01	H7149_001_0	5	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7149	001	0	1	01	01	H7149_001_0	5	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								15.00	30.00	45.00					8.00	16.00	24.00					15.00	30.00	45.00																	15.00			15.00			0.50	0.27	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7149	004	0	1	01	01	H7149_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											58.90	50	50	50				56.09	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7149	004	0	1	01	01	H7149_004_0	6	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31											1.00	33						1.00	33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7149	004	0	1	01	01	H7149_004_0	6	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7149	004	0	1	01	01	H7149_004_0	6	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								15.00	30.00	45.00					5.00	10.00	15.00					15.00	30.00	45.00																	15.00			15.00			0.50	0.17	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7149	004	0	1	01	01	H7149_004_0	6	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					0.00	0.00	0.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.00	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7149	005	0	1	01	01	H7149_005_0	5	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	117.50					47.00	94.00	117.50					47.00	94.00	117.50																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7149	005	0	1	01	01	H7149_005_0	5	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								12.00	24.00	30.00					7.00	14.00	17.50					12.00	24.00	30.00																	12.00			12.00			0.40	0.23	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7149	005	0	1	01	01	H7149_005_0	5	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								6.00	12.00	15.00					0.00	0.00	0.00					6.00	12.00	15.00																	6.00			6.00			0.20	0.00	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7149	005	0	1	01	01	H7149_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7149	005	0	1	01	01	H7149_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											34.85	50	50	50				33.51	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7149	005	0	1	01	01	H7149_005_0	5	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								6.00	12.00	15.00					0.00	0.00	0.00					6.00	12.00	15.00																	6.00			6.00			0.20	0.00	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H7172	001	0	1	48	05	H7172_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			
H7172	001	0	1	48	05	H7172_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			
H7172	001	0	1	48	05	H7172_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			
H7173	001	0	1	01	01	H7173_001_0	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	100.00		100.00																					100.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7173	001	0	1	01	01	H7173_001_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	47.00		47.00																					47.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7173	001	0	1	01	01	H7173_001_0	6	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	20.00		20.00																					20.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7173	001	0	1	01	01	H7173_001_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7173	001	0	1	01	01	H7173_001_0	6	5	Specialty Tier	1	4	010010	1	1	110		01	100		1	30		90				2			90				30		31					25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7187	003	0	1	01	01	H7187_003_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				518.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7187	003	0	1	01	01	H7187_003_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7187	003	0	1	01	01	H7187_003_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7187	003	0	1	01	01	H7187_003_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7187	003	0	1	01	01	H7187_003_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7187	009	0	1	01	01	H7187_009_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				467.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7187	009	0	1	01	01	H7187_009_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7187	009	0	1	01	01	H7187_009_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7187	009	0	1	01	01	H7187_009_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7187	009	0	1	01	01	H7187_009_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7187	010	0	1	01	01	H7187_010_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7187	010	0	1	01	01	H7187_010_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7187	010	0	1	01	01	H7187_010_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7187	010	0	1	01	01	H7187_010_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				530.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7187	010	0	1	01	01	H7187_010_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7187	011	0	1	01	01	H7187_011_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				479.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7187	011	0	1	01	01	H7187_011_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7187	011	0	1	01	01	H7187_011_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7187	011	0	1	01	01	H7187_011_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7187	011	0	1	01	01	H7187_011_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7200	006	0	1	01	01	H7200_006_0	7	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7200	006	0	1	01	01	H7200_006_0	7	2	Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								1.00	2.00	3.00					1.00	2.00	3.00					1.00	3.00	3.00																1.00				1.00			0.03	0.03	0.03			0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7200	006	0	1	01	01	H7200_006_0	7	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								34.00	68.00	102.00					34.00	68.00	102.00					34.00	102.00	102.00																34.00				34.00			1.13	1.13	1.13			1.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7200	006	0	1	01	01	H7200_006_0	7	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								85.00	170.00	255.00					80.00	160.00	240.00					80.00	240.00	240.00																85.00				85.00			2.83	2.67	2.67			2.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7200	006	0	1	01	01	H7200_006_0	7	5	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34											706.38	25						706.38	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7200	006	0	1	01	01	H7200_006_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7200	007	0	1	01	01	H7200_007_0	8	2	Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7200	007	0	1	01	01	H7200_007_0	8	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7200	007	0	1	01	01	H7200_007_0	8	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7200	007	0	1	01	01	H7200_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7200	007	0	1	01	01	H7200_007_0	8	5	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34											1064.38	33						1064.38	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7200	007	0	1	01	01	H7200_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								88.00	176.00	264.00					83.00	166.00	249.00					83.00	249.00	249.00																88.00				88.00			2.93	2.77	2.77			2.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7200	013	0	1	01	01	H7200_013_0	7	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7200	013	0	1	01	01	H7200_013_0	7	2	Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7200	013	0	1	01	01	H7200_013_0	7	5	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34											1026.23	33						1026.23	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7200	013	0	1	01	01	H7200_013_0	7	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								96.00	192.00	288.00					91.00	182.00	273.00					91.00	273.00	273.00																96.00				96.00			3.20	3.03	3.03			2.82	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7200	013	0	1	01	01	H7200_013_0	7	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7200	013	0	1	01	01	H7200_013_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	003	0	1	01	01	H7220_003_0	12	3	Preferred Brand	1	4	010001	1	2	110		01	110		1	30		90				1	30		90				30		31	45.00		126.00																			45.00		126.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7220	003	0	1	01	01	H7220_003_0	12	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	6.00		18.00																			6.00		18.00																6.00				6.00		.20			.20			.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7220	003	0	1	01	01	H7220_003_0	12	2	Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	15.00		44.00																			15.00		44.00																15.00				15.00		.50			.50			.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7220	003	0	1	01	01	H7220_003_0	12	4	Non-Preferred Brand	1	4	110000	1	2	110		01	110		1	30		90				1	30		90				30		31	95.00		266.00																			95.00		266.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7220	003	0	1	01	01	H7220_003_0	12	5	Specialty Tier	1	4	010010	1	1	010		10	010		1	30							30							29	31				1110.00	33																				33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7220	004	0	1	02	01	H7220_004_0	10	3	Preferred Brand	1	4	010001	1	2	110		01	110		1	30		90				1	30		90				30		31	42.00		118.00																			42.00		118.00																42.00				42.00		1.40			1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7220	004	0	1	02	01	H7220_004_0	10	2	Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	8.00		24.00																			8.00		24.00																8.00				8.00		.27			.27			.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7220	004	0	1	02	01	H7220_004_0	10	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	4.00		12.00																			4.00		12.00																4.00				4.00		.13			.13			.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7220	004	0	1	02	01	H7220_004_0	10	4	Non-Preferred Brand	1	4	110000	1	2	110		01	110		1	30		90				1	30		90				30		31	95.00		266.00																			95.00		266.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7220	004	0	1	02	01	H7220_004_0	10	5	Specialty Tier	1	4	010010	1	1	010		10	010		1	30							30							29	31				2373.00	33																				33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7220	004	0	1	02	01	H7220_004_0	10	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	10.00		30.00																			10.00		30.00																10.00				10.00		.33			.33			.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H7245	001	0	1	01	01	H7245_001_0	6	6	Specialty Tier	1	3	010010	1	1		010	01		010	1				30							30			30		34											1.00	25						1.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H7245	001	0	1	01	01	H7245_001_0	6	5	Injectable Drugs	1	3	010010	1	1		010	01		010	1				30							30			30		34											19.47	25						19.47	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H7245	001	0	1	01	01	H7245_001_0	6	3	Preferred Brand	1	3	000001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34								45.00	90.00	135.00					45.00	90.00	135.00											45.00	90.00	135.00				45.00	90.00	135.00				45.00				45.00			1.50	1.50		1.50	1.50	1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H7245	001	0	1	01	01	H7245_001_0	6	4	Non-Preferred Brand	1	3	100000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H7245	001	0	1	01	01	H7245_001_0	6	2	Generic	1	3	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34								20.00	40.00	60.00					12.00	24.00	36.00											20.00	40.00	60.00				12.00	24.00	36.00				20.00				20.00			0.66	0.40		0.66	0.40	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H7245	001	0	1	01	01	H7245_001_0	6	1	Preferred Generic	1	3	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34								12.00	24.00	36.00					4.00	8.00	12.00											12.00	24.00	36.00				4.00	8.00	12.00				12.00				12.00			0.40	0.13		0.40	0.13	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H7245	002	0	1	02	01	H7245_002_0	8	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34								45.00	90.00	135.00					45.00	90.00	135.00											45.00	90.00	135.00				45.00	90.00	135.00				45.00				45.00			1.50	1.50		1.50	1.50	1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H7245	002	0	1	02	01	H7245_002_0	8	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34								12.00	24.00	36.00					4.00	8.00	12.00											12.00	24.00	36.00				4.00	8.00	12.00				12.00				12.00			0.40	0.13		0.40	0.13	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H7245	002	0	1	02	01	H7245_002_0	8	2	Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34								20.00	40.00	60.00					12.00	24.00	36.00											20.00	40.00	60.00				12.00	24.00	36.00				20.00				20.00			0.66	0.40		0.66	0.40	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H7245	002	0	1	02	01	H7245_002_0	8	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H7245	002	0	1	02	01	H7245_002_0	8	5	Injectable Drugs	1	4	010010	1	1		010	01		010	1				30							30			30		34											46.75	25						46.75	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H7245	002	0	1	02	01	H7245_002_0	8	6	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34											1.00	25						1.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H7245	003	0	1	01	01	H7245_003_0	6	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, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H7245	003	0	1	01	01	H7245_003_0	6	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34								45.00	90.00	135.00					45.00	90.00	135.00											45.00	90.00	135.00				45.00	90.00	135.00				45.00				45.00			1.50	1.50		1.50	1.50	1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H7245	003	0	1	01	01	H7245_003_0	6	5	Injectable Drugs	1	4	010010	1	1		010	01		010	1				30							30			30		34											23.46	33						23.46	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H7245	003	0	1	01	01	H7245_003_0	6	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H7245	003	0	1	01	01	H7245_003_0	6	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34								12.00	24.00	36.00					4.00	8.00	12.00											12.00	24.00	36.00				4.00	8.00	12.00				12.00				12.00			0.40	0.13		0.40	0.13	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H7245	003	0	1	01	01	H7245_003_0	6	2	Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34								20.00	40.00	60.00					12.00	24.00	36.00											20.00	40.00	60.00				12.00	24.00	36.00				20.00				20.00			0.66	0.40		0.66	0.40	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H7301	002	0	1	04	01	H7301_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7301	002	0	1	04	01	H7301_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											37.22	50	50	50				35.44	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7301	002	0	1	04	01	H7301_002_0	6	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7301	002	0	1	04	01	H7301_002_0	6	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					10.00	20.00	30.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.33	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7301	002	0	1	04	01	H7301_002_0	6	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					3.00	6.00	9.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.10	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7301	006	0	1	04	01	H7301_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7301	006	0	1	04	01	H7301_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											34.93	50	50	50				30.32	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7301	006	0	1	04	01	H7301_006_0	4	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7301	006	0	1	04	01	H7301_006_0	4	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					10.00	20.00	30.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.33	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7301	006	0	1	04	01	H7301_006_0	4	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					4.00	8.00	12.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.13	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7301	006	0	1	04	01	H7301_006_0	4	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					4.00	8.00	12.00					10.00	20.00	30.00																	10.00			10.00			0.20	0.10	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H7301	007	0	1	04	01	H7301_007_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7301	007	0	1	04	01	H7301_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											34.78	50	50	50				31.26	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7301	007	0	1	04	01	H7301_007_0	7	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7301	007	0	1	04	01	H7301_007_0	7	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								12.00	24.00	36.00					7.00	14.00	21.00					12.00	24.00	36.00																	12.00			12.00			0.40	0.23	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7301	007	0	1	04	01	H7301_007_0	7	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7301	008	0	1	04	01	H7301_008_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7301	008	0	1	04	01	H7301_008_0	7	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											38.57	50	50	50				35.85	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7301	008	0	1	04	01	H7301_008_0	7	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	117.50					47.00	94.00	117.50					47.00	94.00	117.50																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7301	008	0	1	04	01	H7301_008_0	7	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								12.00	24.00	30.00					7.00	14.00	17.50					12.00	24.00	30.00																	12.00			12.00			0.40	0.23	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7301	008	0	1	04	01	H7301_008_0	7	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								6.00	12.00	15.00					0.00	0.00	0.00					6.00	12.00	15.00																	6.00			6.00			0.20	0.00	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H7301	008	0	1	04	01	H7301_008_0	7	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								6.00	12.00	15.00					0.00	0.00	0.00					6.00	12.00	15.00																	6.00			6.00			0.20	0.00	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7419	001	0	1	48	05	H7419_001_0	6	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 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	6	3	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 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	6	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 OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H7522	001	0	1	04	01	H7522_001_0	7	3	Preferred Brand	1	4	000101	1	2	110		01	100		1	30		90				2			90				30		31	40.00		120.00																					80.00																40.00				40.00		1.33						1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7522	001	0	1	04	01	H7522_001_0	7	3	Preferred Brand	3	4	000101	1	2	110		01	100		1	30		90				2			90				30		31	40.00		120.00																					80.00																40.00				40.00		1.33						1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H7522	001	0	1	04	01	H7522_001_0	7	2	Generic	3	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	14.00		42.00																					28.00																14.00				14.00		.47						.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H7522	001	0	1	04	01	H7522_001_0	7	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	6.00		18.00																					12.00																6.00				6.00		.20						.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H7522	001	0	1	04	01	H7522_001_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	6.00		18.00																					12.00																6.00				6.00		.20						.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7522	001	0	1	04	01	H7522_001_0	7	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	14.00		42.00																					28.00																14.00				14.00		.47						.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7522	001	0	1	04	01	H7522_001_0	7	4	Non-Preferred Brand	3	4	100100	1	2	110		01	100		1	30		90				2			90				30		31	65.00		195.00																					130.00																65.00				65.00		2.17						2.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H7522	001	0	1	04	01	H7522_001_0	7	4	Non-Preferred Brand	1	4	100100	1	2	110		01	100		1	30		90				2			90				30		31	65.00		195.00																					130.00																65.00				65.00		2.17						2.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7522	001	0	1	04	01	H7522_001_0	7	5	Specialty Tier	1	4	010010	1	1	110		01			1	30		90				2							30		31				2648.00	33		33																																			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7542	001	0	1	48	05	H7542_001_0	10	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			
H7542	001	0	1	48	05	H7542_001_0	10	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			
H7542	001	0	1	48	05	H7542_001_0	10	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			
H7542	001	0	1	48	05	H7542_001_0	10	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			
H7678	001	0	1	01	01	H7678_001_0	6	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7678	001	0	1	01	01	H7678_001_0	6	2	Generic	1	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	15.00	30.00	45.00																			15.00	30.00	45.00																15.00				15.00		0.48			0.48			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7678	001	0	1	01	01	H7678_001_0	6	3	Preferred Brand	1	4	010001	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7678	001	0	1	01	01	H7678_001_0	6	4	Non-Preferred Brand	1	4	110000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.06			3.06			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7678	001	0	1	01	01	H7678_001_0	6	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7678	001	0	1	01	01	H7678_001_0	6	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H7680	001	0	1	01	01	H7680_001_0	10	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7680	001	0	1	01	01	H7680_001_0	10	5	Specialty Tier	1	4	000010	1	1	010		10	010		1	30							30							10	31				600.00	33																				33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7680	001	0	1	01	01	H7680_001_0	10	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7680	001	0	1	01	01	H7680_001_0	10	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7680	001	0	1	01	01	H7680_001_0	10	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7680	002	0	1	01	01	H7680_002_0	7	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H7680	002	0	1	01	01	H7680_002_0	7	5	Specialty Tier	1	4	000010	1	1	010		10	010		1	30							30							10	31				600.00	33																				33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7680	002	0	1	01	01	H7680_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	60.00	120.00	180.00																			60.00	120.00	120.00																60.00				60.00		2.00			2.00			1.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7680	002	0	1	01	01	H7680_002_0	7	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	30.00	60.00	90.00																			30.00	60.00	60.00																30.00				30.00		1.00			1.00			0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7680	002	0	1	01	01	H7680_002_0	7	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7680	002	0	1	01	01	H7680_002_0	7	2	Generic	3	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H7680	002	0	1	01	01	H7680_002_0	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7728	002	0	1	04	01	H7728_002_0	9	5	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34											1379.43	29						1379.43	29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7728	002	0	1	04	01	H7728_002_0	9	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7728	002	0	1	04	01	H7728_002_0	9	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7728	002	0	1	04	01	H7728_002_0	9	2	Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7728	002	0	1	04	01	H7728_002_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7728	002	0	1	04	01	H7728_002_0	9	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00	9.00	9.00																8.00				8.00			0.27	0.10	0.10			0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7787	001	0	1	04	01	H7787_001_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31				524.40	33	33	33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7787	001	0	1	04	01	H7787_001_0	5	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	80.00	160.00	240.00																			80.00		240.00																80.00				80.00		2.67			2.67			2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7787	001	0	1	04	01	H7787_001_0	5	3	Preferred Brand	1	4	000101	1	2	111		01	110		1	30	60	90				2	30		90				30		31	40.00	80.00	120.00																			40.00		120.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7787	001	0	1	04	01	H7787_001_0	5	2	Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	4.00	8.00	10.00																			4.00		10.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7787	001	0	1	04	01	H7787_001_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	0.00	0.00	0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7833	001	0	1	48	05	H7833_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	2.95	0.00	2.95	0.00	2.95	0.00	2.95			
H7833	001	0	1	48	05	H7833_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	7.40	0.00	7.40	0.00	7.40	0.00	7.40			
H7833	001	0	1	48	05	H7833_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																																														0.00			0.00			0.00	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			
H7844	001	0	1	48	05	H7844_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			
H7844	001	0	1	48	05	H7844_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	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H7844	001	0	1	48	05	H7844_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			
H7885	001	0	1	48	05	H7885_001_0	4	1	Generic Drugs	1	4	010000			110		01			1	31		93				2							31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	2.95	0.00	2.95			0.00	2.95			
H7885	001	0	1	48	05	H7885_001_0	4	3	Non-Medicare Rx/OTC Drugs	1	4	010010			110		01			1	31		93				2							31		31																																														0.00						0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00			0.00	0.00			
H7885	001	0	1	48	05	H7885_001_0	4	2	Brand Drugs	1	4	000010			110		01			1	31		93				2							31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	7.40	0.00	7.40			0.00	7.40			
H7890	001	0	1	48	05	H7890_001_0	4	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	4	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	4	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	4	4	Non-Medicare OTC Drugs	1	4	010010			110		01	110		1	31		90				1	31		90				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	5	5	Specialty Tier	1	4	000010	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7903	001	0	1	01	01	H7903_001_0	5	4	Non-Preferred Brand	1	4	100000	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31				89.31	35	35	35																		35	35	35															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7903	001	0	1	01	01	H7903_001_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	2.00	4.00	5.00																			2.00	4.00	6.00																2.00				2.00		0.06			0.06			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7903	001	0	1	01	01	H7903_001_0	5	2	Generic	1	4	000100	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	10.00	20.00	25.00																			10.00	20.00	30.00																10.00				10.00		0.32			0.32			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7903	001	0	1	01	01	H7903_001_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	38.00	76.00	95.00																			38.00	76.00	114.00																38.00				38.00		1.23			1.23			1.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	008	0	1	04	01	H7917_008_0	4	5	Specialty Tier	1	4	010010	1	1	111		10	111		1	30	60	90				2	30	60	90					14	31				1.00	33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	008	0	1	04	01	H7917_008_0	4	4	Non-Preferred Brand	1	4	110000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	50.00	100.00	125.00																			50.00	100.00	125.00																	50.00			50.00		1.67			1.67			1.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	008	0	1	04	01	H7917_008_0	4	3	Preferred Brand	1	4	010001	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	30.00	60.00	75.00																			30.00	60.00	75.00																	30.00			30.00		1.00			1.00			.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	008	0	1	04	01	H7917_008_0	4	2	Generic	1	4	000100	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	6.00	12.00	15.00																			6.00	12.00	15.00																	6.00			6.00		.20			.20			.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	008	0	1	04	01	H7917_008_0	4	1	Preferred Generic	3	4	001000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		.10			.10			.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H7917	008	0	1	04	01	H7917_008_0	4	1	Preferred Generic	1	4	001000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		.10			.10			.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	009	0	1	04	01	H7917_009_0	4	3	Preferred Brand	1	4	010001	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	30.00	60.00	75.00																			30.00	60.00	75.00																	30.00			30.00		1.00			1.00			.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	009	0	1	04	01	H7917_009_0	4	2	Generic	1	4	000100	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	6.00	12.00	15.00																			6.00	12.00	15.00																	6.00			6.00		.20			.20			.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	009	0	1	04	01	H7917_009_0	4	1	Preferred Generic	1	4	001000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		.10			.10			.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	009	0	1	04	01	H7917_009_0	4	4	Non-Preferred Brand	1	4	110000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	50.00	100.00	125.00																			50.00	100.00	125.00																	50.00			50.00		1.67			1.67			1.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	009	0	1	04	01	H7917_009_0	4	1	Preferred Generic	3	4	001000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		.10			.10			.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H7917	009	0	1	04	01	H7917_009_0	4	5	Specialty Tier	1	4	010010	1	1	111		10	111		1	30	60	90				2	30	60	90					14	31				1.00	33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	010	0	1	04	01	H7917_010_0	4	1	Preferred Generic	1	4	001000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		.10			.10			.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	010	0	1	04	01	H7917_010_0	4	2	Generic	1	4	000100	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	6.00	12.00	15.00																			6.00	12.00	15.00																	6.00			6.00		.20			.20			.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	010	0	1	04	01	H7917_010_0	4	3	Preferred Brand	1	4	010001	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	30.00	60.00	75.00																			30.00	60.00	75.00																	30.00			30.00		1.00			1.00			.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	010	0	1	04	01	H7917_010_0	4	4	Non-Preferred Brand	1	4	110000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	50.00	100.00	125.00																			50.00	100.00	125.00																	50.00			50.00		1.67			1.67			1.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	010	0	1	04	01	H7917_010_0	4	5	Specialty Tier	1	4	010010	1	1	111		10	111		1	30	60	90				2	30	60	90					14	31				1.00	33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	010	0	1	04	01	H7917_010_0	4	1	Preferred Generic	3	4	001000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		.10			.10			.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H7917	011	0	1	04	01	H7917_011_0	5	1	Preferred Generic	1	4	001000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		.10			.10			.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	011	0	1	04	01	H7917_011_0	5	2	Generic	1	4	000100	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	6.00	12.00	15.00																			6.00	12.00	15.00																	6.00			6.00		.20			.20			.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	011	0	1	04	01	H7917_011_0	5	3	Preferred Brand	1	4	010001	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	30.00	60.00	75.00																			30.00	60.00	75.00																	30.00			30.00		1.00			1.00			.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	011	0	1	04	01	H7917_011_0	5	5	Specialty Tier	1	4	010010	1	1	111		10	111		1	30	60	90				2	30	60	90					14	31				1.00	33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	011	0	1	04	01	H7917_011_0	5	4	Non-Preferred Brand	1	4	110000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	50.00	100.00	125.00																			50.00	100.00	125.00																	50.00			50.00		1.67			1.67			1.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	011	0	1	04	01	H7917_011_0	5	1	Preferred Generic	3	4	001000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		.10			.10			.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H7917	012	0	1	04	01	H7917_012_0	6	1	Preferred Generic	1	4	001000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		.10			.10			.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	012	0	1	04	01	H7917_012_0	6	1	Preferred Generic	3	4	001000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		.10			.10			.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H7917	012	0	1	04	01	H7917_012_0	6	5	Specialty Tier	1	4	010010	1	1	111		10	111		1	30	60	90				2	30	60	90					14	31				1.00	33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	012	0	1	04	01	H7917_012_0	6	4	Non-Preferred Brand	1	4	110000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	65.00	130.00	162.50																			65.00	130.00	162.50																	65.00			65.00		2.17			2.17			2.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	012	0	1	04	01	H7917_012_0	6	3	Preferred Brand	1	4	010001	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	30.00	60.00	75.00																			30.00	60.00	75.00																	30.00			30.00		1.00			1.00			.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	012	0	1	04	01	H7917_012_0	6	2	Generic	1	4	000100	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	6.00	12.00	15.00																			6.00	12.00	15.00																	6.00			6.00		.20			.20			.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	013	0	1	04	01	H7917_013_0	4	5	Specialty Tier	1	4	010010	1	1	111		10	111		1	30	60	90				2	30	60	90					14	31				1.00	33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	013	0	1	04	01	H7917_013_0	4	4	Non-Preferred Brand	1	4	110000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	65.00	130.00	162.50																			65.00	130.00	162.50																	65.00			65.00		2.17			2.17			2.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	013	0	1	04	01	H7917_013_0	4	3	Preferred Brand	1	4	010001	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	30.00	60.00	75.00																			30.00	60.00	75.00																	30.00			30.00		1.00			1.00			.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	013	0	1	04	01	H7917_013_0	4	2	Generic	1	4	000100	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	6.00	12.00	15.00																			6.00	12.00	15.00																	6.00			6.00		.20			.20			.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	013	0	1	04	01	H7917_013_0	4	1	Preferred Generic	1	4	001000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		.10			.10			.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	013	0	1	04	01	H7917_013_0	4	1	Preferred Generic	3	4	001000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		.10			.10			.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H7917	014	0	1	04	01	H7917_014_0	5	5	Specialty Tier	1	4	010010	1	1	111		10	111		1	30	60	90				2	30	60	90					14	31				1.00	33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	014	0	1	04	01	H7917_014_0	5	4	Non-Preferred Brand	1	4	110000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	65.00	130.00	162.50																			65.00	130.00	162.50																	65.00			65.00		2.17			2.17			2.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	014	0	1	04	01	H7917_014_0	5	3	Preferred Brand	1	4	010001	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	30.00	60.00	75.00																			30.00	60.00	75.00																	30.00			30.00		1.00			1.00			.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	014	0	1	04	01	H7917_014_0	5	2	Generic	1	4	000100	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	6.00	12.00	15.00																			6.00	12.00	15.00																	6.00			6.00		.20			.20			.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	014	0	1	04	01	H7917_014_0	5	1	Preferred Generic	1	4	001000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		.10			.10			.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	014	0	1	04	01	H7917_014_0	5	1	Preferred Generic	3	4	001000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		.10			.10			.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H7917	015	0	1	04	01	H7917_015_0	4	1	Preferred Generic	1	4	001000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		.10			.10			.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	015	0	1	04	01	H7917_015_0	4	2	Generic	1	4	000100	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	6.00	12.00	15.00																			6.00	12.00	15.00																	6.00			6.00		.20			.20			.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	015	0	1	04	01	H7917_015_0	4	3	Preferred Brand	1	4	010001	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	30.00	60.00	75.00																			30.00	60.00	75.00																	30.00			30.00		1.00			1.00			.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	015	0	1	04	01	H7917_015_0	4	4	Non-Preferred Brand	1	4	110000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	65.00	130.00	162.50																			65.00	130.00	162.50																	65.00			65.00		2.17			2.17			2.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	015	0	1	04	01	H7917_015_0	4	5	Specialty Tier	1	4	010010	1	1	111		10	111		1	30	60	90				2	30	60	90					14	31				1.00	33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	015	0	1	04	01	H7917_015_0	4	1	Preferred Generic	3	4	001000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		.10			.10			.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H7917	030	0	1	04	01	H7917_030_0	4	5	Specialty Tier	1	4	010010	1	1	111		10	111		1	30	60	90				2	30	60	90					14	31				1.00	33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	030	0	1	04	01	H7917_030_0	4	4	Non-Preferred Brand	1	4	110000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	90.00	180.00	225.00																			90.00	180.00	225.00																	90.00			90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	030	0	1	04	01	H7917_030_0	4	3	Preferred Brand	1	4	010001	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	45.00	90.00	112.50																			45.00	90.00	112.50																	45.00			45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	030	0	1	04	01	H7917_030_0	4	2	Generic	1	4	000100	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	12.00	24.00	30.00																			12.00	24.00	30.00																	12.00			12.00		.40			.40			.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	030	0	1	04	01	H7917_030_0	4	1	Preferred Generic	1	4	001000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		.10			.10			.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	030	0	1	04	01	H7917_030_0	4	1	Preferred Generic	3	4	001000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		.10			.10			.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H7917	031	0	1	04	01	H7917_031_0	5	1	Preferred Generic	3	4	001000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		.10			.10			.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H7917	031	0	1	04	01	H7917_031_0	5	1	Preferred Generic	1	4	001000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		.10			.10			.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	031	0	1	04	01	H7917_031_0	5	2	Generic	1	4	000100	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	12.00	24.00	30.00																			12.00	24.00	30.00																	12.00			12.00		.40			.40			.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	031	0	1	04	01	H7917_031_0	5	3	Preferred Brand	1	4	010001	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	45.00	90.00	112.50																			45.00	90.00	112.50																	45.00			45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	031	0	1	04	01	H7917_031_0	5	4	Non-Preferred Brand	1	4	110000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	90.00	180.00	225.00																			90.00	180.00	225.00																	90.00			90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	031	0	1	04	01	H7917_031_0	5	5	Specialty Tier	1	4	010010	1	1	111		10	111		1	30	60	90				2	30	60	90					14	31				1.00	33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	032	0	1	04	01	H7917_032_0	5	5	Specialty Tier	1	4	010010	1	1	111		10	111		1	30	60	90				2	30	60	90					14	31				1.00	33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	032	0	1	04	01	H7917_032_0	5	4	Non-Preferred Brand	1	4	110000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	90.00	180.00	225.00																			90.00	180.00	225.00																	90.00			90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	032	0	1	04	01	H7917_032_0	5	3	Preferred Brand	1	4	010001	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	45.00	90.00	112.50																			45.00	90.00	112.50																	45.00			45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	032	0	1	04	01	H7917_032_0	5	2	Generic	1	4	000100	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	12.00	24.00	30.00																			12.00	24.00	30.00																	12.00			12.00		.40			.40			.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	032	0	1	04	01	H7917_032_0	5	1	Preferred Generic	1	4	001000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		.10			.10			.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	032	0	1	04	01	H7917_032_0	5	1	Preferred Generic	3	4	001000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		.10			.10			.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H7917	033	0	1	04	01	H7917_033_0	5	5	Specialty Tier	1	4	010010	1	1	111		10	111		1	30	60	90				2	30	60	90					14	31				1.00	33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	033	0	1	04	01	H7917_033_0	5	4	Non-Preferred Brand	1	4	110000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	90.00	180.00	225.00																			90.00	180.00	225.00																	90.00			90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	033	0	1	04	01	H7917_033_0	5	3	Preferred Brand	1	4	010001	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	45.00	90.00	112.50																			45.00	90.00	112.50																	45.00			45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	033	0	1	04	01	H7917_033_0	5	2	Generic	1	4	000100	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	12.00	24.00	30.00																			12.00	24.00	30.00																	12.00			12.00		.40			.40			.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	033	0	1	04	01	H7917_033_0	5	1	Preferred Generic	1	4	001000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		.10			.10			.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7917	033	0	1	04	01	H7917_033_0	5	1	Preferred Generic	3	4	001000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		.10			.10			.10	Preferred Generic, 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	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7960	001	0	1	01	01	H7960_001_0	8	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, 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	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, 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	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, 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	010		01	010		1	30							30						30		31				775.35	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7960	001	0	1	01	01	H7960_001_0	8	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H7960	002	0	1	01	01	H7960_002_0	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.13			.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7960	002	0	1	01	01	H7960_002_0	7	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	40.00																20.00				20.00		0.33			.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7960	002	0	1	01	01	H7960_002_0	7	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7960	002	0	1	01	01	H7960_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	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7960	002	0	1	01	01	H7960_002_0	7	5	Specialty Tier	1	4	100101	1	1	010		01	010		1	30							30						30		31				793.68	27																				27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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																																														0.00						0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00			0.00	0.00			
H8016	001	0	1	48	05	H8016_001_0	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	7.40	0.00	7.40			0.00	7.40			
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	2.95	0.00	2.95			0.00	2.95			
H8026	001	0	1	48	05	H8026_001_0	12	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	12	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			
H8026	001	0	1	48	05	H8026_001_0	12	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			
H8029	001	0	1	48	05	H8029_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			
H8029	001	0	1	48	05	H8029_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			
H8029	001	0	1	48	05	H8029_001_0	9	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	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
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	8	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	8	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	8	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	9	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	5.00	10.00	15.00																			5.00	0.00	0.00																5.00				5.00		.16			.16			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8064	002	0	1	04	01	H8064_002_0	9	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				750.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8064	002	0	1	04	01	H8064_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	90.00	180.00	270.00																			90.00	180.00	225.00																90.00				90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8064	002	0	1	04	01	H8064_002_0	9	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8064	002	0	1	04	01	H8064_002_0	9	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	5.00	10.00	15.00																			5.00	0.00	0.00																5.00				5.00		.16			.16			.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8064	002	0	1	04	01	H8064_002_0	9	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	50.00																20.00				20.00		.67			.67			.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8091	002	0	1	04	01	H8091_002_0	9	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				30		90	1	30		90				30		31								40.00		80.00					35.00		70.00					35.00		70.00																40.00				35.00			1.33	1.16	1.16			1.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8091	002	0	1	04	01	H8091_002_0	9	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				30		90	1	30		90				30		31								10.00		20.00					3.00		6.00					3.00		6.00																10.00				3.00			.33	0.10	0.10			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8091	002	0	1	04	01	H8091_002_0	9	2	Generic	1	4	000100	1	2		110	01	110		1				30		90	1	30		90				30		31								18.00		36.00					13.00		26.00					13.00		26.00																18.00				13.00			0.60	0.43	0.43			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8091	002	0	1	04	01	H8091_002_0	9	4	Non-Preferred Brand	1	4	110000	1	2		110	01	110		1				30		90	1	30		90				30		31								100.00		200.00					95.00		190.00					95.00		190.00																100.00				95.00			3.33	3.16	3.16			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8091	002	0	1	04	01	H8091_002_0	9	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8091	002	0	1	04	01	H8091_002_0	9	1	Preferred Generic	3	4	001000	1	2		110	01	110		1				30		90	1	30		90				30		31								10.00		20.00					3.00		6.00					3.00		6.00																10.00				3.00			0.33	0.10	0.10			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8091	004	0	1	04	01	H8091_004_0	8	4	Non-Preferred Brand	1	4	110000	1	2		110	01	110		1				30		90	1	30		90				30		31								100.00		200.00					95.00		190.00					95.00		190.00																100.00				95.00			3.33	3.16	3.16			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8091	004	0	1	04	01	H8091_004_0	8	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															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8091	004	0	1	04	01	H8091_004_0	8	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				30		90	1	30		90				30		31								40.00		80.00					35.00		70.00					35.00		70.00																40.00				35.00			1.33	1.16	1.16			1.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8091	004	0	1	04	01	H8091_004_0	8	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				30		90	1	30		90				30		31								10.00		20.00					3.00		6.00					3.00		6.00																10.00				3.00			0.33	0.10	0.10			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8091	004	0	1	04	01	H8091_004_0	8	2	Generic	1	4	000100	1	2		110	01	110		1				30		90	1	30		90				30		31								18.00		36.00					13.00		26.00					13.00		26.00																18.00				13.00			0.60	0.43	0.43			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8130	001	0	1	01	01	H8130_001_0	7	2	Generic	3	4	000100	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8130	001	0	1	01	01	H8130_001_0	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8130	001	0	1	01	01	H8130_001_0	7	2	Generic	1	4	000100	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8130	001	0	1	01	01	H8130_001_0	7	3	Preferred Brand	1	4	010001	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8130	001	0	1	01	01	H8130_001_0	7	4	Non-Preferred Brand	1	4	110000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.06			3.06			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8130	001	0	1	01	01	H8130_001_0	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8130	001	0	1	01	01	H8130_001_0	7	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8133	001	0	1	01	01	H8133_001_0	6	2	Generic	3	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								11.00		33.00					6.00		18.00							33.00																11.00				11.00			.36	.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8133	001	0	1	01	01	H8133_001_0	6	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	001	0	1	01	01	H8133_001_0	6	2	Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								11.00		33.00					6.00		18.00							33.00																11.00				11.00			0.37	0.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	001	0	1	01	01	H8133_001_0	6	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31								44.00		132.00					39.00		117.00							132.00																44.00				44.00			1.47	1.30				1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	001	0	1	01	01	H8133_001_0	6	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			.16	.00				.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8133	001	0	1	01	01	H8133_001_0	6	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31											1330.00	33		33				1330.00	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	001	0	1	01	01	H8133_001_0	6	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					85.00		255.00							285.00																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	003	0	1	01	01	H8133_003_0	9	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31											1330.00	33		33				1330.00	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	003	0	1	01	01	H8133_003_0	9	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8133	003	0	1	01	01	H8133_003_0	9	2	Generic	3	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								11.00		33.00					6.00		18.00							33.00																11.00				11.00			0.37	0.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8133	003	0	1	01	01	H8133_003_0	9	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					85.00		255.00							285.00																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	003	0	1	01	01	H8133_003_0	9	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	003	0	1	01	01	H8133_003_0	9	2	Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								11.00		33.00					6.00		18.00							33.00																11.00				11.00			0.37	0.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	003	0	1	01	01	H8133_003_0	9	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31								44.00		132.00					39.00		117.00							132.00																44.00				44.00			1.47	1.30				1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	004	0	1	01	01	H8133_004_0	10	2	Generic	3	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								11.00		33.00					6.00		18.00							33.00																11.00				11.00			0.37	0.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8133	004	0	1	01	01	H8133_004_0	10	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8133	004	0	1	01	01	H8133_004_0	10	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31											1330.00	33		33				1330.00	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	004	0	1	01	01	H8133_004_0	10	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					85.00		255.00							285.00																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	004	0	1	01	01	H8133_004_0	10	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31								44.00		132.00					39.00		117.00							132.00																44.00				44.00			1.47	1.30				1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	004	0	1	01	01	H8133_004_0	10	2	Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								11.00		33.00					6.00		18.00							33.00																11.00				11.00			0.37	0.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	004	0	1	01	01	H8133_004_0	10	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	005	0	1	01	01	H8133_005_0	9	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31											1330.00	33		33				1330.00	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	005	0	1	01	01	H8133_005_0	9	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8133	005	0	1	01	01	H8133_005_0	9	2	Generic	3	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								11.00		33.00					6.00		18.00							33.00																11.00				11.00			0.37	0.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8133	005	0	1	01	01	H8133_005_0	9	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					85.00		255.00							285.00																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	005	0	1	01	01	H8133_005_0	9	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31								44.00		132.00					39.00		117.00							132.00																44.00				44.00			1.47	1.30				1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	005	0	1	01	01	H8133_005_0	9	2	Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								11.00		33.00					6.00		18.00							33.00																11.00				11.00			0.37	0.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	005	0	1	01	01	H8133_005_0	9	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	006	0	1	01	01	H8133_006_0	11	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8133	006	0	1	01	01	H8133_006_0	11	2	Generic	3	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								11.00		33.00					6.00		18.00							33.00																11.00				11.00			0.37	0.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8133	006	0	1	01	01	H8133_006_0	11	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31											1330.00	33		33				1330.00	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	006	0	1	01	01	H8133_006_0	11	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					85.00		255.00							285.00																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	006	0	1	01	01	H8133_006_0	11	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31								44.00		132.00					39.00		117.00							132.00																44.00				44.00			1.47	1.30				1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	006	0	1	01	01	H8133_006_0	11	2	Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								11.00		33.00					6.00		18.00							33.00																11.00				11.00			0.37	0.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	006	0	1	01	01	H8133_006_0	11	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	007	0	1	01	01	H8133_007_0	16	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31								44.00		132.00					39.00		117.00							132.00																44.00				44.00			1.47	1.30				1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	007	0	1	01	01	H8133_007_0	16	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					85.00		255.00							285.00																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	007	0	1	01	01	H8133_007_0	16	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31											1330.00	33		33				1330.00	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	007	0	1	01	01	H8133_007_0	16	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8133	007	0	1	01	01	H8133_007_0	16	2	Generic	3	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								11.00		33.00					6.00		18.00							33.00																11.00				11.00			0.37	0.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8133	007	0	1	01	01	H8133_007_0	16	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	007	0	1	01	01	H8133_007_0	16	2	Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								11.00		33.00					6.00		18.00							33.00																11.00				11.00			0.37	0.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	008	0	1	01	01	H8133_008_0	10	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	008	0	1	01	01	H8133_008_0	10	2	Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								11.00		33.00					6.00		18.00							33.00																11.00				11.00			0.37	0.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	008	0	1	01	01	H8133_008_0	10	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31								44.00		132.00					39.00		117.00							132.00																44.00				44.00			1.47	1.30				1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	008	0	1	01	01	H8133_008_0	10	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					85.00		255.00							285.00																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	008	0	1	01	01	H8133_008_0	10	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8133	008	0	1	01	01	H8133_008_0	10	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31											1330.00	33		33				1330.00	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	008	0	1	01	01	H8133_008_0	10	2	Generic	3	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								11.00		33.00					6.00		18.00							33.00																11.00				11.00			0.37	0.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8133	011	0	1	01	01	H8133_011_0	7	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31											1330.00	33		33				1330.00	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	011	0	1	01	01	H8133_011_0	7	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	011	0	1	01	01	H8133_011_0	7	2	Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								11.00		33.00					6.00		18.00							33.00																11.00				11.00			0.37	0.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	011	0	1	01	01	H8133_011_0	7	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31								44.00		132.00					39.00		117.00							132.00																44.00				44.00			1.47	1.30				1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	011	0	1	01	01	H8133_011_0	7	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					85.00		255.00							285.00																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	011	0	1	01	01	H8133_011_0	7	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			.16	.00				.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8133	011	0	1	01	01	H8133_011_0	7	2	Generic	3	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								11.00		33.00					6.00		18.00							33.00																11.00				11.00			.36	.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8145	003	0	1	09	04	H8145_003_0	4	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, 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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	003	0	1	09	04	H8145_003_0	4	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	004	0	1	09	04	H8145_004_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, 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, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	004	0	1	09	04	H8145_004_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, 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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, 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, 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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	006	0	1	09	04	H8145_006_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, 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	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	006	0	1	09	04	H8145_006_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, 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	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	008	0	1	09	04	H8145_008_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, 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	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	008	0	1	09	04	H8145_008_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8145	011	0	1	09	04	H8145_011_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	011	0	1	09	04	H8145_011_0	4	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	011	0	1	09	04	H8145_011_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	011	0	1	09	04	H8145_011_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	011	0	1	09	04	H8145_011_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	011	0	1	09	04	H8145_011_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8145	011	0	1	09	04	H8145_011_0	4	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8145	011	0	1	09	04	H8145_011_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	011	0	1	09	04	H8145_011_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	011	0	1	09	04	H8145_011_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, 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	3.00		9.00																									3.00		9.00				3.00		0.00				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	020	0	1	09	04	H8145_020_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	11.00		33.00																									11.00		33.00				11.00		0.00				11.00				11.00		0.36				0.36	0.36	0.35	Preferred Generic, 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, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	020	0	1	09	04	H8145_020_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	11.00		33.00																									11.00		33.00				11.00		0.00				11.00				11.00		0.36				0.36	0.36	0.35	Preferred Generic, 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	3.00		9.00																									3.00		9.00				3.00		0.00				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	021	0	1	09	04	H8145_021_0	4	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	11.00		33.00																									11.00		33.00				11.00		0.00				11.00				11.00		0.36				0.36	0.36	0.35	Preferred Generic, 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, 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, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	021	0	1	09	04	H8145_021_0	4	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	11.00		33.00																									11.00		33.00				11.00		0.00				11.00				11.00		0.36				0.36	0.36	0.35	Preferred Generic, 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	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8145	032	0	1	09	04	H8145_032_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	032	0	1	09	04	H8145_032_0	4	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	032	0	1	09	04	H8145_032_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	032	0	1	09	04	H8145_032_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	032	0	1	09	04	H8145_032_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	032	0	1	09	04	H8145_032_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8145	032	0	1	09	04	H8145_032_0	4	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8145	032	0	1	09	04	H8145_032_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	032	0	1	09	04	H8145_032_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	032	0	1	09	04	H8145_032_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, 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	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	051	0	1	09	04	H8145_051_0	3	2	Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		0.00				12.00				12.00		0.40				0.40	0.40	0.38	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	052	0	1	09	04	H8145_052_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	052	0	1	09	04	H8145_052_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	052	0	1	09	04	H8145_052_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	052	0	1	09	04	H8145_052_0	4	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8145	052	0	1	09	04	H8145_052_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8145	052	0	1	09	04	H8145_052_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	052	0	1	09	04	H8145_052_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	052	0	1	09	04	H8145_052_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	052	0	1	09	04	H8145_052_0	4	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	052	0	1	09	04	H8145_052_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8145	053	0	1	09	04	H8145_053_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, 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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	053	0	1	09	04	H8145_053_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	061	0	1	09	04	H8145_061_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, 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					28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8145	061	0	1	09	04	H8145_061_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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					28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	063	0	1	09	04	H8145_063_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	063	0	1	09	04	H8145_063_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	063	0	1	09	04	H8145_063_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	063	0	1	09	04	H8145_063_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	063	0	1	09	04	H8145_063_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	063	0	1	09	04	H8145_063_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	063	0	1	09	04	H8145_063_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	063	0	1	09	04	H8145_063_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	063	0	1	09	04	H8145_063_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8145	063	0	1	09	04	H8145_063_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8145	069	0	1	09	04	H8145_069_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	069	0	1	09	04	H8145_069_0	4	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	069	0	1	09	04	H8145_069_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	069	0	1	09	04	H8145_069_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	069	0	1	09	04	H8145_069_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	069	0	1	09	04	H8145_069_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	069	0	1	09	04	H8145_069_0	4	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8145	069	0	1	09	04	H8145_069_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8145	069	0	1	09	04	H8145_069_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	069	0	1	09	04	H8145_069_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	075	0	1	09	04	H8145_075_0	3	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	075	0	1	09	04	H8145_075_0	3	2	Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	075	0	1	09	04	H8145_075_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	075	0	1	09	04	H8145_075_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	075	0	1	09	04	H8145_075_0	3	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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					27																										27						27					27			27								Preferred Generic, 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	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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					27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	084	0	1	09	04	H8145_084_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		0.00				12.00				12.00		0.40				0.40	0.40	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	084	0	1	09	04	H8145_084_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		0.00				12.00				12.00		0.40				0.40	0.40	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	087	0	1	09	04	H8145_087_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	087	0	1	09	04	H8145_087_0	3	2	Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.66				0.66	0.66	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	087	0	1	09	04	H8145_087_0	3	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	087	0	1	09	04	H8145_087_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	087	0	1	09	04	H8145_087_0	3	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	089	0	1	09	04	H8145_089_0	3	2	Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	16.00		48.00																									16.00		48.00				16.00		0.00				16.00				16.00		0.53				0.53	0.53	0.51	Preferred Generic, 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	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, 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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	091	0	1	09	04	H8145_091_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	091	0	1	09	04	H8145_091_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	16.00		48.00																									16.00		48.00				16.00		0.00				16.00				16.00		0.53				0.53	0.53	0.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	091	0	1	09	04	H8145_091_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	091	0	1	09	04	H8145_091_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	091	0	1	09	04	H8145_091_0	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	091	0	1	09	04	H8145_091_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8145	091	0	1	09	04	H8145_091_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	16.00		48.00																									16.00		48.00				16.00		0.00				16.00				16.00		0.53				0.53	0.53	0.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8145	091	0	1	09	04	H8145_091_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	091	0	1	09	04	H8145_091_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	091	0	1	09	04	H8145_091_0	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	95.00		285.00																									95.00		285.00				95.00		275.00				95.00				95.00		3.16				3.16	3.16	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, 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	95.00		285.00																									95.00		285.00				95.00		275.00				95.00				95.00		3.16				3.16	3.16	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8145	093	0	1	09	04	H8145_093_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, 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	45.00		135.00																									45.00		135.00				45.00		125.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	093	0	1	09	04	H8145_093_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	103	0	1	09	04	H8145_103_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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					28																										28						28					28			28								Preferred Generic, 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					28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	103	0	1	09	04	H8145_103_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, 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	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.16				0.16	0.16	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, 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	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	122	0	1	09	04	H8145_122_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	8.00		24.00																									8.00		24.00				8.00		0.00				8.00				8.00		0.26				0.26	0.26	0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	122	0	1	09	04	H8145_122_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	8.00		24.00																									8.00		24.00				8.00		0.00				8.00				8.00		0.26				0.26	0.26	0.25	Preferred Generic, 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					26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	123	0	1	09	04	H8145_123_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, 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					26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8145	123	0	1	09	04	H8145_123_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	8.00		24.00																									8.00		24.00				8.00		0.00				8.00				8.00		0.26				0.26	0.26	0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	125	0	1	09	04	H8145_125_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, 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					27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	8.00		24.00																									8.00		24.00				8.00		0.00				8.00				8.00		0.26				0.26	0.26	0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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					27																										27						27					27			27								Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8145	125	0	1	09	04	H8145_125_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8146	001	0	1	01	01	H8146_001_0	7	1	Preferred Generic	1	4	001000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		.10			.10			.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	001	0	1	01	01	H8146_001_0	7	2	Generic	1	4	000100	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	12.00	24.00	30.00																			12.00	24.00	30.00																	12.00			12.00		.40			.40			.39	Preferred Generic, 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		10	111		1	30	60	90				2	30	60	90					14	31	45.00	90.00	112.50																			45.00	90.00	112.50																	45.00			45.00		1.50			1.50			1.45	Preferred Generic, 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		10	111		1	30	60	90				2	30	60	90					14	31	90.00	180.00	225.00																			90.00	180.00	225.00																	90.00			90.00		3.00			3.00			2.90	Preferred Generic, 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		10	111		1	30	60	90				2	30	60	90					14	31				1.00	33	33	33																		33	33	33																33		33								Preferred Generic, 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		10	111		1	30	60	90				2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		.10			.10			.10	Preferred Generic, 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		10	111		1	30	60	90				2	30	60	90					14	31				1.00	33	33	33																		33	33	33																33		33								Preferred Generic, 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		10	111		1	30	60	90				2	30	60	90					14	31	90.00	180.00	225.00																			90.00	180.00	225.00																	90.00			90.00		3.00			3.00			2.90	Preferred Generic, 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		10	111		1	30	60	90				2	30	60	90					14	31	45.00	90.00	112.50																			45.00	90.00	112.50																	45.00			45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	002	0	1	01	01	H8146_002_0	7	2	Generic	1	4	000100	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	12.00	24.00	30.00																			12.00	24.00	30.00																	12.00			12.00		.40			.40			.39	Preferred Generic, 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		10	111		1	30	60	90				2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		.10			.10			.10	Preferred Generic, 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		10	111		1	30	60	90				2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		.10			.10			.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8146	003	0	1	01	01	H8146_003_0	6	1	Preferred Generic	1	4	001000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		.10			.10			.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	003	0	1	01	01	H8146_003_0	6	2	Generic	1	4	000100	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	12.00	24.00	30.00																			12.00	24.00	30.00																	12.00			12.00		.40			.40			.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	003	0	1	01	01	H8146_003_0	6	3	Preferred Brand	1	4	010001	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	45.00	90.00	112.50																			45.00	90.00	112.50																	45.00			45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	003	0	1	01	01	H8146_003_0	6	4	Non-Preferred Brand	1	4	110000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	90.00	180.00	225.00																			90.00	180.00	225.00																	90.00			90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	003	0	1	01	01	H8146_003_0	6	5	Specialty Tier	1	4	010010	1	1	111		10	111		1	30	60	90				2	30	60	90					14	31				1.00	33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	003	0	1	01	01	H8146_003_0	6	1	Preferred Generic	3	4	001000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		.10			.10			.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8146	004	0	1	01	01	H8146_004_0	6	1	Preferred Generic	1	4	001000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		.10			.10			.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	004	0	1	01	01	H8146_004_0	6	2	Generic	1	4	000100	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	12.00	24.00	30.00																			12.00	24.00	30.00																	12.00			12.00		.40			.40			.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	004	0	1	01	01	H8146_004_0	6	3	Preferred Brand	1	4	010001	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	45.00	90.00	112.50																			45.00	90.00	112.50																	45.00			45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	004	0	1	01	01	H8146_004_0	6	4	Non-Preferred Brand	1	4	110000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	90.00	180.00	225.00																			90.00	180.00	225.00																	90.00			90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	004	0	1	01	01	H8146_004_0	6	5	Specialty Tier	1	4	010010	1	1	111		10	111		1	30	60	90				2	30	60	90					14	31				1.00	33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	004	0	1	01	01	H8146_004_0	6	1	Preferred Generic	3	4	001000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		.10			.10			.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8146	005	0	1	01	01	H8146_005_0	6	5	Specialty Tier	1	4	010010	1	1	111		10	111		1	30	60	90				2	30	60	90					14	31				1.00	33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	005	0	1	01	01	H8146_005_0	6	4	Non-Preferred Brand	1	4	110000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	90.00	180.00	225.00																			90.00	180.00	225.00																	90.00			90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	005	0	1	01	01	H8146_005_0	6	3	Preferred Brand	1	4	010001	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	45.00	90.00	112.50																			45.00	90.00	112.50																	45.00			45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	005	0	1	01	01	H8146_005_0	6	2	Generic	1	4	000100	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	12.00	24.00	30.00																			12.00	24.00	30.00																	12.00			12.00		.40			.40			.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	005	0	1	01	01	H8146_005_0	6	1	Preferred Generic	1	4	001000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		.10			.10			.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	005	0	1	01	01	H8146_005_0	6	1	Preferred Generic	3	4	001000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		.10			.10			.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8146	006	0	1	01	01	H8146_006_0	6	2	Generic	1	4	000100	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	12.00	24.00	30.00																			12.00	24.00	30.00																	12.00			12.00		.40			.40			.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	006	0	1	01	01	H8146_006_0	6	1	Preferred Generic	1	4	001000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		.10			.10			.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	006	0	1	01	01	H8146_006_0	6	3	Preferred Brand	1	4	010001	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	45.00	90.00	112.50																			45.00	90.00	112.50																	45.00			45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	006	0	1	01	01	H8146_006_0	6	4	Non-Preferred Brand	1	4	110000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	90.00	180.00	225.00																			90.00	180.00	225.00																	90.00			90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	006	0	1	01	01	H8146_006_0	6	5	Specialty Tier	1	4	010010	1	1	111		10	111		1	30	60	90				2	30	60	90					14	31				1.00	33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	006	0	1	01	01	H8146_006_0	6	1	Preferred Generic	3	4	001000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		.10			.10			.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8146	007	0	1	01	01	H8146_007_0	6	1	Preferred Generic	1	4	001000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		.10			.10			.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	007	0	1	01	01	H8146_007_0	6	2	Generic	1	4	000100	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	12.00	24.00	30.00																			12.00	24.00	30.00																	12.00			12.00		.40			.40			.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	007	0	1	01	01	H8146_007_0	6	3	Preferred Brand	1	4	010001	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	45.00	90.00	112.50																			45.00	90.00	112.50																	45.00			45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	007	0	1	01	01	H8146_007_0	6	4	Non-Preferred Brand	1	4	110000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	90.00	180.00	225.00																			90.00	180.00	225.00																	90.00			90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	007	0	1	01	01	H8146_007_0	6	5	Specialty Tier	1	4	010010	1	1	111		10	111		1	30	60	90				2	30	60	90					14	31				1.00	33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	007	0	1	01	01	H8146_007_0	6	1	Preferred Generic	3	4	001000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		.10			.10			.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8146	008	0	1	01	01	H8146_008_0	6	2	Generic	1	4	000100	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	12.00	24.00	30.00																			12.00	24.00	30.00																	12.00			12.00		.40			.40			.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	008	0	1	01	01	H8146_008_0	6	1	Preferred Generic	1	4	001000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		.10			.10			.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	008	0	1	01	01	H8146_008_0	6	3	Preferred Brand	1	4	010001	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	45.00	90.00	112.50																			45.00	90.00	112.50																	45.00			45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	008	0	1	01	01	H8146_008_0	6	1	Preferred Generic	3	4	001000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		.10			.10			.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8146	008	0	1	01	01	H8146_008_0	6	5	Specialty Tier	1	4	010010	1	1	111		10	111		1	30	60	90				2	30	60	90					14	31				1.00	33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	008	0	1	01	01	H8146_008_0	6	4	Non-Preferred Brand	1	4	110000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	90.00	180.00	225.00																			90.00	180.00	225.00																	90.00			90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	009	0	1	01	01	H8146_009_0	6	1	Preferred Generic	1	4	001000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		.10			.10			.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	009	0	1	01	01	H8146_009_0	6	2	Generic	1	4	000100	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	12.00	24.00	30.00																			12.00	24.00	30.00																	12.00			12.00		.40			.40			.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	009	0	1	01	01	H8146_009_0	6	3	Preferred Brand	1	4	010001	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	45.00	90.00	112.50																			45.00	90.00	112.50																	45.00			45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	009	0	1	01	01	H8146_009_0	6	4	Non-Preferred Brand	1	4	110000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	90.00	180.00	225.00																			90.00	180.00	225.00																	90.00			90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	009	0	1	01	01	H8146_009_0	6	5	Specialty Tier	1	4	010010	1	1	111		10	111		1	30	60	90				2	30	60	90					14	31				1.00	33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	009	0	1	01	01	H8146_009_0	6	1	Preferred Generic	3	4	001000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		.10			.10			.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8146	010	0	1	01	01	H8146_010_0	6	1	Preferred Generic	1	4	001000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		.10			.10			.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	010	0	1	01	01	H8146_010_0	6	2	Generic	1	4	000100	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	12.00	24.00	30.00																			12.00	24.00	30.00																	12.00			12.00		.40			.40			.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	010	0	1	01	01	H8146_010_0	6	5	Specialty Tier	1	4	010010	1	1	111		10	111		1	30	60	90				2	30	60	90					14	31				1.00	33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	010	0	1	01	01	H8146_010_0	6	4	Non-Preferred Brand	1	4	110000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	90.00	180.00	225.00																			90.00	180.00	225.00																	90.00			90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	010	0	1	01	01	H8146_010_0	6	3	Preferred Brand	1	4	010001	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	45.00	90.00	112.50																			45.00	90.00	112.50																	45.00			45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	010	0	1	01	01	H8146_010_0	6	1	Preferred Generic	3	4	001000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		.10			.10			.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8146	011	0	1	01	01	H8146_011_0	6	2	Generic	1	4	000100	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	12.00	24.00	30.00																			12.00	24.00	30.00																	12.00			12.00		.40			.40			.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	011	0	1	01	01	H8146_011_0	6	3	Preferred Brand	1	4	010001	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	45.00	90.00	112.50																			45.00	90.00	112.50																	45.00			45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	011	0	1	01	01	H8146_011_0	6	1	Preferred Generic	3	4	001000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		.10			.10			.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8146	011	0	1	01	01	H8146_011_0	6	4	Non-Preferred Brand	1	4	110000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	90.00	180.00	225.00																			90.00	180.00	225.00																	90.00			90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	011	0	1	01	01	H8146_011_0	6	5	Specialty Tier	1	4	010010	1	1	111		10	111		1	30	60	90				2	30	60	90					14	31				1.00	33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	011	0	1	01	01	H8146_011_0	6	1	Preferred Generic	1	4	001000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		.10			.10			.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	012	0	1	01	01	H8146_012_0	6	1	Preferred Generic	1	4	001000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		.10			.10			.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	012	0	1	01	01	H8146_012_0	6	2	Generic	1	4	000100	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	12.00	24.00	30.00																			12.00	24.00	30.00																	12.00			12.00		.40			.40			.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	012	0	1	01	01	H8146_012_0	6	3	Preferred Brand	1	4	010001	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	45.00	90.00	112.50																			45.00	90.00	112.50																	45.00			45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	012	0	1	01	01	H8146_012_0	6	4	Non-Preferred Brand	1	4	110000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	90.00	180.00	225.00																			90.00	180.00	225.00																	90.00			90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	012	0	1	01	01	H8146_012_0	6	5	Specialty Tier	1	4	010010	1	1	111		10	111		1	30	60	90				2	30	60	90					14	31				1.00	33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	012	0	1	01	01	H8146_012_0	6	1	Preferred Generic	3	4	001000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		.10			.10			.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8146	013	0	1	01	01	H8146_013_0	7	1	Preferred Generic	3	4	001000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		.10			.10			.10	Preferred Generic, 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		10	111		1	30	60	90				2	30	60	90					14	31				1.00	33	33	33																		33	33	33																33		33								Preferred Generic, 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		10	111		1	30	60	90				2	30	60	90					14	31	90.00	180.00	225.00																			90.00	180.00	225.00																	90.00			90.00		3.00			3.00			2.90	Preferred Generic, 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		10	111		1	30	60	90				2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		.10			.10			.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	013	0	1	01	01	H8146_013_0	7	2	Generic	1	4	000100	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	12.00	24.00	30.00																			12.00	24.00	30.00																	12.00			12.00		.40			.40			.39	Preferred Generic, 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		10	111		1	30	60	90				2	30	60	90					14	31	45.00	90.00	112.50																			45.00	90.00	112.50																	45.00			45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	014	0	1	01	01	H8146_014_0	6	1	Preferred Generic	3	4	001000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		.10			.10			.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8146	014	0	1	01	01	H8146_014_0	6	5	Specialty Tier	1	4	010010	1	1	111		10	111		1	30	60	90				2	30	60	90					14	31				1.00	33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	014	0	1	01	01	H8146_014_0	6	4	Non-Preferred Brand	1	4	110000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	90.00	180.00	225.00																			90.00	180.00	225.00																	90.00			90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	014	0	1	01	01	H8146_014_0	6	3	Preferred Brand	1	4	010001	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	45.00	90.00	112.50																			45.00	90.00	112.50																	45.00			45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	014	0	1	01	01	H8146_014_0	6	1	Preferred Generic	1	4	001000	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		.10			.10			.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8146	014	0	1	01	01	H8146_014_0	6	2	Generic	1	4	000100	1	2	111		10	111		1	30	60	90				2	30	60	90					14	31	12.00	24.00	30.00																			12.00	24.00	30.00																	12.00			12.00		.40			.40			.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8170	001	0	1	01	01	H8170_001_0	5	1	Generic	1	4	001000	3	2	110		01	110		1	30		90				1	30		90				30		31	4.00		12.00																			4.00		10.00																4.00				4.00		0.13			0.13			0.13	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8170	001	0	1	01	01	H8170_001_0	5	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31				960.46	33		33																		33		33															33			33								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8170	001	0	1	01	01	H8170_001_0	5	3	Non-Preferred Brand	1	4	100100	3	2	110		01	110		1	30		90				1	30		90				30		31	95.00		285.00																			95.00		237.50																95.00				95.00		3.17			3.17			3.06	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8170	001	0	1	01	01	H8170_001_0	5	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	45.00		135.00																			45.00		112.50																45.00				45.00		1.50			1.50			1.45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8170	002	0	1	01	01	H8170_002_0	5	3	Non-Preferred Brand	1	4	100100	3	2	110		01	110		1	30		90				1	30		90				30		31	95.00		285.00																			95.00		237.50																95.00				95.00		3.17			3.17			3.06	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8170	002	0	1	01	01	H8170_002_0	5	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31				1058.10	33		33																		33		33															33			33								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8170	002	0	1	01	01	H8170_002_0	5	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	45.00		135.00																			45.00		112.50																45.00				45.00		1.50			1.50			1.45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8170	002	0	1	01	01	H8170_002_0	5	1	Generic	1	4	001000	3	2	110		01	110		1	30		90				1	30		90				30		31	4.00		12.00																			4.00		10.00																4.00				4.00		0.13			0.13			0.13	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8197	001	0	1	48	05	H8197_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			
H8197	001	0	1	48	05	H8197_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	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8197	001	0	1	48	05	H8197_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			
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																																														0.00						0.00	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	2	Brand Drugs	1	4	000010			110		01	100		1	30		90				1			90				30		31																																														0.00						0.00	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	3	Non-Medicare Rx/OTC Drugs	1	4	000010			110		01	100		1	30		90				1			90				30		31																																														0.00						0.00	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			
H8237	001	0	1	01	01	H8237_001_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8237	001	0	1	01	01	H8237_001_0	8	4	Non-Preferred Brand	1	4	100100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8237	001	0	1	01	01	H8237_001_0	8	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8237	001	0	1	01	01	H8237_001_0	8	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8237	001	0	1	01	01	H8237_001_0	8	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8237	003	0	1	02	01	H8237_003_0	9	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8237	003	0	1	02	01	H8237_003_0	9	4	Non-Preferred Brand	1	4	100100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8237	003	0	1	02	01	H8237_003_0	9	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8237	003	0	1	02	01	H8237_003_0	9	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8237	003	0	1	02	01	H8237_003_0	9	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8258	001	0	1	48	05	H8258_001_0	4	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	7.40			0.00	7.40	0.00	7.40			
H8258	001	0	1	48	05	H8258_001_0	4	1	Generic Drugs	1	4	010000			111		01	111		1	30	60	90				1	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	2.95	0.00	2.95	0.00	2.95	0.00	2.95			
H8258	001	0	1	48	05	H8258_001_0	4	3	Non-Medicare Rx Drugs	1	4	010010			111		01	111		1	30	60	90				1	30	60	90				30		31																																														0.00			0.00			0.00	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	4	4	Non-Medicare OTC Drugs	1	4	010010			111		01	111		1	30	60	90				1	30	60	90				30		31																																														0.00			0.00			0.00	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			
H8266	001	0	1	01	01	H8266_001_0	9	1	Generic	1	4	010000	1	2	111		01	100		1	30	60	90				1			90				30		31	5.00	10.00	15.00																					15.00																5.00				5.00		0.17						0.16	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8266	001	0	1	01	01	H8266_001_0	9	4	Specialty Tier	1	4	010010	1	1	111		01	100		1	30	60	90				1			90				30		31				1123.34	33	33	33																				33															33			33								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8266	001	0	1	01	01	H8266_001_0	9	1	Generic	3	4	010000	1	2	111		01	100		1	30	60	90				1			90				30		31	5.00	10.00	15.00																					15.00																5.00				5.00		0.17						0.16	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8266	001	0	1	01	01	H8266_001_0	9	3	Non-Preferred Brand	1	4	100000	3	2	111		01	100		1	30	60	90				1			90				30		31	75.00	150.00	225.00																					225.00																75.00				75.00		2.50						2.42	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8266	001	0	1	01	01	H8266_001_0	9	2	Preferred Brand	1	4	000001	1	2	111		01	100		1	30	60	90				1			90				30		31	40.00	80.00	120.00																					120.00																40.00				40.00		1.33						1.29	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8266	002	0	1	01	01	H8266_002_0	6	2	Preferred Brand	1	2	000001	1	2	111		01	100		1	30	60	90				1			90				30		31	45.00	90.00	135.00																					90.00																45.00				45.00		1.50						1.45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8266	002	0	1	01	01	H8266_002_0	6	3	Non-Preferred Brand	1	2	100000	1	2	111		01	100		1	30	60	90				1			90				30		31	95.00	190.00	285.00																					190.00																95.00				95.00		3.17						3.06	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8266	002	0	1	01	01	H8266_002_0	6	4	Specialty Tier	1	2	010010	1	1	111		01	100		1	30	60	90				1			90				30		31				1074.39	25	25	25																				25															25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8266	002	0	1	01	01	H8266_002_0	6	1	Generic	1	2	010000	1	2	111		01	100		1	30	60	90				1			90				30		31	6.00	12.00	18.00																					12.00																6.00				6.00		0.20						0.19	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8289	001	0	1	01	01	H8289_001_0	5	4	Non-Preferred Brand	1	4	110000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8289	001	0	1	01	01	H8289_001_0	5	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8289	001	0	1	01	01	H8289_001_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	9.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8289	001	0	1	01	01	H8289_001_0	5	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	45.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8289	001	0	1	01	01	H8289_001_0	5	3	Preferred Brand	1	4	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8289	001	0	1	01	01	H8289_001_0	5	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	9.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8289	002	0	1	01	01	H8289_002_0	6	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	9.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8289	002	0	1	01	01	H8289_002_0	6	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8289	002	0	1	01	01	H8289_002_0	6	4	Non-Preferred Brand	1	4	110000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8289	002	0	1	01	01	H8289_002_0	6	3	Preferred Brand	1	4	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8289	002	0	1	01	01	H8289_002_0	6	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	45.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8289	002	0	1	01	01	H8289_002_0	6	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	9.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8420	001	0	1	48	05	H8420_001_0	3	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	3	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			
H8423	001	0	1	48	05	H8423_001_0	5	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			
H8423	001	0	1	48	05	H8423_001_0	5	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			
H8432	002	0	1	01	01	H8432_002_0	7	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								95.00	190.00	285.00					90.00	180.00	270.00					90.00	270.00	270.00																95.00				95.00			3.17	3.00	3.00			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8432	002	0	1	01	01	H8432_002_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8432	002	0	1	01	01	H8432_002_0	7	5	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34											836.81	25						836.81	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8432	002	0	1	01	01	H8432_002_0	7	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								45.00	90.00	135.00					45.00	90.00	135.00					45.00	135.00	135.00																45.00				45.00			1.50	1.50	1.50			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8432	002	0	1	01	01	H8432_002_0	7	2	Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								1.00	2.00	3.00					1.00	2.00	3.00					1.00	3.00	3.00																1.00				1.00			0.03	0.03	0.03			0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8432	002	0	1	01	01	H8432_002_0	7	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8432	003	0	1	01	01	H8432_003_0	7	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34											1333.18	25						1333.18	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8432	003	0	1	01	01	H8432_003_0	7	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8432	003	0	1	01	01	H8432_003_0	7	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8432	003	0	1	01	01	H8432_003_0	7	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								12.00	24.00	36.00					7.00	14.00	21.00					7.00	21.00	21.00																12.00				12.00			0.40	0.23	0.23			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8432	003	0	1	01	01	H8432_003_0	7	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8432	003	0	1	01	01	H8432_003_0	7	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H8432	003	0	1	01	01	H8432_003_0	7	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8432	004	0	1	01	01	H8432_004_0	7	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8432	004	0	1	01	01	H8432_004_0	7	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H8432	004	0	1	01	01	H8432_004_0	7	4	Non-Preferred Brand	1	4	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8432	004	0	1	01	01	H8432_004_0	7	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8432	004	0	1	01	01	H8432_004_0	7	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8432	004	0	1	01	01	H8432_004_0	7	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	15.00	15.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8432	004	0	1	01	01	H8432_004_0	7	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		34											1460.02	33						1460.02	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8452	001	0	1	48	05	H8452_001_0	4	2	Brand Drugs	1	4	000010			110		01	100		1	30		90				2			90				30		31																																														0.00						0.00	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	4	1	Generic Drugs	1	4	010000			110		01	100		1	30		90				2			90				30		31																																														0.00						0.00	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	4	3	Non-Medicare Rx Drugs	1	4	010010			110		01	100		1	30		90				2			90				30		31																																														0.00						0.00	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	4	4	Non-Medicare OTC Drugs	1	4	010010			110		01	100		1	30		90				2			90				30		31																																														0.00						0.00	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	10	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	10	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	10	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	10	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	4	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	62	93				1	31	62	93				31		31	5.00	10.00	15.00																			5.00	10.00	15.00																5.00				5.00		.16			.16			.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8506	001	0	1	01	01	H8506_001_0	4	2	Generic	1	4	000100	1	2	111		01	111		1	31	62	93				1	31	62	93				31		31	10.00	20.00	30.00																			10.00	20.00	30.00																10.00				10.00		.32			.32			.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8506	001	0	1	01	01	H8506_001_0	4	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	62	93				1	31	62	93				31		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.45			1.45			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8506	001	0	1	01	01	H8506_001_0	4	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	31	62	93				1	31	62	93				31		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.06			3.06			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8506	001	0	1	01	01	H8506_001_0	4	5	Specialty Tier	1	4	100000	1	1	010		01	010		1	31							31						31		31				300.00	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8552	020	0	1	04	01	H8552_020_0	10	2	Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8552	020	0	1	04	01	H8552_020_0	10	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8552	020	0	1	04	01	H8552_020_0	10	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8552	020	0	1	04	01	H8552_020_0	10	5	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34											1112.16	30						1112.16	30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8552	020	0	1	04	01	H8552_020_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8552	020	0	1	04	01	H8552_020_0	10	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	15.00	15.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8552	021	0	1	04	01	H8552_021_0	10	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8552	021	0	1	04	01	H8552_021_0	10	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8552	021	0	1	04	01	H8552_021_0	10	5	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34											780.79	31						780.79	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8552	021	0	1	04	01	H8552_021_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8552	021	0	1	04	01	H8552_021_0	10	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	15.00	15.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8552	021	0	1	04	01	H8552_021_0	10	2	Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8554	001	0	1	01	01	H8554_001_0	13	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			.50			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8554	001	0	1	01	01	H8554_001_0	13	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8554	001	0	1	01	01	H8554_001_0	13	5	Specialty Tier	1	4	100101	1	1	111		01	010		1	30	60	90				1	30						30		31				675.11	33	33	33																		33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8554	001	0	1	01	01	H8554_001_0	13	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8554	001	0	1	01	01	H8554_001_0	13	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.06			.06			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8554	002	0	1	01	01	H8554_002_0	12	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8554	002	0	1	01	01	H8554_002_0	12	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8554	002	0	1	01	01	H8554_002_0	12	5	Specialty Tier	1	4	100101	1	1	111		01	010		1	30	60	90				1	30						30		31				755.99	33	33	33																		33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8554	002	0	1	01	01	H8554_002_0	12	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	30.00	60.00	90.00																			30.00	60.00	60.00																30.00				30.00		1.00			1.00			.96	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8554	002	0	1	01	01	H8554_002_0	12	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.33			.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8554	002	0	1	01	01	H8554_002_0	12	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.06			.06			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	001	0	1	01	01	H8578_001_0	6	2	Preferred Brand	1	4	000001	3	2	111		01	100		1	30	60	90				1			90				30		31	45.00	90.00	135.00																					90.00																45.00				45.00		1.50						1.45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	001	0	1	01	01	H8578_001_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	001	0	1	01	01	H8578_001_0	6	1	Generic	3	4	010000	1	2	111		01	100		1	30	60	90				1			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		.32						.32	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8578	001	0	1	01	01	H8578_001_0	6	3	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	30	60	90				1			90				30		31	90.00	180.00	270.00																					270.00																90.00				90.00		3.00						2.90	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	001	0	1	01	01	H8578_001_0	6	1	Generic	1	4	010000	1	2	111		01	100		1	30	60	90				1			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	004	0	1	01	01	H8578_004_0	6	1	Generic	1	4	010000	1	2	111		01	100		1	30	60	90				1			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	004	0	1	01	01	H8578_004_0	6	2	Preferred Brand	1	4	000001	3	2	111		01	100		1	30	60	90				1			90				30		31	45.00	90.00	135.00																					90.00																45.00				45.00		1.50						1.45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	004	0	1	01	01	H8578_004_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	004	0	1	01	01	H8578_004_0	6	1	Generic	3	4	010000	1	2	111		01	100		1	30	60	90				1			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		.32						.32	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8578	004	0	1	01	01	H8578_004_0	6	3	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	30	60	90				1			90				30		31	90.00	180.00	270.00																					270.00																90.00				90.00		3.00						2.90	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	007	0	1	01	01	H8578_007_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	007	0	1	01	01	H8578_007_0	6	3	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	30	60	90				1			90				30		31	90.00	180.00	270.00																					270.00																90.00				90.00		3.00						2.90	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	007	0	1	01	01	H8578_007_0	6	2	Preferred Brand	1	4	000001	3	2	111		01	100		1	30	60	90				1			90				30		31	45.00	90.00	135.00																					90.00																45.00				45.00		1.50						1.45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	007	0	1	01	01	H8578_007_0	6	1	Generic	1	4	010000	1	2	111		01	100		1	30	60	90				1			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	012	0	1	01	01	H8578_012_0	6	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	012	0	1	01	01	H8578_012_0	6	3	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	30	60	90				1			90				30		31	90.00	180.00	270.00																					270.00																90.00				90.00		1.45						2.90	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	012	0	1	01	01	H8578_012_0	6	2	Preferred Brand	1	4	000001	3	2	111		01	100		1	30	60	90				1			90				30		31	45.00	90.00	135.00																					90.00																45.00				45.00		0.40						1.45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	012	0	1	01	01	H8578_012_0	6	1	Generic	1	4	010000	1	2	111		01	100		1	30	60	90				1			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	013	0	1	01	01	H8578_013_0	7	1	Generic	1	4	010000	1	2	111		01	100		1	30	60	90				1			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	013	0	1	01	01	H8578_013_0	7	2	Preferred Brand	1	4	000001	3	2	111		01	100		1	30	60	90				1			90				30		31	45.00	90.00	135.00																					90.00																45.00				45.00		1.50						1.45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	013	0	1	01	01	H8578_013_0	7	3	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	30	60	90				1			90				30		31	90.00	180.00	270.00																					270.00																90.00				90.00		3.00						2.90	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	013	0	1	01	01	H8578_013_0	7	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	6	1	Generic	1	4	010000	1	2	111		01	100		1	30	60	90				1			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	014	0	1	01	01	H8578_014_0	6	1	Generic	3	4	010000	1	2	111		01	100		1	30	60	90				1			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		.32						.32	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8578	014	0	1	01	01	H8578_014_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	014	0	1	01	01	H8578_014_0	6	3	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	30	60	90				1			90				30		31	90.00	180.00	270.00																					270.00																90.00				90.00		3.00						2.90	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	014	0	1	01	01	H8578_014_0	6	2	Preferred Brand	1	4	000001	3	2	111		01	100		1	30	60	90				1			90				30		31	45.00	90.00	135.00																					90.00																45.00				45.00		1.50						1.45	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	45.00	90.00	135.00																					90.00																45.00				45.00		1.50						1.45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	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	90.00	180.00	270.00																					270.00																90.00				90.00		3.00						2.90	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	010	0	1	04	01	H8604_010_0	11	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								13.00		39.00					3.00		9.00							6.00																13.00				13.00			0.43	0.10				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8604	010	0	1	04	01	H8604_010_0	11	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											1000.00	33						1000.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8604	010	0	1	04	01	H8604_010_0	11	2	Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								20.00		60.00					10.00		30.00							20.00																20.00				20.00			0.67	0.33				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8604	010	0	1	04	01	H8604_010_0	11	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31								45.00		135.00					35.00		105.00							70.00																45.00				45.00			1.50	1.17				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8604	010	0	1	04	01	H8604_010_0	11	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	2			90				30		31								95.00		285.00					85.00		255.00							170.00																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8604	010	0	1	04	01	H8604_010_0	11	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								13.00		39.00					3.00		9.00							6.00																13.00				13.00			0.43	0.10				0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8604	011	0	1	04	01	H8604_011_0	12	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								13.00		39.00					3.00		9.00							6.00																13.00				13.00			0.43	0.10				0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8604	011	0	1	04	01	H8604_011_0	12	2	Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								20.00		60.00					10.00		30.00							20.00																20.00				20.00			0.67	0.33				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8604	011	0	1	04	01	H8604_011_0	12	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31								45.00		135.00					35.00		105.00							70.00																45.00				45.00			1.50	1.17				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8604	011	0	1	04	01	H8604_011_0	12	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	2			90				30		31								95.00		285.00					85.00		255.00							170.00																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8604	011	0	1	04	01	H8604_011_0	12	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								13.00		39.00					3.00		9.00							6.00																13.00				13.00			0.43	0.10				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8604	011	0	1	04	01	H8604_011_0	12	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											1000.00	33						1000.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8604	013	0	1	04	01	H8604_013_0	10	3	Preferred Brand	1	4	000001	1	2		110	01	100		1				30		90	1			90				30		31								45.00		135.00					35.00		105.00							70.00																45.00				45.00			1.50	1.17				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8604	013	0	1	04	01	H8604_013_0	10	4	Non-Preferred Brand	1	4	100000	1	2		110	01	100		1				30		90	2			90				30		31								95.00		285.00					85.00		255.00							170.00																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8604	013	0	1	04	01	H8604_013_0	10	2	Generic	1	4	000100	1	2		110	01	100		1				30		90	1			90				30		31								20.00		60.00					10.00		30.00							20.00																20.00				20.00			0.67	0.33				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8604	013	0	1	04	01	H8604_013_0	10	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								13.00		39.00					3.00		9.00							6.00																13.00				13.00			0.43	0.10				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8604	013	0	1	04	01	H8604_013_0	10	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											1000.00	33						1000.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8604	013	0	1	04	01	H8604_013_0	10	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								13.00		39.00					3.00		9.00							6.00																13.00				13.00			0.43	0.10				0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	001	0	1	04	01	H8634_001_0	8	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31								44.00		132.00					39.00		117.00							132.00																44.00				44.00			1.47	1.30				1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	001	0	1	04	01	H8634_001_0	8	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					85.00		255.00							285.00																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	001	0	1	04	01	H8634_001_0	8	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31											1330.00	33		33				1330.00	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	001	0	1	04	01	H8634_001_0	8	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			.16	.00				.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8634	001	0	1	04	01	H8634_001_0	8	2	Generic	3	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								11.00		33.00					6.00		18.00							33.00																11.00				11.00			.36	.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8634	001	0	1	04	01	H8634_001_0	8	2	Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								11.00		33.00					6.00		18.00							33.00																11.00				11.00			0.37	0.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	001	0	1	04	01	H8634_001_0	8	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	002	0	1	04	01	H8634_002_0	9	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					85.00		255.00							285.00																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	002	0	1	04	01	H8634_002_0	9	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31											1330.00	33		33				1330.00	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	002	0	1	04	01	H8634_002_0	9	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31								44.00		132.00					39.00		117.00							132.00																44.00				44.00			1.47	1.30				1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	002	0	1	04	01	H8634_002_0	9	2	Generic	3	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								11.00		33.00					6.00		18.00							33.00																11.00				11.00			.36	.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8634	002	0	1	04	01	H8634_002_0	9	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			.16	.00				.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8634	002	0	1	04	01	H8634_002_0	9	2	Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								11.00		33.00					6.00		18.00							33.00																11.00				11.00			0.37	0.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	002	0	1	04	01	H8634_002_0	9	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	003	0	1	04	01	H8634_003_0	10	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					85.00		255.00							285.00																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	003	0	1	04	01	H8634_003_0	10	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31											1330.00	33		33				1330.00	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	003	0	1	04	01	H8634_003_0	10	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8634	003	0	1	04	01	H8634_003_0	10	2	Generic	3	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								11.00		33.00					6.00		18.00							33.00																11.00				11.00			0.37	0.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8634	003	0	1	04	01	H8634_003_0	10	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31								44.00		132.00					39.00		117.00							132.00																44.00				44.00			1.47	1.30				1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	003	0	1	04	01	H8634_003_0	10	2	Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								11.00		33.00					6.00		18.00							33.00																11.00				11.00			0.37	0.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	003	0	1	04	01	H8634_003_0	10	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	004	0	1	04	01	H8634_004_0	11	2	Generic	3	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								11.00		33.00					6.00		18.00							33.00																11.00				11.00			0.37	0.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8634	004	0	1	04	01	H8634_004_0	11	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8634	004	0	1	04	01	H8634_004_0	11	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31								44.00		132.00					39.00		117.00							132.00																44.00				44.00			1.47	1.30				1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	004	0	1	04	01	H8634_004_0	11	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					85.00		255.00							285.00																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	004	0	1	04	01	H8634_004_0	11	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31											1330.00	33		33				1330.00	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	004	0	1	04	01	H8634_004_0	11	2	Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								11.00		33.00					6.00		18.00							33.00																11.00				11.00			0.37	0.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	004	0	1	04	01	H8634_004_0	11	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	006	0	1	04	01	H8634_006_0	10	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					85.00		255.00							285.00																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	006	0	1	04	01	H8634_006_0	10	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31								44.00		132.00					39.00		117.00							132.00																44.00				44.00			1.47	1.30				1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	006	0	1	04	01	H8634_006_0	10	2	Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								11.00		33.00					6.00		18.00							33.00																11.00				11.00			0.37	0.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	006	0	1	04	01	H8634_006_0	10	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	006	0	1	04	01	H8634_006_0	10	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31											1330.00	33		33				1330.00	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	006	0	1	04	01	H8634_006_0	10	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8634	006	0	1	04	01	H8634_006_0	10	2	Generic	3	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								11.00		33.00					6.00		18.00							33.00																11.00				11.00			0.37	0.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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								7.00	14.00	21.00					2.00	4.00	4.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8649	003	0	1	01	01	H8649_003_0	9	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								15.00	30.00	45.00					9.00	18.00	18.00					15.00	30.00	45.00																	15.00			15.00			0.50	0.30	0.50			0.48	Preferred Generic, 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								47.00	94.00	141.00					47.00	94.00	94.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, 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	2		111	10	111		1				30	60	90	1	30	60	90					10	31								100.00	200.00	300.00					100.00	200.00	200.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, 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	28						1.00	28						28																		28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8649	008	0	1	01	01	H8649_008_0	8	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								15.00	30.00	45.00					9.00	18.00	18.00					15.00	30.00	45.00																	15.00			15.00			0.50	0.30	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8649	008	0	1	01	01	H8649_008_0	8	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	4.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8649	008	0	1	01	01	H8649_008_0	8	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	94.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8649	008	0	1	01	01	H8649_008_0	8	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											48.79	50	50	50				45.27	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8649	008	0	1	01	01	H8649_008_0	8	5	Specialty Tier	1	4	010010	1	1		010	10	010		1				30				30							10	31											1.00	29						1.00	29						29																		29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8677	001	0	1	48	05	H8677_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			
H8677	001	0	1	48	05	H8677_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			
H8677	001	0	1	48	05	H8677_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	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8677	002	0	1	48	05	H8677_002_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	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8677	002	0	1	48	05	H8677_002_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			
H8677	002	0	1	48	05	H8677_002_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			
H8748	002	0	1	01	01	H8748_002_0	3	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				536.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8748	002	0	1	01	01	H8748_002_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8748	002	0	1	01	01	H8748_002_0	3	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8748	002	0	1	01	01	H8748_002_0	3	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8748	002	0	1	01	01	H8748_002_0	3	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8764	001	0	1	01	01	H8764_001_0	11	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8764	001	0	1	01	01	H8764_001_0	11	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	85.00		170.00																					170.00																85.00				85.00		2.83						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8764	001	0	1	01	01	H8764_001_0	11	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	45.00		90.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8764	001	0	1	01	01	H8764_001_0	11	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	5.00		10.00																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8764	001	0	1	01	01	H8764_001_0	11	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	2.00		4.00																					4.00																2.00				2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8764	002	0	1	02	01	H8764_002_0	9	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	2.00		4.00																					4.00																2.00				2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8764	002	0	1	02	01	H8764_002_0	9	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8764	002	0	1	02	01	H8764_002_0	9	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	85.00		170.00																					170.00																85.00				85.00		2.83						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8764	002	0	1	02	01	H8764_002_0	9	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	45.00		90.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8764	002	0	1	02	01	H8764_002_0	9	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	5.00		10.00																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8764	003	0	1	01	01	H8764_003_0	11	4	Non-Preferred Brand	1	3	100000	1	2	110		01	100		1	30		90				1			90				30		31	85.00		170.00																					170.00																85.00				85.00		2.83						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8764	003	0	1	01	01	H8764_003_0	11	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8764	003	0	1	01	01	H8764_003_0	11	3	Preferred Brand	1	3	000001	1	2	110		01	100		1	30		90				1			90				30		31	45.00		90.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8764	003	0	1	01	01	H8764_003_0	11	2	Generic	1	3	000100	1	2	110		01	100		1	30		90				1			90				30		31	15.00		30.00																					30.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8764	003	0	1	01	01	H8764_003_0	11	1	Preferred Generic	1	3	001000	1	2	110		01	100		1	30		90				1			90				30		31	4.00		8.00																					8.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8786	001	0	1	48	05	H8786_001_0	7	1	Generic Drugs	1	4	010010			111		10	111		1	31	62	93				2	31	62	93					10	31																																														0.00			0.00			0.00	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			
H8786	001	0	1	48	05	H8786_001_0	7	2	Brand Drugs	1	4	010010			111		10	111		1	31	62	93				2	31	62	93					10	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	7.40			0.00	7.40	0.00	7.40			
H8786	001	0	1	48	05	H8786_001_0	7	3	Non-Medicare Rx Drugs	1	4	010010			010		10			1	31														10	31																																														0.00						0.00	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			
H8786	001	0	1	48	05	H8786_001_0	7	4	Non-Medicare OTC Drugs	1	4	010010			010		10			1	31														10	31																																														0.00						0.00	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			
H8822	004	0	1	01	01	H8822_004_0	13	2	Generic	3	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H8822	004	0	1	01	01	H8822_004_0	13	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H8822	004	0	1	01	01	H8822_004_0	13	6	Select Care Drugs	1	4	010000	1	2	110		01	110		1	30		90				2	30		90				30		31	3.00		9.00																			3.00		6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8822	004	0	1	01	01	H8822_004_0	13	6	Select Care Drugs	3	4	010000	1	2	110		01	110		1	30		90				2	30		90				30		31	3.00		9.00																			3.00		6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H8822	004	0	1	01	01	H8822_004_0	13	5	Specialty Tier	1	4	000010	1	1	110		01	110		1	30		90				2	30		90				30		31				33.00	33		33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8822	004	0	1	01	01	H8822_004_0	13	2	Generic	1	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8822	004	0	1	01	01	H8822_004_0	13	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				2	30		90				30		31	47.00		141.00																			47.00		94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8822	004	0	1	01	01	H8822_004_0	13	4	Non-Preferred Brand	1	4	100000	1	1	110		01	110		1	30		90				2	30		90				30		31				25.00	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8822	004	0	1	01	01	H8822_004_0	13	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
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			
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	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			
H8854	001	0	1	01	01	H8854_001_0	7	1	Preferred Generic	1	4	001010	1	2	110		10	110		1	30		90				2	30		90					10	31	4.00		12.00																			4.00		12.00																	4.00			4.00		.13			.13			.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8854	001	0	1	01	01	H8854_001_0	7	2	Generic	1	4	000110	1	2	110		10	110		1	30		90				2	30		90					10	31	15.00		45.00																			15.00		45.00																	15.00			15.00		.50			.50			.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8854	001	0	1	01	01	H8854_001_0	7	3	Preferred Brand	1	4	010001	1	2	110		10	110		1	30		90				2	30		90					10	31	47.00		141.00																			47.00		141.00																	47.00			47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8854	001	0	1	01	01	H8854_001_0	7	4	Non-Preferred Brand	1	4	110000	1	2	110		10	110		1	30		90				2	30		90					10	31	100.00		300.00																			100.00		300.00																	100.00			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8854	001	0	1	01	01	H8854_001_0	7	5	Specialty Tier	1	4	010010	1	1	010		10	010		1	30							30							10	31				198.00	33																				33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8908	001	0	1	01	01	H8908_001_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8908	001	0	1	01	01	H8908_001_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8908	002	0	1	01	01	H8908_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8908	002	0	1	01	01	H8908_002_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8908	002	0	1	01	01	H8908_002_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8908	002	0	1	01	01	H8908_002_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8908	002	0	1	01	01	H8908_002_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8908	002	0	1	01	01	H8908_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8908	002	0	1	01	01	H8908_002_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8908	002	0	1	01	01	H8908_002_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8908	002	0	1	01	01	H8908_002_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8908	002	0	1	01	01	H8908_002_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, 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, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	002	0	1	01	01	H8953_002_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, 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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8953	002	0	1	01	01	H8953_002_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8953	003	0	1	01	01	H8953_003_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, 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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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, 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, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	003	0	1	01	01	H8953_003_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, 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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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					25																										25						25					25			25								Preferred Generic, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8953	005	0	1	01	01	H8953_005_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, 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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	005	0	1	01	01	H8953_005_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	006	0	1	01	01	H8953_006_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8953	006	0	1	01	01	H8953_006_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8953	007	0	1	01	01	H8953_007_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	007	0	1	01	01	H8953_007_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	007	0	1	01	01	H8953_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	007	0	1	01	01	H8953_007_0	3	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	007	0	1	01	01	H8953_007_0	3	2	Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	010	0	1	01	01	H8953_010_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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, 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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8953	010	0	1	01	01	H8953_010_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8953	011	0	1	01	01	H8953_011_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H8953	011	0	1	01	01	H8953_011_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H8953	011	0	1	01	01	H8953_011_0	4	6	Select Care Drugs	1	4	010010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8953	011	0	1	01	01	H8953_011_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8953	011	0	1	01	01	H8953_011_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8953	011	0	1	01	01	H8953_011_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	3	
H8953	011	0	1	01	01	H8953_011_0	4	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8953	011	0	1	01	01	H8953_011_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8953	011	0	1	01	01	H8953_011_0	4	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H8953	011	0	1	01	01	H8953_011_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	2	
H8953	011	0	1	01	01	H8953_011_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	014	0	1	01	01	H8953_014_0	4	2	Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00		9.00																									3.00		9.00				3.00		0.00				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	016	0	1	01	01	H8953_016_0	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8953	016	0	1	01	01	H8953_016_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	016	0	1	01	01	H8953_016_0	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8953	016	0	1	01	01	H8953_016_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8953	016	0	1	01	01	H8953_016_0	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8953	016	0	1	01	01	H8953_016_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	016	0	1	01	01	H8953_016_0	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	1.00		3.00																									1.00		3.00				1.00		0.00				1.00				1.00		0.03				0.03	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8953	016	0	1	01	01	H8953_016_0	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	1.00		3.00																									1.00		3.00				1.00		0.00				1.00				1.00		0.03				0.03	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	016	0	1	01	01	H8953_016_0	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	016	0	1	01	01	H8953_016_0	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	017	0	1	01	01	H8953_017_0	4	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8953	017	0	1	01	01	H8953_017_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8953	017	0	1	01	01	H8953_017_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8953	017	0	1	01	01	H8953_017_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8953	017	0	1	01	01	H8953_017_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	1.00		3.00																									1.00		3.00				1.00		0.00				1.00				1.00		0.03				0.03	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	017	0	1	01	01	H8953_017_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	017	0	1	01	01	H8953_017_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	017	0	1	01	01	H8953_017_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	017	0	1	01	01	H8953_017_0	4	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	017	0	1	01	01	H8953_017_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	1.00		3.00																									1.00		3.00				1.00		0.00				1.00				1.00		0.03				0.03	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8953	018	1	1	01	01	H8953_018_1	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8953	018	1	1	01	01	H8953_018_1	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	018	1	1	01	01	H8953_018_1	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	018	1	1	01	01	H8953_018_1	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	018	1	1	01	01	H8953_018_1	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	018	1	1	01	01	H8953_018_1	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	018	1	1	01	01	H8953_018_1	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8953	018	1	1	01	01	H8953_018_1	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8953	018	1	1	01	01	H8953_018_1	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8953	018	1	1	01	01	H8953_018_1	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8953	018	2	1	01	01	H8953_018_2	3	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	018	2	1	01	01	H8953_018_2	3	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	018	2	1	01	01	H8953_018_2	3	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	018	2	1	01	01	H8953_018_2	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8953	018	2	1	01	01	H8953_018_2	3	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8953	018	2	1	01	01	H8953_018_2	3	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8953	018	2	1	01	01	H8953_018_2	3	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
H8953	018	2	1	01	01	H8953_018_2	3	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8953	018	2	1	01	01	H8953_018_2	3	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H8953	018	2	1	01	01	H8953_018_2	3	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	013	0	1	02	01	H9001_013_0	6	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																1.00				1.00			0.20	0.03	0.03			0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	013	0	1	02	01	H9001_013_0	6	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31								11.00	22.00	33.00					6.00	12.00	18.00					6.00	12.00	18.00																6.00				6.00			0.37	0.20	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	013	0	1	02	01	H9001_013_0	6	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31								37.00	74.00	111.00					32.00	64.00	96.00					32.00	64.00	96.00																32.00				32.00			1.23	1.07	1.07			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	013	0	1	02	01	H9001_013_0	6	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31								91.00	182.00	273.00					86.00	172.00	258.00					86.00	172.00	258.00																86.00				86.00			3.03	2.87	2.87			2.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	013	0	1	02	01	H9001_013_0	6	5	Specialty Tier	1	4	100100	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31											988.00	33	33	33				988.00	33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	015	0	1	01	01	H9001_015_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																1.00				1.00			0.20	0.03	0.03			0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	015	0	1	01	01	H9001_015_0	5	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31								11.00	22.00	33.00					6.00	12.00	18.00					6.00	12.00	18.00																6.00				6.00			0.37	0.20	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	015	0	1	01	01	H9001_015_0	5	5	Specialty Tier	1	4	100100	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31											879.00	33	33	33				879.00	33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	015	0	1	01	01	H9001_015_0	5	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31								91.00	182.00	273.00					86.00	172.00	258.00					86.00	172.00	258.00																86.00				86.00			3.03	2.87	2.87			2.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	015	0	1	01	01	H9001_015_0	5	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31								37.00	74.00	111.00					32.00	64.00	96.00					32.00	64.00	96.00																32.00				32.00			1.23	1.07	1.07			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	019	0	1	01	01	H9001_019_0	4	1	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								Generic, Preferred Brand, Non-Preferred Brand												
H9001	019	0	1	01	01	H9001_019_0	4	2	Preferred Brand	1	3	000101	1	1	111		01	111		1	30	60	90				2	30	60	90				30		31					25	25	25																		25	25	25															25			25								Generic, Preferred Brand, Non-Preferred Brand												
H9001	019	0	1	01	01	H9001_019_0	4	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								Generic, Preferred Brand, Non-Preferred Brand												
H9001	030	1	1	01	01	H9001_030_1	5	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31								37.00	74.00	111.00					32.00	64.00	96.00					32.00	64.00	96.00																32.00				32.00			1.23	1.07	1.07			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	1	1	01	01	H9001_030_1	5	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31								91.00	182.00	273.00					86.00	172.00	258.00					86.00	172.00	258.00																86.00				86.00			3.03	2.87	2.87			2.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	1	1	01	01	H9001_030_1	5	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31								11.00	22.00	33.00					6.00	12.00	18.00					6.00	12.00	18.00																6.00				6.00			0.37	0.20	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	1	1	01	01	H9001_030_1	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																1.00				1.00			0.20	0.03	0.03			0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	1	1	01	01	H9001_030_1	5	5	Specialty Tier	1	4	100100	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31											788.00	33	33	33				788.00	33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	2	1	01	01	H9001_030_2	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																1.00				1.00			0.20	0.03	0.03			0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	2	1	01	01	H9001_030_2	5	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31								11.00	22.00	33.00					6.00	12.00	18.00					6.00	12.00	18.00																6.00				6.00			0.37	0.20	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	2	1	01	01	H9001_030_2	5	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31								37.00	74.00	111.00					32.00	64.00	96.00					32.00	64.00	96.00																32.00				32.00			1.23	1.07	1.07			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	2	1	01	01	H9001_030_2	5	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31								91.00	182.00	273.00					86.00	172.00	258.00					86.00	172.00	258.00																86.00				86.00			3.03	2.87	2.87			2.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	2	1	01	01	H9001_030_2	5	5	Specialty Tier	1	4	100100	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31											788.00	33	33	33				788.00	33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	4	1	01	01	H9001_030_4	5	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31								11.00	22.00	33.00					6.00	12.00	18.00					6.00	12.00	18.00																6.00				6.00			0.37	0.20	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	4	1	01	01	H9001_030_4	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																1.00				1.00			0.20	0.03	0.03			0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	4	1	01	01	H9001_030_4	5	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31								37.00	74.00	111.00					32.00	64.00	96.00					32.00	64.00	96.00																32.00				32.00			1.23	1.07	1.07			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	4	1	01	01	H9001_030_4	5	5	Specialty Tier	1	4	100100	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31											788.00	33	33	33				788.00	33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	4	1	01	01	H9001_030_4	5	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31								91.00	182.00	273.00					86.00	172.00	258.00					86.00	172.00	258.00																86.00				86.00			3.03	2.87	2.87			2.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	5	1	01	01	H9001_030_5	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																1.00				1.00			0.20	0.03	0.03			0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	5	1	01	01	H9001_030_5	5	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31								11.00	22.00	33.00					6.00	12.00	18.00					6.00	12.00	18.00																6.00				6.00			0.37	0.20	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	5	1	01	01	H9001_030_5	5	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31								37.00	74.00	111.00					32.00	64.00	96.00					32.00	64.00	96.00																32.00				32.00			1.23	1.07	1.07			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	5	1	01	01	H9001_030_5	5	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31								91.00	182.00	273.00					86.00	172.00	258.00					86.00	172.00	258.00																86.00				86.00			3.03	2.87	2.87			2.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	5	1	01	01	H9001_030_5	5	5	Specialty Tier	1	4	100100	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31											788.00	33	33	33				788.00	33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	031	1	1	01	01	H9001_031_1	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																1.00				1.00			0.20	0.03	0.03			0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	031	1	1	01	01	H9001_031_1	5	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31								11.00	22.00	33.00					6.00	12.00	18.00					6.00	12.00	18.00																6.00				6.00			0.37	0.20	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	031	1	1	01	01	H9001_031_1	5	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31								91.00	182.00	273.00					86.00	172.00	258.00					86.00	172.00	258.00																86.00				86.00			3.03	2.87	2.87			2.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	031	1	1	01	01	H9001_031_1	5	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31								37.00	74.00	111.00					32.00	64.00	96.00					32.00	64.00	96.00																32.00				32.00			1.23	1.07	1.07			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	031	1	1	01	01	H9001_031_1	5	5	Specialty Tier	1	4	100100	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31											653.00	33	33	33				653.00	33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	031	2	1	01	01	H9001_031_2	5	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31								91.00	182.00	273.00					86.00	172.00	258.00					86.00	172.00	258.00																86.00				86.00			3.03	2.87	2.87			2.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	031	2	1	01	01	H9001_031_2	5	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31								37.00	74.00	111.00					32.00	64.00	96.00					32.00	64.00	96.00																32.00				32.00			1.23	1.07	1.07			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	031	2	1	01	01	H9001_031_2	5	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31								11.00	22.00	33.00					6.00	12.00	18.00					6.00	12.00	18.00																6.00				6.00			0.37	0.20	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	031	2	1	01	01	H9001_031_2	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																1.00				1.00			0.20	0.03	0.03			0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	031	2	1	01	01	H9001_031_2	5	5	Specialty Tier	1	4	100100	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31											653.00	33	33	33				653.00	33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	031	4	1	01	01	H9001_031_4	5	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31								91.00	182.00	273.00					86.00	172.00	258.00					86.00	172.00	258.00																86.00				86.00			3.03	2.87	2.87			2.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	031	4	1	01	01	H9001_031_4	5	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31								37.00	74.00	111.00					32.00	64.00	96.00					32.00	64.00	96.00																32.00				32.00			1.23	1.07	1.07			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	031	4	1	01	01	H9001_031_4	5	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31								11.00	22.00	33.00					6.00	12.00	18.00					6.00	12.00	18.00																6.00				6.00			0.37	0.20	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	031	4	1	01	01	H9001_031_4	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																1.00				1.00			0.20	0.03	0.03			0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	031	4	1	01	01	H9001_031_4	5	5	Specialty Tier	1	4	100100	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31											653.00	33	33	33				653.00	33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	031	6	1	01	01	H9001_031_6	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																1.00				1.00			0.20	0.03	0.03			0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	031	6	1	01	01	H9001_031_6	5	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31								11.00	22.00	33.00					6.00	12.00	18.00					6.00	12.00	18.00																6.00				6.00			0.37	0.20	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	031	6	1	01	01	H9001_031_6	5	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31								37.00	74.00	111.00					32.00	64.00	96.00					32.00	64.00	96.00																32.00				32.00			1.23	1.07	1.07			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	031	6	1	01	01	H9001_031_6	5	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31								91.00	182.00	273.00					86.00	172.00	258.00					86.00	172.00	258.00																86.00				86.00			3.03	2.87	2.87			2.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	031	6	1	01	01	H9001_031_6	5	5	Specialty Tier	1	4	100100	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31											653.00	33	33	33				653.00	33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	1	1	01	01	H9001_032_1	5	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31								91.00	182.00	273.00					86.00	172.00	258.00					86.00	172.00	258.00																86.00				86.00			3.03	2.87	2.87			2.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	1	1	01	01	H9001_032_1	5	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31								42.00	84.00	126.00					37.00	74.00	111.00					37.00	74.00	111.00																37.00				37.00			1.40	1.23	1.23			1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	1	1	01	01	H9001_032_1	5	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31								11.00	22.00	33.00					6.00	12.00	18.00					6.00	12.00	18.00																6.00				6.00			0.37	0.20	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	1	1	01	01	H9001_032_1	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	6.00																2.00				2.00			0.23	0.07	0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	1	1	01	01	H9001_032_1	5	5	Specialty Tier	1	4	100100	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31											976.00	25	25	25				976.00	25	25	25				25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	2	1	01	01	H9001_032_2	5	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31								11.00	22.00	33.00					6.00	12.00	18.00					6.00	12.00	18.00																6.00				6.00			0.37	0.20	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	2	1	01	01	H9001_032_2	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	6.00																2.00				2.00			0.23	0.07	0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	2	1	01	01	H9001_032_2	5	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31								42.00	84.00	126.00					37.00	74.00	111.00					37.00	74.00	111.00																37.00				37.00			1.40	1.23	1.23			1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	2	1	01	01	H9001_032_2	5	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31								91.00	182.00	273.00					86.00	172.00	258.00					86.00	172.00	258.00																86.00				86.00			3.03	2.87	2.87			2.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	2	1	01	01	H9001_032_2	5	5	Specialty Tier	1	4	100100	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31											976.00	25	25	25				976.00	25	25	25				25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	4	1	01	01	H9001_032_4	5	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31								11.00	22.00	33.00					6.00	12.00	18.00					6.00	12.00	18.00																6.00				6.00			0.37	0.20	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	4	1	01	01	H9001_032_4	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	6.00																2.00				2.00			0.23	0.07	0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	4	1	01	01	H9001_032_4	5	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31								42.00	84.00	126.00					37.00	74.00	111.00					37.00	74.00	111.00																37.00				37.00			1.40	1.23	1.23			1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	4	1	01	01	H9001_032_4	5	5	Specialty Tier	1	4	100100	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31											976.00	25	25	25				976.00	25	25	25				25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	4	1	01	01	H9001_032_4	5	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31								91.00	182.00	273.00					86.00	172.00	258.00					86.00	172.00	258.00																86.00				86.00			3.03	2.87	2.87			2.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	5	1	01	01	H9001_032_5	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	6.00																2.00				2.00			0.23	0.07	0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	5	1	01	01	H9001_032_5	5	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31								11.00	22.00	33.00					6.00	12.00	18.00					6.00	12.00	18.00																6.00				6.00			0.37	0.20	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	5	1	01	01	H9001_032_5	5	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31								91.00	182.00	273.00					86.00	172.00	258.00					86.00	172.00	258.00																86.00				86.00			3.03	2.87	2.87			2.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	5	1	01	01	H9001_032_5	5	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31								42.00	84.00	126.00					37.00	74.00	111.00					37.00	74.00	111.00																37.00				37.00			1.40	1.23	1.23			1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	5	1	01	01	H9001_032_5	5	5	Specialty Tier	1	4	100100	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31											976.00	25	25	25				976.00	25	25	25				25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	6	1	01	01	H9001_032_6	5	5	Specialty Tier	1	4	100100	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31											976.00	25	25	25				976.00	25	25	25				25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	6	1	01	01	H9001_032_6	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	6.00																2.00				2.00			0.23	0.07	0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	6	1	01	01	H9001_032_6	5	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31								11.00	22.00	33.00					6.00	12.00	18.00					6.00	12.00	18.00																6.00				6.00			0.37	0.20	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	6	1	01	01	H9001_032_6	5	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31								42.00	84.00	126.00					37.00	74.00	111.00					37.00	74.00	111.00																37.00				37.00			1.40	1.23	1.23			1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	6	1	01	01	H9001_032_6	5	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31								91.00	182.00	273.00					86.00	172.00	258.00					86.00	172.00	258.00																86.00				86.00			3.03	2.87	2.87			2.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	033	0	1	02	01	H9001_033_0	6	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31								11.00	22.00	33.00					6.00	12.00	18.00					6.00	12.00	18.00																6.00				6.00			0.37	0.20	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	033	0	1	02	01	H9001_033_0	6	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31								37.00	74.00	111.00					32.00	64.00	96.00					32.00	64.00	96.00																32.00				32.00			1.23	1.07	1.07			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	033	0	1	02	01	H9001_033_0	6	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31								91.00	182.00	273.00					86.00	172.00	258.00					86.00	172.00	258.00																86.00				86.00			3.03	2.87	2.87			2.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	033	0	1	02	01	H9001_033_0	6	5	Specialty Tier	1	4	100100	1	1		111	01	111		1				30	60	90	2	30	60	90				30		31											817.00	33	33	33				817.00	33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	033	0	1	02	01	H9001_033_0	6	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	2	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																1.00				1.00			0.20	0.03	0.03			0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9003	001	0	1	01	01	H9003_001_0	10	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		.16			.16			.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H9003	001	0	1	01	01	H9003_001_0	10	2	Generic	3	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		.33			.33			.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H9003	001	0	1	01	01	H9003_001_0	10	6	Vaccines	3	4	000001	1	2	010		01			1	30													30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H9003	001	0	1	01	01	H9003_001_0	10	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.16			0.16			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	001	0	1	01	01	H9003_001_0	10	2	Generic	1	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		.33			.33			.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	001	0	1	01	01	H9003_001_0	10	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				2	30		90				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	001	0	1	01	01	H9003_001_0	10	4	Non-Preferred Brand	1	4	100000	1	2	110		01	110		1	30		90				2	30		90				30		31	90.00		270.00																			90.00		180.00																90.00				90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	001	0	1	01	01	H9003_001_0	10	5	Specialty Tier	1	4	100001	1	1	110		01	110		1	30		90				2	30		90				30		31				1461.00	33		33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	001	0	1	01	01	H9003_001_0	10	6	Vaccines	1	4	000001	1	2	010		01			1	30													30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
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	5.00		15.00																			5.00		10.00																5.00				5.00		0.16			0.16			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	006	0	1	01	01	H9003_006_0	9	2	Generic	1	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		.33			.33			.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H9003	006	0	1	01	01	H9003_006_0	9	2	Generic	3	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		.33			.33			.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
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	5.00		15.00																			5.00		10.00																5.00				5.00		.16			0.16			.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
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, 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				1853.00	33		33																		33		33															33			33								Preferred Generic, 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	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, 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	90.00		270.00																			90.00		180.00																90.00				90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9047	001	0	1	01	01	H9047_001_0	21	3	Preferred Brand	1	3	000001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00				47.00				47.00			1.56	1.56		1.56	1.56	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	001	0	1	01	01	H9047_001_0	21	2	Generic	1	3	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	45.00				20.00				20.00			0.66	0.50		0.66	0.50	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	001	0	1	01	01	H9047_001_0	21	1	Preferred Generic	1	3	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34								12.00	24.00	36.00					6.00	12.00	18.00											12.00	24.00	36.00				6.00	12.00	18.00				12.00				12.00			0.40	0.20		0.40	0.20	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	001	0	1	01	01	H9047_001_0	21	5	Injectable Drugs	1	3	010010	1	1		010	01		010	1				30							30			30		34											78.58	33						78.58	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	001	0	1	01	01	H9047_001_0	21	4	Non-Preferred Brand	1	3	100000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34								95.00	190.00	285.00					95.00	190.00	285.00											95.00	190.00	285.00				95.00	190.00	285.00				95.00				95.00			3.16	3.16		3.16	3.16	2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	001	0	1	01	01	H9047_001_0	21	6	Specialty Tier	1	3	010010	1	1		010	01		010	1				30							30			30		34											1716.02	33						1716.02	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	013	0	2	01	01	H9047_013_0	19	6	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34											1951.39	33						1951.39	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	013	0	2	01	01	H9047_013_0	19	5	Injectable Drugs	1	4	010010	1	1		010	01		010	1				30							30			30		34											55.65	33						55.65	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	013	0	2	01	01	H9047_013_0	19	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34								95.00	190.00	285.00					95.00	190.00	285.00											95.00	190.00	285.00				95.00	190.00	285.00				95.00				95.00			3.16	3.16		3.16	3.16	2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	013	0	2	01	01	H9047_013_0	19	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00				47.00				47.00			1.56	1.56		1.56	1.56	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	013	0	2	01	01	H9047_013_0	19	2	Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	45.00				20.00				20.00			.66	.50		.66	.50	.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	013	0	2	01	01	H9047_013_0	19	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34								12.00	24.00	36.00					6.00	12.00	18.00											12.00	24.00	36.00				6.00	12.00	18.00				12.00				12.00			0.40	0.20		0.40	0.20	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	024	0	1	02	01	H9047_024_0	16	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00				47.00				47.00			1.56	1.56		1.56	1.56	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	024	0	1	02	01	H9047_024_0	16	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34								12.00	24.00	36.00					6.00	12.00	18.00											12.00	24.00	36.00				6.00	12.00	18.00				12.00				12.00			0.40	0.20		0.40	0.20	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	024	0	1	02	01	H9047_024_0	16	2	Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	45.00				20.00				20.00			.66	.50		.66	.50	.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	024	0	1	02	01	H9047_024_0	16	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34								95.00	190.00	285.00					95.00	190.00	285.00											95.00	190.00	285.00				95.00	190.00	285.00				95.00				95.00			3.16	3.16		3.16	3.16	2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	024	0	1	02	01	H9047_024_0	16	5	Injectable Drugs	1	4	010010	1	1		010	01		010	1				30							30			30		34											55.15	33						55.15	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	024	0	1	02	01	H9047_024_0	16	6	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34											1904.34	33						1904.34	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	037	0	1	02	01	H9047_037_0	20	6	Specialty Tier	1	3	010010	1	1		010	01		010	1				30							30			30		34											1872.35	30						1872.35	30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	037	0	1	02	01	H9047_037_0	20	5	Injectable Drugs	1	3	010010	1	1		010	01		010	1				30							30			30		34											48.42	30						48.42	30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	037	0	1	02	01	H9047_037_0	20	3	Preferred Brand	1	3	000001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00				47.00				47.00			1.56	1.56		1.56	1.56	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	037	0	1	02	01	H9047_037_0	20	2	Generic	1	3	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	45.00				20.00				20.00			.66	.50		.66	.50	.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	037	0	1	02	01	H9047_037_0	20	1	Preferred Generic	1	3	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	36.00				7.00	14.00	21.00				12.00				12.00			0.40	0.23		0.40	0.23	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	037	0	1	02	01	H9047_037_0	20	4	Non-Preferred Brand	1	3	100000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34								95.00	190.00	285.00					95.00	190.00	285.00											95.00	190.00	285.00				95.00	190.00	285.00				95.00				95.00			3.16	3.16		3.16	3.16	2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	038	0	1	02	01	H9047_038_0	17	2	Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34								20.00	40.00	60.00					12.00	24.00	36.00											20.00	40.00	60.00				12.00	24.00	36.00				20.00				20.00			.66	.40		.66	.40	.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	038	0	1	02	01	H9047_038_0	17	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34								45.00	90.00	135.00					45.00	90.00	135.00											45.00	90.00	135.00				45.00	90.00	135.00				45.00				45.00			1.50	1.50		1.50	1.50	1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	038	0	1	02	01	H9047_038_0	17	4	Non-Preferred Brand	1	4	100000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34								95.00	190.00	285.00					95.00	190.00	285.00											95.00	190.00	285.00				95.00	190.00	285.00				95.00				95.00			3.16	3.16		3.16	3.16	2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	038	0	1	02	01	H9047_038_0	17	5	Injectable Drugs	1	4	010010	1	1		010	01		010	1				30							30			30		34											57.15	33						57.15	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	038	0	1	02	01	H9047_038_0	17	6	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34											1938.63	33						1938.63	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	038	0	1	02	01	H9047_038_0	17	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34								10.00	20.00	30.00					4.00	8.00	12.00											10.00	20.00	30.00				4.00	8.00	12.00				10.00				10.00			0.33	0.13		0.33	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	039	0	1	02	01	H9047_039_0	19	6	Specialty Tier	1	3	010010	1	1		010	01		010	1				30							30			30		34											1892.26	32						1892.26	32												32						32					32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	039	0	1	02	01	H9047_039_0	19	5	Injectable Drugs	1	3	010010	1	1		010	01		010	1				30							30			30		34											53.96	32						53.96	32												32						32					32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	039	0	1	02	01	H9047_039_0	19	4	Non-Preferred Brand	1	3	100000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34								95.00	190.00	285.00					95.00	190.00	285.00											95.00	190.00	285.00				95.00	190.00	285.00				95.00				95.00			3.16	3.16		3.16	3.16	2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	039	0	1	02	01	H9047_039_0	19	2	Generic	1	3	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34								20.00	40.00	60.00					18.00	36.00	54.00											20.00	40.00	60.00				18.00	36.00	54.00				20.00				20.00			.66	.60		.66	.60	.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	039	0	1	02	01	H9047_039_0	19	1	Preferred Generic	1	3	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34								12.00	24.00	36.00					10.00	20.00	30.00											12.00	24.00	36.00				10.00	20.00	30.00				12.00				12.00			0.40	0.33		0.40	0.33	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9047	039	0	1	02	01	H9047_039_0	19	3	Preferred Brand	1	3	000001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		34								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00				47.00				47.00			1.56	1.56		1.56	1.56	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H9096	001	0	1	01	01	H9096_001_0	8	5	Specialty Tier	1	3	010010	1	1	010		01	010		1	31							31						31		31				420.75	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9096	001	0	1	01	01	H9096_001_0	8	1	Preferred Generic	1	3	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	4.00	8.00	8.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9096	001	0	1	01	01	H9096_001_0	8	4	Non-Preferred Brand	1	3	100000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	100.00	200.00	200.00																			100.00	200.00	200.00																100.00				100.00		3.23			3.23			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9096	001	0	1	01	01	H9096_001_0	8	3	Preferred Brand	1	3	000001	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	45.00	90.00	90.00																			45.00	90.00	90.00																45.00				45.00		1.45			1.45			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9096	001	0	1	01	01	H9096_001_0	8	2	Generic	1	3	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	14.00	28.00	28.00																			14.00	28.00	28.00																14.00				14.00		0.45			0.45			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9096	002	0	1	01	01	H9096_002_0	8	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31				454.41	27																				27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9096	002	0	1	01	01	H9096_002_0	8	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	45.00	90.00	90.00																			45.00	90.00	90.00																45.00				45.00		1.45			1.45			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9096	002	0	1	01	01	H9096_002_0	8	2	Generic	1	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	10.00	20.00	20.00																			10.00	20.00	20.00																10.00				10.00		0.32			0.32			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9096	002	0	1	01	01	H9096_002_0	8	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	4.00	8.00	8.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9096	002	0	1	01	01	H9096_002_0	8	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	100.00	200.00	200.00																			100.00	200.00	200.00																100.00				100.00		3.23			2.23			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9096	003	0	1	02	01	H9096_003_0	12	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	100.00	200.00	200.00																			100.00	200.00	200.00																100.00				100.00		3.23			3.23			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9096	003	0	1	02	01	H9096_003_0	12	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	45.00	90.00	90.00																			45.00	90.00	90.00																45.00				45.00		1.45			1.45			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9096	003	0	1	02	01	H9096_003_0	12	2	Generic	1	4	000100	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	8.00	16.00	16.00																			8.00	16.00	16.00																8.00				8.00		0.26			0.26			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9096	003	0	1	02	01	H9096_003_0	12	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	60	90				1	31	60	90				31		31	4.00	8.00	8.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9096	003	0	1	02	01	H9096_003_0	12	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	31							31						31		31				555.39	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9104	006	0	1	01	01	H9104_006_0	4	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9104	006	0	1	01	01	H9104_006_0	4	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9104	006	0	1	01	01	H9104_006_0	4	3	Preferred Brand	1	4	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	131.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9104	006	0	1	01	01	H9104_006_0	4	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H9104	006	0	1	01	01	H9104_006_0	4	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				1.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9104	006	0	1	01	01	H9104_006_0	4	6	Select Care Drugs	1	4	000010	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	11.00	22.00	33.00																			11.00	22.00	23.00																11.00				11.00		0.37			0.37			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9104	006	0	1	01	01	H9104_006_0	4	4	Non-Preferred Brand	1	4	100000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	290.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9110	002	0	1	01	01	H9110_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	100.00	200.00	250.00																			100.00	200.00	250.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9110	002	0	1	01	01	H9110_002_0	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9110	002	0	1	01	01	H9110_002_0	7	6	Select Care Drugs	1	4	010000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9110	002	0	1	01	01	H9110_002_0	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	7.00	14.00	14.00																			7.00	14.00	14.00																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9110	002	0	1	01	01	H9110_002_0	7	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	12.00	24.00	24.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9110	002	0	1	01	01	H9110_002_0	7	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	94.00	117.50																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
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			
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			
H9122	001	0	1	01	01	H9122_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9122	001	0	1	01	01	H9122_001_0	8	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	20.00		60.00																					40.00																20.00				20.00		0.67						0.65	Preferred Generic, 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	100		1	30		90				1			90				30		31					33		33																				33															33			33								Preferred Generic, 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	100		1	30		90				1			90				30		31	95.00		285.00																					190.00																95.00				95.00		3.17						3.06	Preferred Generic, 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	100		1	30		90				1			90				30		31	40.00		120.00																					80.00																40.00				40.00		1.33						1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9162	001	0	1	01	01	H9162_001_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	4.00		12.00																					10.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9162	001	0	1	01	01	H9162_001_0	7	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	10.00		30.00																					25.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9162	001	0	1	01	01	H9162_001_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	47.00		141.00																					118.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9162	001	0	1	01	01	H9162_001_0	7	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	100.00		300.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9162	001	0	1	01	01	H9162_001_0	7	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9162	002	0	1	01	01	H9162_002_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9162	002	0	1	01	01	H9162_002_0	6	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	10.00		30.00																					25.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9162	002	0	1	01	01	H9162_002_0	6	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	47.00		141.00																					118.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9162	002	0	1	01	01	H9162_002_0	6	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	100.00		300.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9162	002	0	1	01	01	H9162_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	003	0	1	01	01	H9190_003_0	12	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	30	60	90				1			90				30		31	4.00	8.00	12.00																					12.00																4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9190	003	0	1	01	01	H9190_003_0	12	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	30	60	90				1			90				30		31	95.00	190.00	285.00																					285.00																95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9190	003	0	1	01	01	H9190_003_0	12	6	Select Care Drugs	1	4	000010	1	2	111		01	100		1	30	60	90				1			90				30		31	11.00	22.00	33.00																					33.00																11.00				11.00		0.37						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9190	003	0	1	01	01	H9190_003_0	12	5	Specialty Tier	1	4	010010	1	1	111		01			1	30	60	90				1							30		31				1.00	25	25	25																																			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9190	003	0	1	01	01	H9190_003_0	12	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	30	60	90				1			90				30		31	45.00	90.00	135.00																					135.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9190	003	0	1	01	01	H9190_003_0	12	2	Generic	1	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	10.00	20.00	30.00																					30.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9190	004	0	1	01	01	H9190_004_0	11	2	Generic	1	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	10.00	20.00	30.00																					30.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9190	004	0	1	01	01	H9190_004_0	11	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	30	60	90				1			90				30		31	4.00	8.00	12.00																					12.00																4.00				4.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9190	004	0	1	01	01	H9190_004_0	11	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	30	60	90				1			90				30		31	45.00	90.00	135.00																					135.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9190	004	0	1	01	01	H9190_004_0	11	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	30	60	90				1			90				30		31	95.00	190.00	285.00																					285.00																95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9190	004	0	1	01	01	H9190_004_0	11	5	Specialty Tier	1	4	010010	1	1	111		01			1	30	60	90				1							30		31				1.00	27	27	27																																			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9190	004	0	1	01	01	H9190_004_0	11	6	Select Care Drugs	1	4	000010	1	2	111		01	100		1	30	60	90				1			90				30		31	11.00	22.00	33.00																					33.00																11.00				11.00		0.37						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9190	006	0	1	01	01	H9190_006_0	11	2	Generic	1	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	20.00	40.00	60.00																					60.00																20.00				20.00		0.66						0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	006	0	1	01	01	H9190_006_0	11	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	30	60	90				1			90				30		31	45.00	90.00	135.00																					135.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	006	0	1	01	01	H9190_006_0	11	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	30	60	90				1			90				30		31	95.00	190.00	285.00																					285.00																95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	006	0	1	01	01	H9190_006_0	11	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	006	0	1	01	01	H9190_006_0	11	5	Specialty Tier	1	4	010010	1	1	111		01			1	30	60	90				1							30		31				1.00	27	27	27																																			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	009	0	1	01	01	H9190_009_0	11	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	30	60	90				1			90				30		31	4.00	8.00	12.00																					12.00																4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9190	009	0	1	01	01	H9190_009_0	11	2	Generic	1	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	10.00	20.00	30.00																					30.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9190	009	0	1	01	01	H9190_009_0	11	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	30	60	90				1			90				30		31	95.00	190.00	285.00																					285.00																95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9190	009	0	1	01	01	H9190_009_0	11	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	30	60	90				1			90				30		31	45.00	90.00	135.00																					135.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9190	009	0	1	01	01	H9190_009_0	11	6	Select Care Drugs	1	4	000010	1	2	111		01	100		1	30	60	90				1			90				30		31	11.00	22.00	33.00																					33.00																11.00				11.00		0.37						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9190	009	0	1	01	01	H9190_009_0	11	5	Specialty Tier	1	4	010010	1	1	111		01			1	30	60	90				1							30		31				1.00	25	25	25																																			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9190	010	0	1	01	01	H9190_010_0	12	5	Specialty Tier	1	4	010010	1	1	111		01			1	30	60	90				1							30		31				1.00	27	27	27																																			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9190	010	0	1	01	01	H9190_010_0	12	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	30	60	90				1			90				30		31	4.00	8.00	12.00																					12.00																4.00				4.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9190	010	0	1	01	01	H9190_010_0	12	2	Generic	1	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	10.00	20.00	30.00																					30.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9190	010	0	1	01	01	H9190_010_0	12	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	30	60	90				1			90				30		31	95.00	190.00	285.00																					285.00																95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9190	010	0	1	01	01	H9190_010_0	12	6	Select Care Drugs	1	4	000010	1	2	111		01	100		1	30	60	90				1			90				30		31	11.00	22.00	33.00																					33.00																11.00				11.00		0.37						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9190	010	0	1	01	01	H9190_010_0	12	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	30	60	90				1			90				30		31	45.00	90.00	135.00																					135.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9190	012	0	1	01	01	H9190_012_0	11	5	Specialty Tier	1	4	010010	1	1	111		01			1	30	60	90				1							30		31				1.00	27	27	27																																			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	012	0	1	01	01	H9190_012_0	11	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	30	60	90				1			90				30		31	95.00	190.00	285.00																					285.00																95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	012	0	1	01	01	H9190_012_0	11	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	30	60	90				1			90				30		31	45.00	90.00	135.00																					135.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	012	0	1	01	01	H9190_012_0	11	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	012	0	1	01	01	H9190_012_0	11	2	Generic	1	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	20.00	40.00	60.00																					60.00																20.00				20.00		0.66						0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	015	0	1	01	01	H9190_015_0	12	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	30	60	90				1			90				30		31	4.00	8.00	12.00																					12.00																4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9190	015	0	1	01	01	H9190_015_0	12	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	30	60	90				1			90				30		31	45.00	90.00	135.00																					135.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9190	015	0	1	01	01	H9190_015_0	12	2	Generic	1	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	10.00	20.00	30.00																					30.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9190	015	0	1	01	01	H9190_015_0	12	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	30	60	90				1			90				30		31	95.00	190.00	285.00																					285.00																95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9190	015	0	1	01	01	H9190_015_0	12	5	Specialty Tier	1	4	010010	1	1	111		01			1	30	60	90				1							30		31				1.00	25	25	25																																			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9190	015	0	1	01	01	H9190_015_0	12	6	Select Care Drugs	1	4	000010	1	2	111		01	100		1	30	60	90				1			90				30		31	11.00	22.00	33.00																					33.00																11.00				11.00		0.37						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9190	016	0	1	01	01	H9190_016_0	11	2	Generic	1	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	10.00	20.00	30.00																					30.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9190	016	0	1	01	01	H9190_016_0	11	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	30	60	90				1			90				30		31	4.00	8.00	12.00																					12.00																4.00				4.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9190	016	0	1	01	01	H9190_016_0	11	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	30	60	90				1			90				30		31	45.00	90.00	135.00																					135.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9190	016	0	1	01	01	H9190_016_0	11	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	30	60	90				1			90				30		31	95.00	190.00	285.00																					285.00																95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9190	016	0	1	01	01	H9190_016_0	11	5	Specialty Tier	1	4	010010	1	1	111		01			1	30	60	90				1							30		31				1.00	27	27	27																																			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9190	016	0	1	01	01	H9190_016_0	11	6	Select Care Drugs	1	4	000010	1	2	111		01	100		1	30	60	90				1			90				30		31	11.00	22.00	33.00																					33.00																11.00				11.00		0.37						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9190	018	0	1	01	01	H9190_018_0	11	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	30	60	90				1			90				30		31	45.00	90.00	135.00																					135.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	018	0	1	01	01	H9190_018_0	11	2	Generic	1	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	20.00	40.00	60.00																					60.00																20.00				20.00		0.66						0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	018	0	1	01	01	H9190_018_0	11	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	30	60	90				1			90				30		31	95.00	190.00	285.00																					285.00																95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	018	0	1	01	01	H9190_018_0	11	5	Specialty Tier	1	4	010010	1	1	111		01			1	30	60	90				1							30		31				1.00	27	27	27																																			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	018	0	1	01	01	H9190_018_0	11	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	019	0	1	01	01	H9190_019_0	12	3	Preferred Brand	1	4	000001	1	2	111		01	100		1	30	60	90				1			90				30		31	45.00	90.00	135.00																					135.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	019	0	1	01	01	H9190_019_0	12	2	Generic	1	4	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	16.00	32.00	48.00																					48.00																16.00				16.00		0.53						0.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	019	0	1	01	01	H9190_019_0	12	1	Preferred Generic	1	4	001000	1	2	111		01	100		1	30	60	90				1			90				30		31	3.00	6.00	9.00																					9.00																3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	019	0	1	01	01	H9190_019_0	12	5	Specialty Tier	1	4	010010	1	1	111		01			1	30	60	90				1							30		31				1.00	25	25	25																																			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	019	0	1	01	01	H9190_019_0	12	4	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	30	60	90				1			90				30		31	95.00	190.00	285.00																					285.00																95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	020	0	1	01	01	H9190_020_0	11	1	Preferred Generic	1	3	001000	1	2	111		01	100		1	30	60	90				1			90				30		31	3.00	6.00	9.00																					9.00																3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	020	0	1	01	01	H9190_020_0	11	2	Generic	1	3	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	16.00	32.00	48.00																					48.00																16.00				16.00		.53						0.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	020	0	1	01	01	H9190_020_0	11	4	Non-Preferred Brand	1	3	100000	1	2	111		01	100		1	30	60	90				1			90				30		31	95.00	190.00	285.00																					285.00																95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	020	0	1	01	01	H9190_020_0	11	3	Preferred Brand	1	3	000001	1	2	111		01	100		1	30	60	90				1			90				30		31	45.00	90.00	135.00																					135.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	020	0	1	01	01	H9190_020_0	11	5	Specialty Tier	1	3	010010	1	1	111		01			1	30	60	90				1							30		31				1.00	25	25	25																																			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	021	0	1	01	01	H9190_021_0	11	4	Non-Preferred Brand	1	3	100000	1	2	111		01	100		1	30	60	90				1			90				30		31	95.00	190.00	285.00																					285.00																95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	021	0	1	01	01	H9190_021_0	11	5	Specialty Tier	1	3	010010	1	1	111		01			1	30	60	90				1							30		31				1.00	25	25	25																																			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	021	0	1	01	01	H9190_021_0	11	1	Preferred Generic	1	3	001000	1	2	111		01	100		1	30	60	90				1			90				30		31	3.00	6.00	9.00																					9.00																3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	021	0	1	01	01	H9190_021_0	11	2	Generic	1	3	000100	1	2	111		01	100		1	30	60	90				1			90				30		31	16.00	32.00	48.00																					48.00																16.00				16.00		0.53						0.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	021	0	1	01	01	H9190_021_0	11	3	Preferred Brand	1	3	000001	1	2	111		01	100		1	30	60	90				1			90				30		31	45.00	90.00	135.00																					135.00																45.00				45.00		1.50						1.45	Preferred Generic, 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	95.00	190.00	190.00																					190.00																95.00				95.00		3.17						3.06	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	45.00	90.00	90.00																					90.00																45.00				45.00		1.50						1.45	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	7.00	14.00	14.00																					14.00																7.00				7.00		0.23						0.23	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					26																				26																	26			26								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9207	003	0	1	01	01	H9207_003_0	7	3	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	30	60	90				1			90				30		31	95.00	190.00	190.00																					190.00																95.00				95.00		3.17						3.06	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9207	003	0	1	01	01	H9207_003_0	7	2	Preferred Brand	1	4	000001	1	2	111		01	100		1	30	60	90				1			90				30		31	45.00	90.00	90.00																					90.00																45.00				45.00		1.50						1.45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9207	003	0	1	01	01	H9207_003_0	7	1	Generic	1	4	010000	1	2	111		01	100		1	30	60	90				1			90				30		31	7.00	14.00	14.00																					14.00																7.00				7.00		0.23						0.23	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9207	003	0	1	01	01	H9207_003_0	7	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	005	0	1	01	01	H9207_005_0	8	1	Generic	1	4	010000	1	2	111		01	100		1	30	60	90				1			90				30		31	7.00	14.00	14.00																					14.00																7.00				7.00		0.23						0.23	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9207	005	0	1	01	01	H9207_005_0	8	2	Preferred Brand	1	4	000001	1	2	111		01	100		1	30	60	90				1			90				30		31	45.00	90.00	90.00																					90.00																45.00				45.00		1.50						1.45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9207	005	0	1	01	01	H9207_005_0	8	3	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	30	60	90				1			90				30		31	95.00	190.00	190.00																					190.00																95.00				95.00		3.17						3.06	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9207	005	0	1	01	01	H9207_005_0	8	4	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					26																				26																	26			26								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9207	006	0	1	01	01	H9207_006_0	7	1	Generic	1	4	010000	1	2	111		01	100		1	30	60	90				1			90				30		31	7.00	14.00	14.00																					14.00																7.00				7.00		0.23						0.23	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9207	006	0	1	01	01	H9207_006_0	7	2	Preferred Brand	1	4	000001	1	2	111		01	100		1	30	60	90				1			90				30		31	45.00	90.00	90.00																					90.00																45.00				45.00		1.50						1.45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9207	006	0	1	01	01	H9207_006_0	7	3	Non-Preferred Brand	1	4	100000	1	2	111		01	100		1	30	60	90				1			90				30		31	95.00	190.00	190.00																					190.00																95.00				95.00		3.17						3.06	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9207	006	0	1	01	01	H9207_006_0	7	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	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	2.00	4.00	5.00																			2.00	4.00	6.00																2.00				2.00		0.06			0.06			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9208	001	0	1	01	01	H9208_001_0	5	5	Specialty Tier	1	4	000010	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9208	001	0	1	01	01	H9208_001_0	5	4	Non-Preferred Brand	1	4	100000	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31				95.82	35	35	35																		35	35	35															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9208	001	0	1	01	01	H9208_001_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	38.00	76.00	95.00																			38.00	76.00	114.00																38.00				38.00		1.23			1.23			1.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9208	001	0	1	01	01	H9208_001_0	5	2	Generic	1	4	000100	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	10.00	20.00	25.00																			10.00	20.00	30.00																10.00				10.00		0.32			0.32			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9208	002	0	1	01	01	H9208_002_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	2.00	4.00	5.00																			2.00	4.00	6.00																2.00				2.00		0.06			0.06			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9208	002	0	1	01	01	H9208_002_0	5	2	Generic	1	4	000100	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	10.00	20.00	25.00																			10.00	20.00	30.00																10.00				10.00		0.32			0.32			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9208	002	0	1	01	01	H9208_002_0	5	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	38.00	76.00	95.00																			38.00	76.00	114.00																38.00				38.00		1.23			1.23			1.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9208	002	0	1	01	01	H9208_002_0	5	4	Non-Preferred Brand	1	4	100000	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31				91.84	35	35	35																		35	35	35															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9208	002	0	1	01	01	H9208_002_0	5	5	Specialty Tier	1	4	000010	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9285	001	0	1	01	01	H9285_001_0	6	1	Generic	1	4	001000	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9285	001	0	1	01	01	H9285_001_0	6	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9285	001	0	1	01	01	H9285_001_0	6	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31				1123.55	33		33																		33		33															33			33								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9285	001	0	1	01	01	H9285_001_0	6	3	Non-Preferred Brand	1	4	100100	3	2	110		01	110		1	30		90				1	30		90				30		31	95.00		285.00																			95.00		190.00																95.00				95.00		3.17			3.17			3.06	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9285	003	0	1	01	01	H9285_003_0	7	2	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				1	30		90				30		31	35.00		105.00																			35.00		70.00																35.00				35.00		1.17			1.17			1.13	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9285	003	0	1	01	01	H9285_003_0	7	3	Non-Preferred Brand	1	4	100100	3	2	110		01	110		1	30		90				1	30		90				30		31	90.00		270.00																			90.00		180.00																90.00				90.00		3.00			3.00			2.90	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9285	003	0	1	01	01	H9285_003_0	7	1	Generic	1	4	001000	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	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9285	003	0	1	01	01	H9285_003_0	7	4	Specialty Tier	1	4	100100	1	1	110		01	110		1	30		90				1	30		90				30		31				904.96	33		33																		33		33															33			33								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9302	003	0	1	01	01	H9302_003_0	6	5	Specialty Tier	1	4	000010	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9302	003	0	1	01	01	H9302_003_0	6	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	47.00	94.00	117.50																			47.00	94.00	141.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9302	003	0	1	01	01	H9302_003_0	6	2	Generic	1	4	000100	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	20.00	40.00	50.00																			20.00	40.00	60.00																20.00				20.00		0.65			0.65			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9302	003	0	1	01	01	H9302_003_0	6	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	4.00	8.00	10.00																			4.00	8.00	12.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9302	003	0	1	01	01	H9302_003_0	6	4	Non-Preferred Brand	1	4	100000	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31				92.34	35	35	35																		35	35	35															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9302	007	0	1	01	01	H9302_007_0	7	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	47.00	94.00	117.50																			47.00	94.00	141.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9302	007	0	1	01	01	H9302_007_0	7	2	Generic	1	4	000100	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	20.00	40.00	50.00																			20.00	40.00	60.00																20.00				20.00		0.65			0.65			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9302	007	0	1	01	01	H9302_007_0	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	4.00	8.00	10.00																			4.00	8.00	12.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9302	007	0	1	01	01	H9302_007_0	7	4	Non-Preferred Brand	1	4	100000	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31				88.67	35	35	35																		35	35	35															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9302	007	0	1	01	01	H9302_007_0	7	5	Specialty Tier	1	4	000010	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9302	011	0	1	01	01	H9302_011_0	6	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	47.00	94.00	117.50																			47.00	94.00	141.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9302	011	0	1	01	01	H9302_011_0	6	2	Generic	1	4	000100	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	20.00	40.00	50.00																			20.00	40.00	60.00																20.00				20.00		0.65			0.65			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9302	011	0	1	01	01	H9302_011_0	6	5	Specialty Tier	1	4	000010	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9302	011	0	1	01	01	H9302_011_0	6	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	4.00	8.00	10.00																			4.00	8.00	12.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9302	011	0	1	01	01	H9302_011_0	6	4	Non-Preferred Brand	1	4	100000	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31				96.30	35	35	35																		35	35	35															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9312	001	0	1	04	01	H9312_001_0	6	5	Specialty Tier	1	4	010010	1	1	010		10	010		1	31							30							10	31					25																				25																		25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9312	001	0	1	04	01	H9312_001_0	6	4	Non-Preferred Brand	1	4	100000	1	1	110		10	100		1	31		90				1			90					10	31				149.29	25		25																				25																25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9312	001	0	1	04	01	H9312_001_0	6	2	Generic	1	4	000100	1	1	110		10	100		1	31		90				1			90					10	31				13.63	25		25																				25																25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9312	001	0	1	04	01	H9312_001_0	6	3	Preferred Brand	1	4	000001	1	1	110		10	100		1	31		90				1			90					10	31				60.05	25		25																				25																25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9312	001	0	1	04	01	H9312_001_0	6	1	Preferred Generic	1	4	001000	1	2	110		10	100		1	31		90				1			90					10	31	0.00		0.00																					0.00																	0.00			0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9312	002	0	1	04	01	H9312_002_0	5	4	Non-Preferred Brand	1	4	100000	1	1	110		10	100		1	31		90				1			90					10	31				161.82	25		25																				25																25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9312	002	0	1	04	01	H9312_002_0	5	3	Preferred Brand	1	4	000001	1	1	110		10	100		1	31		90				1			90					10	31				82.50	25		25																				25																25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9312	002	0	1	04	01	H9312_002_0	5	2	Generic	1	4	000100	1	1	110		10	100		1	31		90				1			90					10	31				16.95	25		25																				25																25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9312	002	0	1	04	01	H9312_002_0	5	1	Preferred Generic	1	4	001000	1	2	110		10	100		1	31		90				1			90					10	31	0.00		0.00																					0.00																	0.00			0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9312	002	0	1	04	01	H9312_002_0	5	5	Specialty Tier	1	4	010010	1	1	010		10	010		1	31							30							10	31					25																				25																		25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9345	001	0	1	48	05	H9345_001_0	7	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	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			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			
H9345	001	0	1	48	05	H9345_001_0	7	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			
H9345	001	0	1	48	05	H9345_001_0	7	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 Drugs, Non-Medicare OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H9412	003	0	1	04	01	H9412_003_0	8	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				2			90				30		31	47.00		141.00																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9412	003	0	1	04	01	H9412_003_0	8	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	3.00		9.00																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H9412	003	0	1	04	01	H9412_003_0	8	5	Specialty Tier	1	4	010010	1	1	010		01			1	30													30		31				1720.19	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9412	003	0	1	04	01	H9412_003_0	8	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9412	003	0	1	04	01	H9412_003_0	8	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				2			90				30		31	20.00		60.00																					60.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9412	003	0	1	04	01	H9412_003_0	8	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				2			90				30		31	3.00		9.00																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9460	001	0	1	01	01	H9460_001_0	5	1	Preferred Generic	1	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	1.00	2.00	3.00																			1.00		3.00																1.00				1.00		0.03			0.03			0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9460	001	0	1	01	01	H9460_001_0	5	2	Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	3.00	6.00	9.00																			3.00		9.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9460	001	0	1	01	01	H9460_001_0	5	5	Specialty Tier	1	4	010010	1	1	111		01	110		1	30	60	90				2	30		90				30		31				506.35	30	30	30																		30		30															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9460	001	0	1	01	01	H9460_001_0	5	3	Preferred Brand	1	4	000101	1	2	111		01	110		1	30	60	90				2	30		90				30		31	45.00	90.00	135.00																			45.00		135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9460	001	0	1	01	01	H9460_001_0	5	4	Non-Preferred Brand	1	4	100100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	95.00	190.00	285.00																			95.00		285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9487	001	0	1	48	05	H9487_001_0	6	1	Generic Drugs	1	4	010000			110		01	100		1	30		90				2			90				30		31																																														0.00						0.00	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	6	2	Brand Drugs	1	4	000010			110		01	100		1	30		90				2			90				30		31																																														0.00						0.00	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	6	3	Non-Medicare Rx/OTC Drugs	1	4	010010			110		01	100		1	30		90				2			90				30		31																																														0.00						0.00	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			
H9492	001	0	1	02	01	H9492_001_0	4	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	2.00	4.00	5.00																			2.00	4.00	6.00																2.00				2.00		0.06			0.06			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9492	001	0	1	02	01	H9492_001_0	4	2	Generic	1	4	000100	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	10.00	20.00	25.00																			10.00	20.00	30.00																10.00				10.00		0.32			0.32			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9492	001	0	1	02	01	H9492_001_0	4	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	38.00	76.00	95.00																			38.00	76.00	114.00																38.00				38.00		1.23			1.23			1.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9492	001	0	1	02	01	H9492_001_0	4	4	Non-Preferred Brand	1	4	100000	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31				91.76	35	35	35																		35	35	35															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9492	001	0	1	02	01	H9492_001_0	4	5	Specialty Tier	1	4	000010	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9525	003	0	1	01	01	H9525_003_0	8	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9525	003	0	1	01	01	H9525_003_0	8	2	Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								1.00	2.00	3.00					1.00	2.00	3.00					1.00	3.00	3.00																1.00				1.00			0.03	0.03	0.03			0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9525	003	0	1	01	01	H9525_003_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9525	003	0	1	01	01	H9525_003_0	8	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								97.00	194.00	291.00					92.00	184.00	276.00					92.00	276.00	276.00																97.00				97.00			3.23	3.07	3.07			2.85	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9525	003	0	1	01	01	H9525_003_0	8	5	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34											787.54	25						787.54	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9525	003	0	1	01	01	H9525_003_0	8	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9525	004	0	1	01	01	H9525_004_0	8	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9525	004	0	1	01	01	H9525_004_0	8	2	Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9525	004	0	1	01	01	H9525_004_0	8	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9525	004	0	1	01	01	H9525_004_0	8	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9525	004	0	1	01	01	H9525_004_0	8	5	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34											1292.69	28						1292.69	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9525	004	0	1	01	01	H9525_004_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9525	005	0	1	01	01	H9525_005_0	8	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9525	005	0	1	01	01	H9525_005_0	8	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9525	005	0	1	01	01	H9525_005_0	8	2	Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9525	005	0	1	01	01	H9525_005_0	8	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9525	005	0	1	01	01	H9525_005_0	8	5	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34											1142.14	29						1142.14	29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9525	005	0	1	01	01	H9525_005_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9525	006	0	1	01	01	H9525_006_0	8	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9525	006	0	1	01	01	H9525_006_0	8	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9525	006	0	1	01	01	H9525_006_0	8	2	Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9525	006	0	1	01	01	H9525_006_0	8	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9525	006	0	1	01	01	H9525_006_0	8	5	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34											1292.73	30						1292.73	30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9525	006	0	1	01	01	H9525_006_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9572	001	1	1	04	01	H9572_001_1	7	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31								3.00		9.00					3.00		7.50					3.00		7.50																3.00				3.00			0.09	0.09	0.09			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	001	1	1	04	01	H9572_001_1	7	2	Generic	1	4	000100	1	2		110	01	110		1				31		90	1	31		90				31		31								15.00		45.00					15.00		37.50					15.00		37.50																15.00				15.00			.48	.48	.48			.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	001	1	1	04	01	H9572_001_1	7	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				31		90	1	31		90				31		31								45.00		135.00					45.00		112.50					45.00		112.50																45.00				45.00			1.45	1.45	1.45			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	001	1	1	04	01	H9572_001_1	7	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				31		90	1	31		90				31		31								98.00		294.00					98.00		245.00					98.00		245.00																98.00				98.00			3.16	3.16	3.16			3.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	001	1	1	04	01	H9572_001_1	7	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	001	2	1	04	01	H9572_001_2	7	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31								3.00		9.00					3.00		7.50					3.00		7.50																3.00				3.00			0.09	0.09	0.09			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	001	2	1	04	01	H9572_001_2	7	2	Generic	1	4	000100	1	2		110	01	110		1				31		90	1	31		90				31		31								15.00		45.00					15.00		37.50					15.00		37.50																15.00				15.00			.48	.48	.48			.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	001	2	1	04	01	H9572_001_2	7	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				31		90	1	31		90				31		31								45.00		135.00					45.00		112.50					45.00		112.50																45.00				45.00			1.45	1.45	1.45			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	001	2	1	04	01	H9572_001_2	7	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				31		90	1	31		90				31		31								98.00		294.00					98.00		245.00					98.00		245.00																98.00				98.00			3.16	3.16	3.16			3.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	001	2	1	04	01	H9572_001_2	7	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	001	3	1	04	01	H9572_001_3	7	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	001	3	1	04	01	H9572_001_3	7	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31								3.00		9.00					3.00		7.50					3.00		7.50																3.00				3.00			0.09	0.09	0.09			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	001	3	1	04	01	H9572_001_3	7	2	Generic	1	4	000100	1	2		110	01	110		1				31		90	1	31		90				31		31								15.00		45.00					15.00		37.50					15.00		37.50																15.00				15.00			.48	.48	.48			.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	001	3	1	04	01	H9572_001_3	7	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				31		90	1	31		90				31		31								45.00		135.00					45.00		112.50					45.00		112.50																45.00				45.00			1.45	1.45	1.45			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	001	3	1	04	01	H9572_001_3	7	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				31		90	1	31		90				31		31								98.00		294.00					98.00		245.00					98.00		245.00																98.00				98.00			3.16	3.16	3.16			3.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	001	4	1	04	01	H9572_001_4	7	2	Generic	1	4	000100	1	2		110	01	110		1				31		90	1	31		90				31		31								15.00		45.00					15.00		37.50					15.00		37.50																15.00				15.00			.48	.48	.48			.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	001	4	1	04	01	H9572_001_4	7	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				31		90	1	31		90				31		31								45.00		135.00					45.00		112.50					45.00		112.50																45.00				45.00			1.45	1.45	1.45			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	001	4	1	04	01	H9572_001_4	7	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31								3.00		9.00					3.00		7.50					3.00		7.50																3.00				3.00			0.09	0.09	0.09			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	001	4	1	04	01	H9572_001_4	7	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				31		90	1	31		90				31		31								98.00		294.00					98.00		245.00					98.00		245.00																98.00				98.00			3.16	3.16	3.16			3.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	001	4	1	04	01	H9572_001_4	7	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	001	6	1	04	01	H9572_001_6	6	2	Generic	1	4	000100	1	2		110	01	110		1				31		90	1	31		90				31		31								15.00		45.00					15.00		37.50					15.00		37.50																15.00				15.00			.48	.48	.48			.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	001	6	1	04	01	H9572_001_6	6	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31								3.00		9.00					3.00		7.50					3.00		7.50																3.00				3.00			0.09	0.09	0.09			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	001	6	1	04	01	H9572_001_6	6	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				31		90	1	31		90				31		31								45.00		135.00					45.00		112.50					45.00		112.50																45.00				45.00			1.45	1.45	1.45			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	001	6	1	04	01	H9572_001_6	6	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	001	6	1	04	01	H9572_001_6	6	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				31		90	1	31		90				31		31								98.00		294.00					98.00		245.00					98.00		245.00																98.00				98.00			3.16	3.16	3.16			3.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	003	1	1	04	01	H9572_003_1	7	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31								3.00		9.00					3.00		7.50					3.00		7.50																3.00				3.00			.09	.09	.09			.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	003	1	1	04	01	H9572_003_1	7	2	Generic	1	4	000100	1	2		110	01	110		1				31		90	1	31		90				31		31								14.00		42.00					14.00		35.00					14.00		35.00																14.00				14.00			.45	.45	.45			.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	003	1	1	04	01	H9572_003_1	7	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				31		90	1	31		90				31		31								40.00		120.00					40.00		100.00					40.00		100.00																40.00				40.00			1.29	1.29	1.29			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	003	1	1	04	01	H9572_003_1	7	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				31				31						31		31											1.00	33						1.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	003	1	1	04	01	H9572_003_1	7	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				31		90	1	31		90				31		31								97.00		291.00					97.00		242.50					97.00		242.50																97.00				97.00			3.12	3.12	3.12			3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	003	1	1	04	01	H9572_003_1	7	1	Preferred Generic	3	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31								3.00		9.00					3.00		7.50					3.00		7.50																3.00				3.00			0.09	0.09	0.09			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H9572	003	2	1	04	01	H9572_003_2	7	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				31		90	1	31		90				31		31								40.00		120.00					40.00		100.00					40.00		100.00																40.00				40.00			1.29	1.29	1.29			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	003	2	1	04	01	H9572_003_2	7	2	Generic	1	4	000100	1	2		110	01	110		1				31		90	1	31		90				31		31								14.00		42.00					14.00		35.00					14.00		35.00																14.00				14.00			.45	.45	.45			.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	003	2	1	04	01	H9572_003_2	7	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31								3.00		9.00					3.00		7.50					3.00		7.50																3.00				3.00			.09	.09	.09			.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	003	2	1	04	01	H9572_003_2	7	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				31		90	1	31		90				31		31								97.00		291.00					97.00		242.50					97.00		242.50																97.00				97.00			3.12	3.12	3.12			3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	003	2	1	04	01	H9572_003_2	7	1	Preferred Generic	3	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31								3.00		9.00					3.00		7.50					3.00		7.50																3.00				3.00			0.09	0.09	0.09			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H9572	003	2	1	04	01	H9572_003_2	7	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				31				31						31		31											1.00	33						1.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	003	3	1	04	01	H9572_003_3	7	2	Generic	1	4	000100	1	2		110	01	110		1				31		90	1	31		90				31		31								14.00		42.00					14.00		35.00					14.00		35.00																14.00				14.00			.45	.45	.45			.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	003	3	1	04	01	H9572_003_3	7	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31								3.00		9.00					3.00		7.50					3.00		7.50																3.00				3.00			.09	.09	.09			.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	003	3	1	04	01	H9572_003_3	7	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				31		90	1	31		90				31		31								40.00		120.00					40.00		100.00					40.00		100.00																40.00				40.00			1.29	1.29	1.29			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	003	3	1	04	01	H9572_003_3	7	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				31		90	1	31		90				31		31								97.00		291.00					97.00		242.50					97.00		242.50																97.00				97.00			3.12	3.12	3.12			3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	003	3	1	04	01	H9572_003_3	7	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				31				31						31		31											1.00	33						1.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	003	3	1	04	01	H9572_003_3	7	1	Preferred Generic	3	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31								3.00		9.00					3.00		7.50					3.00		7.50																3.00				3.00			0.09	0.09	0.09			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H9572	003	4	1	04	01	H9572_003_4	7	2	Generic	1	4	000100	1	2		110	01	110		1				31		90	1	31		90				31		31								14.00		42.00					14.00		35.00					14.00		35.00																14.00				14.00			.45	.45	.45			.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	003	4	1	04	01	H9572_003_4	7	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31								3.00		9.00					3.00		7.50					3.00		7.50																3.00				3.00			.09	.09	.09			.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	003	4	1	04	01	H9572_003_4	7	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				31		90	1	31		90				31		31								40.00		120.00					40.00		100.00					40.00		100.00																40.00				40.00			1.29	1.29	1.29			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	003	4	1	04	01	H9572_003_4	7	1	Preferred Generic	3	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31								3.00		9.00					3.00		7.50					3.00		7.50																3.00				3.00			0.09	0.09	0.09			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H9572	003	4	1	04	01	H9572_003_4	7	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				31				31						31		31											1.00	33						1.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	003	4	1	04	01	H9572_003_4	7	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				31		90	1	31		90				31		31								97.00		291.00					97.00		242.50					97.00		242.50																97.00				97.00			3.12	3.12	3.12			3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	003	6	1	04	01	H9572_003_6	7	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31								3.00		9.00					3.00		7.50					3.00		7.50																3.00				3.00			.09	.09	.09			.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	003	6	1	04	01	H9572_003_6	7	2	Generic	1	4	000100	1	2		110	01	110		1				31		90	1	31		90				31		31								14.00		42.00					14.00		35.00					14.00		35.00																14.00				14.00			.45	.45	.45			.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	003	6	1	04	01	H9572_003_6	7	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				31		90	1	31		90				31		31								97.00		291.00					97.00		242.50					97.00		242.50																97.00				97.00			3.12	3.12	3.12			3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	003	6	1	04	01	H9572_003_6	7	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				31				31						31		31											1.00	33						1.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	003	6	1	04	01	H9572_003_6	7	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				31		90	1	31		90				31		31								40.00		120.00					40.00		100.00					40.00		100.00																40.00				40.00			1.29	1.29	1.29			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9572	003	6	1	04	01	H9572_003_6	7	1	Preferred Generic	3	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31								3.00		9.00					3.00		7.50					3.00		7.50																3.00				3.00			0.09	0.09	0.09			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H9615	007	0	1	04	01	H9615_007_0	9	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				50.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9615	007	0	1	04	01	H9615_007_0	9	3	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				2	30		90				30		31	35.00		105.00																			35.00		70.00																35.00				35.00		1.17			1.17			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9615	007	0	1	04	01	H9615_007_0	9	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9615	007	0	1	04	01	H9615_007_0	9	4	Non-Preferred Brand	1	4	100100	1	2	110		01	110		1	30		90				2	30		90				30		31	90.00		270.00																			90.00		180.00																90.00				90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9615	007	0	1	04	01	H9615_007_0	9	2	Generic	1	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		.33			.33			.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9615	007	0	1	04	01	H9615_007_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9615	007	0	1	04	01	H9615_007_0	9	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H9615	007	0	1	04	01	H9615_007_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H9615	008	0	1	04	01	H9615_008_0	13	3	Preferred Brand	1	3	000101	1	2	110		01	110		1	30		90				2	30		90				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9615	008	0	1	04	01	H9615_008_0	13	1	Preferred Generic	1	3	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	3.00		9.00																			3.00		6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9615	008	0	1	04	01	H9615_008_0	13	2	Generic	1	3	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9615	008	0	1	04	01	H9615_008_0	13	4	Non-Preferred Brand	1	3	100100	1	2	110		01	110		1	30		90				2	30		90				30		31	95.00		285.00																			95.00		190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9615	008	0	1	04	01	H9615_008_0	13	5	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		31				50.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9615	008	0	1	04	01	H9615_008_0	13	6	Vaccines	1	3	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9615	009	0	1	04	01	H9615_009_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H9615	009	0	1	04	01	H9615_009_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9615	009	0	1	04	01	H9615_009_0	10	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				50.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9615	009	0	1	04	01	H9615_009_0	10	4	Non-Preferred Brand	1	4	100100	1	2	110		01	110		1	30		90				2	30		90				30		31	90.00		270.00																			90.00		180.00																90.00				90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9615	009	0	1	04	01	H9615_009_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H9615	009	0	1	04	01	H9615_009_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9615	009	0	1	04	01	H9615_009_0	10	2	Generic	1	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		.33			.33			.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9615	009	0	1	04	01	H9615_009_0	10	3	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				2	30		90				30		31	35.00		105.00																			35.00		70.00																35.00				35.00		1.17			1.17			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9615	010	0	1	04	01	H9615_010_0	9	6	Vaccines	1	3	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9615	010	0	1	04	01	H9615_010_0	9	4	Non-Preferred Brand	1	3	100100	1	2	110		01	110		1	30		90				2	30		90				30		31	95.00		285.00																			95.00		190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9615	010	0	1	04	01	H9615_010_0	9	5	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		31				50.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9615	010	0	1	04	01	H9615_010_0	9	3	Preferred Brand	1	3	000101	1	2	110		01	110		1	30		90				2	30		90				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9615	010	0	1	04	01	H9615_010_0	9	2	Generic	1	3	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9615	010	0	1	04	01	H9615_010_0	9	1	Preferred Generic	1	3	001000	1	2	110		01	110		1	30		90				2	30		90				30		31	3.00		9.00																			3.00		6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9689	001	0	1	01	01	H9689_001_0	5	4	Non-Preferred Brand	1	2	100000	1	2		110	01	110		1				30		90	1	30		90				30		31								100.00		300.00					100.00		200.00					100.00		300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9689	001	0	1	01	01	H9689_001_0	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9689	001	0	1	01	01	H9689_001_0	5	2	Generic	1	2	000100	1	2		110	01	110		1				30		90	1	30		90				30		31								14.00		42.00					14.00		28.00					14.00		42.00																14.00				14.00			.47	.47	.47			.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9689	001	0	1	01	01	H9689_001_0	5	1	Preferred Generic	1	2	001000	1	2		110	01	110		1				30		90	1	30		90				30		31								4.00		12.00					1.50		3.00					4.00		12.00																4.00				4.00			.13	.05	.13			.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9689	001	0	1	01	01	H9689_001_0	5	3	Preferred Brand	1	2	000001	1	2		110	01	110		1				30		90	1	30		90				30		31								47.00		141.00					47.00		94.00					47.00		141.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9699	004	1	1	01	01	H9699_004_1	7	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				30		90	1	30		90				30		31								10.00		20.00					3.00		6.00					3.00		6.00																10.00				3.00			0.33	0.10	0.10			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9699	004	1	1	01	01	H9699_004_1	7	2	Generic	1	4	000100	1	2		110	01	110		1				30		90	1	30		90				30		31								20.00		40.00					15.00		30.00					15.00		30.00																20.00				15.00			0.66	0.50	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9699	004	1	1	01	01	H9699_004_1	7	1	Preferred Generic	3	4	001000	1	2		110	01	110		1				30		90	1	30		90				30		31								10.00		20.00					3.00		6.00					3.00		6.00																10.00				3.00			0.33	0.10	0.10			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H9699	004	1	1	01	01	H9699_004_1	7	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9699	004	1	1	01	01	H9699_004_1	7	4	Non-Preferred Brand	1	4	110000	1	2		110	01	110		1				30		90	1	30		90				30		31								100.00		200.00					95.00		190.00					95.00		190.00																100.00				95.00			3.33	3.16	3.16			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9699	004	1	1	01	01	H9699_004_1	7	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				30		90	1	30		90				30		31								47.00		94.00					42.00		84.00					42.00		84.00																47.00				42.00			1.56	1.40	1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9699	004	2	1	01	01	H9699_004_2	6	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9699	004	2	1	01	01	H9699_004_2	6	4	Non-Preferred Brand	1	4	110000	1	2		110	01	110		1				30		90	1	30		90				30		31								100.00		200.00					95.00		190.00					95.00		190.00																100.00				95.00			3.33	3.16	3.16			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9699	004	2	1	01	01	H9699_004_2	6	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				30		90	1	30		90				30		31								47.00		94.00					42.00		84.00					42.00		84.00																47.00				42.00			1.56	1.40	1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9699	004	2	1	01	01	H9699_004_2	6	1	Preferred Generic	3	4	001000	1	2		110	01	110		1				30		90	1	30		90				30		31								10.00		20.00					3.00		6.00					3.00		6.00																10.00				3.00			0.33	0.10	0.10			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H9699	004	2	1	01	01	H9699_004_2	6	2	Generic	1	4	000100	1	2		110	01	110		1				30		90	1	30		90				30		31								20.00		40.00					15.00		30.00					15.00		30.00																20.00				15.00			0.66	0.50	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9699	004	2	1	01	01	H9699_004_2	6	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				30		90	1	30		90				30		31								10.00		20.00					3.00		6.00					3.00		6.00																10.00				3.00			0.33	0.10	0.10			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9712	001	0	1	48	05	H9712_001_0	7	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	7	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	1	Preferred Generic	1	4	001000	1	2	111		01	110		1	30	60	90				2	30		90				30		31	3.00	6.00	9.00																			3.00		9.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9725	001	0	1	01	01	H9725_001_0	4	2	Generic	1	4	000100	1	2	111		01	110		1	30	60	90				2	30		90				30		31	15.00	30.00	45.00																			15.00		45.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9725	001	0	1	01	01	H9725_001_0	4	3	Preferred Brand	1	4	000101	1	2	111		01	110		1	30	60	90				2	30		90				30		31	47.00	94.00	141.00																			47.00		141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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	95.00	190.00	285.00																			95.00		285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, 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				510.46	28	28	28																		28		28															28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9730	002	0	1	02	01	H9730_002_0	5	1	Preferred Generic	1	4	001000	1	2	110		01		110	1	30		90				1				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9730	002	0	1	02	01	H9730_002_0	5	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9730	002	0	1	02	01	H9730_002_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9730	002	0	1	02	01	H9730_002_0	5	4	Non-Preferred Brand	1	4	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				57.80	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9730	002	0	1	02	01	H9730_002_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9730	003	0	1	01	01	H9730_003_0	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9730	003	0	1	01	01	H9730_003_0	5	4	Non-Preferred Brand	1	3	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				77.20	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9730	003	0	1	01	01	H9730_003_0	5	3	Preferred Brand	1	3	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9730	003	0	1	01	01	H9730_003_0	5	2	Generic	1	3	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		15.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9730	003	0	1	01	01	H9730_003_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9808	004	0	1	04	01	H9808_004_0	5	1	Preferred Generic	1	4	001000	1	2	111		10	111		1	30	60	90				1	30	60	90					29	31	4.00	8.00	12.00																			4.00	8.00	12.00																	4.00			4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9808	004	0	1	04	01	H9808_004_0	5	2	Generic	1	4	000100	1	2	111		10	111		1	30	60	90				1	30	60	90					29	31	15.00	30.00	45.00																			15.00	30.00	45.00																	15.00			15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9808	004	0	1	04	01	H9808_004_0	5	3	Preferred Brand	1	4	000001	1	2	111		10	111		1	30	60	90				1	30	60	90					29	31	45.00	90.00	135.00																			45.00	90.00	135.00																	45.00			45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9808	004	0	1	04	01	H9808_004_0	5	4	Non-Preferred Brand	1	4	100000	1	2	111		10	111		1	30	60	90				1	30	60	90					29	31	85.00	170.00	255.00																			85.00	170.00	255.00																	85.00			85.00		2.83			2.83			2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9808	004	0	1	04	01	H9808_004_0	5	5	Specialty Tier	1	4	010010	1	1	111		10	111		1	30	60	90				2	30	60	90					29	31				1009.34	33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9808	004	0	1	04	01	H9808_004_0	5	1	Preferred Generic	3	4	001000	1	2	111		10	111		1	30	60	90				1	30	60	90					29	31	4.00	8.00	12.00																			4.00	8.00	12.00																	4.00			4.00		.13			.13			.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H9808	005	0	1	04	01	H9808_005_0	6	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9808	005	0	1	04	01	H9808_005_0	6	2	Generic	1	4	000100	1	2	111		10	111		1	30	60	90				1	30	60	90					29	31	12.00	24.00	36.00																			12.00	24.00	36.00																	12.00			12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9808	005	0	1	04	01	H9808_005_0	6	3	Preferred Brand	1	4	000001	1	2	111		10	111		1	30	60	90				1	30	60	90					29	31	40.00	80.00	120.00																			40.00	80.00	120.00																	40.00			40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9808	005	0	1	04	01	H9808_005_0	6	4	Non-Preferred Brand	1	4	100000	1	2	111		10	111		1	30	60	90				1	30	60	90					29	31	75.00	150.00	225.00																			75.00	150.00	225.00																	75.00			75.00		2.50			2.50			2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9808	005	0	1	04	01	H9808_005_0	6	5	Specialty Tier	1	4	010010	1	1	111		10	111		1	30	60	90				2	30	60	90					29	31				1203.48	33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9808	005	0	1	04	01	H9808_005_0	6	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H9834	001	0	1	01	01	H9834_001_0	4	3	Preferred Brand	1	3	010001	1	2	111		01			1	30	60	90				1							30		31	47.00	94.00	141.00																																					47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9834	001	0	1	01	01	H9834_001_0	4	2	Generic	1	3	000100	1	2	111		01			1	30	60	90				1							30		31	20.00	40.00	60.00																																					20.00				20.00		0.67						0.65	Preferred Generic, 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	10.00	20.00	30.00																																					10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9834	001	0	1	01	01	H9834_001_0	4	4	Non-Preferred Brand	1	3	100100	1	2	111		01			1	30	60	90				1							30		31	100.00	200.00	300.00																																					100.00				100.00		3.33						3.23	Preferred Generic, 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					25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9834	003	0	1	01	01	H9834_003_0	4	3	Preferred Brand	1	3	010001	1	2	111		01			1	30	60	90				1							30		31	47.00	94.00	141.00																																					47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9834	003	0	1	01	01	H9834_003_0	4	1	Preferred Generic	1	3	001000	1	2	111		01			1	30	60	90				1							30		31	11.00	22.00	33.00																																					11.00				11.00		0.37						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9834	003	0	1	01	01	H9834_003_0	4	2	Generic	1	3	000100	1	2	111		01			1	30	60	90				1							30		31	20.00	40.00	60.00																																					20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9834	003	0	1	01	01	H9834_003_0	4	4	Non-Preferred Brand	1	3	100100	1	2	111		01			1	30	60	90				1							30		31	100.00	200.00	300.00																																					100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9834	003	0	1	01	01	H9834_003_0	4	5	Specialty Tier	1	3	010010	1	1	010		01			1	30													30		31					25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9859	002	0	1	02	01	H9859_002_0	11	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			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H9859	002	0	1	02	01	H9859_002_0	11	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H9859	002	0	1	02	01	H9859_002_0	11	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9859	002	0	1	02	01	H9859_002_0	11	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31				50.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9859	002	0	1	02	01	H9859_002_0	11	4	Non-Preferred Brand	1	4	100100	1	2	110		01	110		1	30		90				2	30		90				30		31	90.00		270.00																			90.00		180.00																90.00				90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9859	002	0	1	02	01	H9859_002_0	11	3	Preferred Brand	1	4	000101	1	2	110		01	110		1	30		90				2	30		90				30		31	35.00		105.00																			35.00		70.00																35.00				35.00		1.17			1.17			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9859	002	0	1	02	01	H9859_002_0	11	2	Generic	1	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		.33			.33			.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9859	002	0	1	02	01	H9859_002_0	11	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9859	013	0	1	02	01	H9859_013_0	9	2	Generic	1	4	000100	1	2	110		01	110		1	30		90				2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		.33			.33			.32	Preferred Generic, 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	35.00		105.00																			35.00		70.00																35.00				35.00		1.17			1.17			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
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	90.00		270.00																			90.00		180.00																90.00				90.00		3.00			3.00			2.90	Preferred Generic, 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	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
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	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
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, 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	010		01	010		1	30							30						30		31				50.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9886	003	0	1	01	01	H9886_003_0	8	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9886	003	0	1	01	01	H9886_003_0	8	2	Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								1.00	2.00	3.00					1.00	2.00	3.00					1.00	3.00	3.00																1.00				1.00			0.03	0.03	0.03			0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9886	003	0	1	01	01	H9886_003_0	8	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9886	003	0	1	01	01	H9886_003_0	8	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								45.00	90.00	135.00					45.00	90.00	135.00					45.00	135.00	135.00																45.00				45.00			1.50	1.50	1.50			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9886	003	0	1	01	01	H9886_003_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9886	003	0	1	01	01	H9886_003_0	8	5	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34											785.63	25						785.63	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9886	004	0	1	01	01	H9886_004_0	8	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9886	004	0	1	01	01	H9886_004_0	8	2	Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9886	004	0	1	01	01	H9886_004_0	8	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9886	004	0	1	01	01	H9886_004_0	8	5	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34											1437.52	32						1437.52	32						32																	32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9886	004	0	1	01	01	H9886_004_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9886	004	0	1	01	01	H9886_004_0	8	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9915	001	0	1	01	01	H9915_001_0	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9915	001	0	1	01	01	H9915_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	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9915	001	0	1	01	01	H9915_001_0	7	3	Preferred Brand	1	4	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9915	001	0	1	01	01	H9915_001_0	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	12.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9915	001	0	1	01	01	H9915_001_0	7	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	45.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9915	007	0	1	01	01	H9915_007_0	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H9915	007	0	1	01	01	H9915_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	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H9915	007	0	1	01	01	H9915_007_0	7	3	Preferred Brand	1	4	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H9915	007	0	1	01	01	H9915_007_0	7	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	45.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H9915	007	0	1	01	01	H9915_007_0	7	6	Select Diabetic Drugs	1	4	010010	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	30.00																10.00				10.00		0.33			0.33			.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H9915	007	0	1	01	01	H9915_007_0	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	12.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H9915	008	0	1	01	01	H9915_008_0	8	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	45.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9915	008	0	1	01	01	H9915_008_0	8	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	12.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9915	008	0	1	01	01	H9915_008_0	8	3	Preferred Brand	1	4	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9915	008	0	1	01	01	H9915_008_0	8	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9915	008	0	1	01	01	H9915_008_0	8	4	Non-Preferred Brand	1	4	110000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9915	010	0	1	01	01	H9915_010_0	7	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	12.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H9915	010	0	1	01	01	H9915_010_0	7	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	45.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H9915	010	0	1	01	01	H9915_010_0	7	3	Preferred Brand	1	4	010001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H9915	010	0	1	01	01	H9915_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	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H9915	010	0	1	01	01	H9915_010_0	7	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H9915	010	0	1	01	01	H9915_010_0	7	6	Select Diabetic Drugs	1	4	010010	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	30.00																10.00				10.00		0.33			0.33			.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H9947	005	1	1	04	01	H9947_005_1	10	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9947	005	1	1	04	01	H9947_005_1	10	2	Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								18.00	36.00	54.00					13.00	26.00	39.00					13.00	39.00	39.00																18.00				18.00			0.60	0.43	0.43			0.53	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9947	005	1	1	04	01	H9947_005_1	10	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9947	005	1	1	04	01	H9947_005_1	10	5	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34											1320.43	33						1320.43	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9947	005	1	1	04	01	H9947_005_1	10	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								95.00	190.00	285.00					90.00	180.00	270.00					90.00	270.00	270.00																95.00				95.00			3.17	3.00	3.00			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9947	005	1	1	04	01	H9947_005_1	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9947	005	2	1	04	01	H9947_005_2	10	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9947	005	2	1	04	01	H9947_005_2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9947	005	2	1	04	01	H9947_005_2	10	5	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34											1320.43	33						1320.43	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9947	005	2	1	04	01	H9947_005_2	10	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								95.00	190.00	285.00					90.00	180.00	270.00					90.00	270.00	270.00																95.00				95.00			3.17	3.00	3.00			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9947	005	2	1	04	01	H9947_005_2	10	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9947	005	2	1	04	01	H9947_005_2	10	2	Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								18.00	36.00	54.00					13.00	26.00	39.00					13.00	39.00	39.00																18.00				18.00			0.60	0.43	0.43			0.53	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9954	002	0	1	01	01	H9954_002_0	8	5	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34											1681.91	33						1681.91	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9954	002	0	1	01	01	H9954_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								97.00	194.00	291.00					92.00	184.00	276.00					92.00	276.00	276.00																97.00				97.00			3.23	3.07	3.07			2.85	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9954	002	0	1	01	01	H9954_002_0	8	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9954	002	0	1	01	01	H9954_002_0	8	2	Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9954	002	0	1	01	01	H9954_002_0	8	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	15.00	15.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9954	002	0	1	01	01	H9954_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9954	004	0	1	01	01	H9954_004_0	9	5	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34											781.57	25						781.57	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9954	004	0	1	01	01	H9954_004_0	9	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								98.00	196.00	294.00					93.00	186.00	279.00					93.00	279.00	279.00																98.00				98.00			3.27	3.10	3.10			2.88	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9954	004	0	1	01	01	H9954_004_0	9	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9954	004	0	1	01	01	H9954_004_0	9	2	Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								1.00	2.00	3.00					1.00	2.00	3.00					1.00	3.00	3.00																1.00				1.00			0.03	0.03	0.03			0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9954	004	0	1	01	01	H9954_004_0	9	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9954	004	0	1	01	01	H9954_004_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9954	005	0	1	01	01	H9954_005_0	8	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9954	005	0	1	01	01	H9954_005_0	8	2	Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9954	005	0	1	01	01	H9954_005_0	8	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9954	005	0	1	01	01	H9954_005_0	8	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9954	005	0	1	01	01	H9954_005_0	8	5	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34											1585.86	30						1585.86	30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9954	005	0	1	01	01	H9954_005_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9954	006	0	1	01	01	H9954_006_0	8	5	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34											1730.79	31						1730.79	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9954	006	0	1	01	01	H9954_006_0	8	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9954	006	0	1	01	01	H9954_006_0	8	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9954	006	0	1	01	01	H9954_006_0	8	2	Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00	36.00	36.00																17.00				17.00			0.57	0.40	0.40			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9954	006	0	1	01	01	H9954_006_0	8	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9954	006	0	1	01	01	H9954_006_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
R3332	001	0	1	31	11	R3332_001_0	6	2	Generic	1	3	000100	1	2		110	01	110		1				31		90	1	31		90				31		31								20.00		60.00					15.00		45.00					15.00		45.00																20.00				15.00			0.65	0.48	0.48			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R3332	001	0	1	31	11	R3332_001_0	6	1	Preferred Generic	1	3	001000	1	2		110	01	110		1				31		90	1	31		90				31		31								15.00		45.00					10.00		30.00					10.00		30.00																15.00				10.00			0.48	0.32	0.32			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R3332	001	0	1	31	11	R3332_001_0	6	3	Preferred Brand	1	3	010001	1	2		110	01	110		1				31		90	1	31		90				31		31								47.00		141.00					42.00		126.00					42.00		126.00																47.00				42.00			1.52	1.35	1.35			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R3332	001	0	1	31	11	R3332_001_0	6	4	Non-Preferred Brand	1	3	110000	1	2		110	01	110		1				31		90	1	31		90				31		31								100.00		300.00					95.00		285.00					95.00		285.00																100.00				95.00			3.23	3.06	3.06			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R3332	001	0	1	31	11	R3332_001_0	6	5	Specialty Tier	1	3	110001	1	1		010	01	010		1				31				31						31		31											537.88	27						537.88	27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R3444	009	0	1	31	11	R3444_009_0	2	2	Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		.40						.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R3444	009	0	1	31	11	R3444_009_0	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		.13						.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R3444	009	0	1	31	11	R3444_009_0	2	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	46.00		138.00																											138.00						128.00				46.00				46.00		1.53						1.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R3444	009	0	1	31	11	R3444_009_0	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31				549.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R3444	009	0	1	31	11	R3444_009_0	2	4	Non-Preferred Brand	1	3	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R3444	012	0	1	31	11	R3444_012_0	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		.06						.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R3444	012	0	1	31	11	R3444_012_0	2	2	Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		.40						.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R3444	012	0	1	31	11	R3444_012_0	2	4	Non-Preferred Brand	1	3	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R3444	012	0	1	31	11	R3444_012_0	2	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R3444	012	0	1	31	11	R3444_012_0	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31				437.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5287	001	0	1	31	11	R5287_001_0	2	4	Non-Preferred Brand	1	3	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5287	001	0	1	31	11	R5287_001_0	2	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5287	001	0	1	31	11	R5287_001_0	2	2	Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5287	001	0	1	31	11	R5287_001_0	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5287	001	0	1	31	11	R5287_001_0	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31				513.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5342	001	0	1	31	11	R5342_001_0	2	4	Non-Preferred Brand	1	3	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, 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	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5342	001	0	1	31	11	R5342_001_0	2	2	Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, 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	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, 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				441.00	26		26																										26						26			26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5342	005	0	1	31	11	R5342_005_0	2	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5342	005	0	1	31	11	R5342_005_0	2	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5342	005	0	1	31	11	R5342_005_0	2	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5342	005	0	1	31	11	R5342_005_0	2	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5342	005	0	1	31	11	R5342_005_0	2	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				484.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5342	006	0	1	31	11	R5342_006_0	2	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5342	006	0	1	31	11	R5342_006_0	2	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5342	006	0	1	31	11	R5342_006_0	2	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5342	006	0	1	31	11	R5342_006_0	2	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5342	006	0	1	31	11	R5342_006_0	2	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				539.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	001	0	1	31	11	R5826_001_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	95.00		285.00																									95.00		285.00				95.00		275.00				95.00				95.00		3.16				3.16	3.16	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
R5826	001	0	1	31	11	R5826_001_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
R5826	001	0	1	31	11	R5826_001_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	001	0	1	31	11	R5826_001_0	4	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	001	0	1	31	11	R5826_001_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	001	0	1	31	11	R5826_001_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	95.00		285.00																									95.00		285.00				95.00		275.00				95.00				95.00		3.16				3.16	3.16	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	001	0	1	31	11	R5826_001_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	001	0	1	31	11	R5826_001_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
R5826	001	0	1	31	11	R5826_001_0	4	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
R5826	001	0	1	31	11	R5826_001_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
R5826	002	0	1	31	11	R5826_002_0	4	2	Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.66				0.66	0.66	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	002	0	1	31	11	R5826_002_0	4	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	9.00		27.00																									9.00		27.00				9.00		0.00				9.00				9.00		0.30				0.30	0.30	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	002	0	1	31	11	R5826_002_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	002	0	1	31	11	R5826_002_0	4	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	002	0	1	31	11	R5826_002_0	4	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	005	0	1	31	11	R5826_005_0	4	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	8.00		24.00																									8.00		24.00				8.00		0.00				8.00				8.00		0.26				0.26	0.26	0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	005	0	1	31	11	R5826_005_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00		9.00																									3.00		9.00				3.00		0.00				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	005	0	1	31	11	R5826_005_0	4	5	Specialty Tier	3	4	010010	1	1	010		01		010	1	30										30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
R5826	005	0	1	31	11	R5826_005_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	85.00		255.00																									85.00		255.00				85.00		245.00				85.00				85.00		2.83				2.83	2.83	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
R5826	005	0	1	31	11	R5826_005_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	40.00		120.00																									40.00		120.00				40.00		110.00				40.00				40.00		1.33				1.33	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
R5826	005	0	1	31	11	R5826_005_0	4	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	8.00		24.00																									8.00		24.00				8.00		0.00				8.00				8.00		0.26				0.26	0.26	0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
R5826	005	0	1	31	11	R5826_005_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	40.00		120.00																									40.00		120.00				40.00		110.00				40.00				40.00		1.33				1.33	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	005	0	1	31	11	R5826_005_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	85.00		255.00																									85.00		255.00				85.00		245.00				85.00				85.00		2.83				2.83	2.83	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	005	0	1	31	11	R5826_005_0	4	5	Specialty Tier	1	4	010010	1	1	010		01		010	1	30										30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	005	0	1	31	11	R5826_005_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	3.00		9.00																									3.00		9.00				3.00		0.00				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
R5826	007	0	1	31	11	R5826_007_0	5	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	007	0	1	31	11	R5826_007_0	5	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	007	0	1	31	11	R5826_007_0	5	2	Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	007	0	1	31	11	R5826_007_0	5	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	007	0	1	31	11	R5826_007_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	008	0	1	31	11	R5826_008_0	4	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
R5826	008	0	1	31	11	R5826_008_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
R5826	008	0	1	31	11	R5826_008_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	008	0	1	31	11	R5826_008_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	008	0	1	31	11	R5826_008_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	008	0	1	31	11	R5826_008_0	4	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	008	0	1	31	11	R5826_008_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	008	0	1	31	11	R5826_008_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
R5826	008	0	1	31	11	R5826_008_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
R5826	008	0	1	31	11	R5826_008_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
R5826	011	0	1	31	11	R5826_011_0	5	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	011	0	1	31	11	R5826_011_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	011	0	1	31	11	R5826_011_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	011	0	1	31	11	R5826_011_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	011	0	1	31	11	R5826_011_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
R5826	011	0	1	31	11	R5826_011_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
R5826	011	0	1	31	11	R5826_011_0	5	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
R5826	011	0	1	31	11	R5826_011_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
R5826	011	0	1	31	11	R5826_011_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
R5826	011	0	1	31	11	R5826_011_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	012	0	1	31	11	R5826_012_0	4	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		0.00				12.00				12.00		0.40				0.40	0.40	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	012	0	1	31	11	R5826_012_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	012	0	1	31	11	R5826_012_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	012	0	1	31	11	R5826_012_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
R5826	012	0	1	31	11	R5826_012_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
R5826	012	0	1	31	11	R5826_012_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
R5826	012	0	1	31	11	R5826_012_0	4	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		0.00				12.00				12.00		0.40				0.40	0.40	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
R5826	012	0	1	31	11	R5826_012_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	012	0	1	31	11	R5826_012_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	012	0	1	31	11	R5826_012_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
R5826	014	0	1	31	11	R5826_014_0	4	1	Preferred Generic	1	3	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	014	0	1	31	11	R5826_014_0	4	3	Preferred Brand	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	014	0	1	31	11	R5826_014_0	4	4	Non-Preferred Brand	1	3	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	014	0	1	31	11	R5826_014_0	4	2	Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		0.00				12.00				12.00		0.40				0.40	0.40	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	014	0	1	31	11	R5826_014_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, 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	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	074	0	1	31	11	R5826_074_0	4	2	Generic	1	3	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, 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	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, 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	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, 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					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	077	0	1	31	11	R5826_077_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
R5826	077	0	1	31	11	R5826_077_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	077	0	1	31	11	R5826_077_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
R5826	077	0	1	31	11	R5826_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	077	0	1	31	11	R5826_077_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	077	0	1	31	11	R5826_077_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	077	0	1	31	11	R5826_077_0	5	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	077	0	1	31	11	R5826_077_0	5	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.56				0.56	0.56	0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
R5826	077	0	1	31	11	R5826_077_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		281.00				97.00				97.00		3.23				3.23	3.23	3.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
R5826	077	0	1	31	11	R5826_077_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
R5826	079	0	1	31	11	R5826_079_0	5	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.66				0.66	0.66	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
R5826	079	0	1	31	11	R5826_079_0	5	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	9.00		27.00																									9.00		27.00				9.00		0.00				9.00				9.00		0.30				0.30	0.30	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
R5826	079	0	1	31	11	R5826_079_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	079	0	1	31	11	R5826_079_0	5	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	079	0	1	31	11	R5826_079_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
R5826	079	0	1	31	11	R5826_079_0	5	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.66				0.66	0.66	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	079	0	1	31	11	R5826_079_0	5	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	9.00		27.00																									9.00		27.00				9.00		0.00				9.00				9.00		0.30				0.30	0.30	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	079	0	1	31	11	R5826_079_0	5	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
R5826	079	0	1	31	11	R5826_079_0	5	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
R5826	079	0	1	31	11	R5826_079_0	5	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	091	0	1	31	11	R5826_091_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
R5826	091	0	1	31	11	R5826_091_0	4	4	Non-Preferred Brand	3	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
R5826	091	0	1	31	11	R5826_091_0	4	3	Preferred Brand	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
R5826	091	0	1	31	11	R5826_091_0	4	2	Generic	3	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	13.00		39.00																									13.00		39.00				13.00		0.00				13.00				13.00		0.43				0.43	0.43	0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
R5826	091	0	1	31	11	R5826_091_0	4	1	Preferred Generic	3	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	2	
R5826	091	0	1	31	11	R5826_091_0	4	3	Preferred Brand	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.56				1.56	1.56	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	091	0	1	31	11	R5826_091_0	4	4	Non-Preferred Brand	1	4	110000	1	2	110		01		110	1	30		90				2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	091	0	1	31	11	R5826_091_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	091	0	1	31	11	R5826_091_0	4	2	Generic	1	4	000101	1	2	110		01		110	1	30		90				2				30		90	30		31	13.00		39.00																									13.00		39.00				13.00		0.00				13.00				13.00		0.43				0.43	0.43	0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5826	091	0	1	31	11	R5826_091_0	4	1	Preferred Generic	1	4	001010	1	2	110		01		110	1	30		90				2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R5941	014	0	1	31	11	R5941_014_0	11	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
R5941	014	0	1	31	11	R5941_014_0	11	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
R5941	014	0	1	31	11	R5941_014_0	11	2	Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
R5941	014	0	1	31	11	R5941_014_0	11	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
R5941	014	0	1	31	11	R5941_014_0	11	5	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34											1319.20	32						1319.20	32						32																	32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
R5941	014	0	1	31	11	R5941_014_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
R5941	015	0	1	31	11	R5941_015_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
R5941	015	0	1	31	11	R5941_015_0	8	4	Non-Preferred Brand	1	3	100100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
R5941	015	0	1	31	11	R5941_015_0	8	5	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		34											1453.61	33						1453.61	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
R5941	015	0	1	31	11	R5941_015_0	8	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00	9.00	9.00																8.00				8.00			0.27	0.10	0.10			0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
R5941	015	0	1	31	11	R5941_015_0	8	2	Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								18.00	36.00	54.00					13.00	26.00	39.00					13.00	39.00	39.00																18.00				18.00			0.60	0.43	0.43			0.53	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
R5941	015	0	1	31	11	R5941_015_0	8	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
R6694	001	0	1	31	11	R6694_001_0	8	4	Non-Preferred Brand	1	3	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											42.72	50	50	50				40.40	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R6694	001	0	1	31	11	R6694_001_0	8	3	Preferred Brand	1	3	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	117.50					47.00	94.00	117.50					47.00	94.00	117.50																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R6694	001	0	1	31	11	R6694_001_0	8	2	Generic	1	3	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								19.00	38.00	47.50					9.00	18.00	22.50					19.00	38.00	47.50																	19.00			19.00			0.63	0.30	0.63			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R6694	001	0	1	31	11	R6694_001_0	8	1	Preferred Generic	1	3	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								12.00	24.00	30.00					2.00	4.00	5.00					12.00	24.00	30.00																	12.00			12.00			0.40	0.07	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R6694	001	0	1	31	11	R6694_001_0	8	5	Specialty Tier	1	3	010010	1	1		010	10	010		1				30				30							10	31											1.00	28						1.00	28						28																		28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R6694	003	0	1	31	11	R6694_003_0	9	4	Non-Preferred Brand	1	3	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											41.86	50	50	50				39.80	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R6694	003	0	1	31	11	R6694_003_0	9	3	Preferred Brand	1	3	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	117.50					47.00	94.00	117.50					47.00	94.00	117.50																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R6694	003	0	1	31	11	R6694_003_0	9	2	Generic	1	3	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								19.00	38.00	47.50					9.00	18.00	22.50					19.00	38.00	47.50																	19.00			19.00			0.63	0.30	0.63			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R6694	003	0	1	31	11	R6694_003_0	9	1	Preferred Generic	1	3	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								12.00	24.00	30.00					2.00	4.00	5.00					12.00	24.00	30.00																	12.00			12.00			0.40	0.07	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R6694	003	0	1	31	11	R6694_003_0	9	5	Specialty Tier	1	3	010010	1	1		010	10	010		1				30				30							10	31											1.00	28						1.00	28						28																		28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R6801	009	0	1	31	11	R6801_009_0	2	1	Preferred Generic	1	4	001000	1	2	110		01		100	1	30		90				1						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		.13						.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R6801	009	0	1	31	11	R6801_009_0	2	2	Generic	1	4	000100	1	2	110		01		100	1	30		90				1						90	30		31	11.00		33.00																											33.00						0.00				11.00				11.00		.36						.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R6801	009	0	1	31	11	R6801_009_0	2	3	Preferred Brand	1	4	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R6801	009	0	1	31	11	R6801_009_0	2	4	Non-Preferred Brand	1	4	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R6801	009	0	1	31	11	R6801_009_0	2	5	Specialty Tier	1	4	010010	1	1	110		01		100	1	30		90				1						90	30		31				531.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R6801	012	0	1	31	11	R6801_012_0	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		.06						.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R6801	012	0	1	31	11	R6801_012_0	2	2	Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		.40						.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R6801	012	0	1	31	11	R6801_012_0	2	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R6801	012	0	1	31	11	R6801_012_0	2	4	Non-Preferred Brand	1	3	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R6801	012	0	1	31	11	R6801_012_0	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31				518.00	28		28																										28						28			28			28								Preferred Generic, 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	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R7444	001	0	1	31	11	R7444_001_0	2	2	Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, 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				399.00	26		26																										26						26			26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R7444	001	0	1	31	11	R7444_001_0	2	4	Non-Preferred Brand	1	3	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, 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	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R9896	009	0	1	31	11	R9896_009_0	2	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		.13						.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R9896	009	0	1	31	11	R9896_009_0	2	2	Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		.40						.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R9896	009	0	1	31	11	R9896_009_0	2	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R9896	009	0	1	31	11	R9896_009_0	2	4	Non-Preferred Brand	1	3	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R9896	009	0	1	31	11	R9896_009_0	2	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31				608.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R9896	012	0	1	31	11	R9896_012_0	3	1	Preferred Generic	1	3	001000	1	2	110		01		100	1	30		90				1						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		.06						.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R9896	012	0	1	31	11	R9896_012_0	3	2	Generic	1	3	000100	1	2	110		01		100	1	30		90				1						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		.40						.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R9896	012	0	1	31	11	R9896_012_0	3	3	Preferred Brand	1	3	010001	1	2	110		01		100	1	30		90				1						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R9896	012	0	1	31	11	R9896_012_0	3	4	Non-Preferred Brand	1	3	110000	1	2	110		01		100	1	30		90				1						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R9896	012	0	1	31	11	R9896_012_0	3	5	Specialty Tier	1	3	010010	1	1	110		01		100	1	30		90				1						90	30		31				501.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	001	0		29	10	S0522_001_0	4	2	Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								3.00	6.00	9.00					2.00	4.00	6.00					2.00	4.00	6.00																3.00				3.00			0.10	0.06	0.06			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	001	0		29	10	S0522_001_0	4	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								2.00	4.00	6.00					1.00	2.00	3.00					1.00	2.00	3.00																2.00				2.00			0.06	0.03	0.03			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	001	0		29	10	S0522_001_0	4	3	Preferred Brand	1	2	000001	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											16.62	20	20	20				19.39	20	20	20				20	20	20															20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	001	0		29	10	S0522_001_0	4	4	Non-Preferred Brand	1	2	100000	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											36.47	35	35	35				36.34	35	35	35				35	35	35															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	001	0		29	10	S0522_001_0	4	5	Specialty Tier	1	2	010010	1	1		010	01	010		1				30				30						30		31											257.28	25						254.07	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	002	0		29	10	S0522_002_0	8	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								3.00	6.00	9.00					1.00	2.00	3.00					1.00	2.00	3.00																3.00				3.00			0.10	0.03	0.03			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	002	0		29	10	S0522_002_0	8	2	Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								4.00	8.00	12.00					2.00	4.00	6.00					2.00	4.00	6.00																4.00				4.00			0.13	0.06	0.06			0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	002	0		29	10	S0522_002_0	8	3	Preferred Brand	1	2	000001	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											18.44	20	20	20				22.06	20	20	20				20	20	20															20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	002	0		29	10	S0522_002_0	8	4	Non-Preferred Brand	1	2	100000	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											31.33	32	32	32				29.68	32	32	32				32	32	32															32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	002	0		29	10	S0522_002_0	8	5	Specialty Tier	1	2	010010	1	1		010	01	010		1				30				30						30		31											179.08	25						146.07	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	004	0		29	10	S0522_004_0	4	2	Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								3.00	6.00	9.00					2.00	4.00	6.00					2.00	4.00	6.00																3.00				3.00			0.10	0.06	0.06			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	004	0		29	10	S0522_004_0	4	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								2.00	4.00	6.00					1.00	2.00	3.00					1.00	2.00	3.00																2.00				2.00			0.06	0.03	0.03			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	004	0		29	10	S0522_004_0	4	3	Preferred Brand	1	2	000001	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											15.03	20	20	20				16.47	20	20	20				20	20	20															20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	004	0		29	10	S0522_004_0	4	5	Specialty Tier	1	2	010010	1	1		010	01	010		1				30				30						30		31											254.94	25						258.24	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	004	0		29	10	S0522_004_0	4	4	Non-Preferred Brand	1	2	100000	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											33.76	35	35	35				33.29	35	35	35				35	35	35															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	006	0		29	10	S0522_006_0	4	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								2.00	4.00	6.00					1.00	2.00	3.00					1.00	2.00	3.00																2.00				2.00			0.06	0.03	0.03			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	006	0		29	10	S0522_006_0	4	2	Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								3.00	6.00	9.00					2.00	4.00	6.00					2.00	4.00	6.00																3.00				3.00			0.10	0.06	0.06			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	006	0		29	10	S0522_006_0	4	3	Preferred Brand	1	2	000001	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											17.70	20	20	20				18.99	20	20	20				20	20	20															20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	006	0		29	10	S0522_006_0	4	4	Non-Preferred Brand	1	2	100000	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											36.46	35	35	35				36.46	35	35	35				35	35	35															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	006	0		29	10	S0522_006_0	4	5	Specialty Tier	1	2	010010	1	1		010	01	010		1				30				30						30		31											261.41	25						257.06	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	008	0		29	10	S0522_008_0	4	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								2.00	4.00	6.00					1.00	2.00	3.00					1.00	2.00	3.00																2.00				2.00			0.06	0.03	0.03			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	008	0		29	10	S0522_008_0	4	2	Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								3.00	6.00	9.00					2.00	4.00	6.00					2.00	4.00	6.00																3.00				3.00			0.10	0.06	0.06			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	008	0		29	10	S0522_008_0	4	4	Non-Preferred Brand	1	2	100000	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											35.08	35	35	35				34.80	35	35	35				35	35	35															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	008	0		29	10	S0522_008_0	4	3	Preferred Brand	1	2	000001	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											16.64	20	20	20				19.62	20	20	20				20	20	20															20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	008	0		29	10	S0522_008_0	4	5	Specialty Tier	1	2	010010	1	1		010	01	010		1				30				30						30		31											255.34	25						264.63	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	010	0		29	10	S0522_010_0	4	2	Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								3.00	6.00	9.00					2.00	4.00	6.00					2.00	4.00	6.00																3.00				3.00			0.10	0.06	0.06			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	010	0		29	10	S0522_010_0	4	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								2.00	4.00	6.00					1.00	2.00	3.00					1.00	2.00	3.00																2.00				2.00			0.06	0.03	0.03			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	010	0		29	10	S0522_010_0	4	3	Preferred Brand	1	2	000001	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											15.88	20	20	20				17.74	20	20	20				20	20	20															20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	010	0		29	10	S0522_010_0	4	4	Non-Preferred Brand	1	2	100000	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											33.65	34	34	34				33.25	34	34	34				34	34	34															34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	010	0		29	10	S0522_010_0	4	5	Specialty Tier	1	2	010010	1	1		010	01	010		1				30				30						30		31											247.97	25						249.25	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	012	0		29	10	S0522_012_0	7	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								3.00	6.00	9.00					1.00	2.00	3.00					1.00	2.00	3.00																3.00				3.00			0.10	0.03	0.03			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	012	0		29	10	S0522_012_0	7	2	Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								4.00	8.00	12.00					2.00	4.00	6.00					2.00	4.00	6.00																4.00				4.00			0.13	0.06	0.06			0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	012	0		29	10	S0522_012_0	7	3	Preferred Brand	1	2	000001	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											20.02	20	20	20				25.95	20	20	20				20	20	20															20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	012	0		29	10	S0522_012_0	7	4	Non-Preferred Brand	1	2	100000	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											29.48	35	35	35				45.26	35	35	35				35	35	35															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	012	0		29	10	S0522_012_0	7	5	Specialty Tier	1	2	010010	1	1		010	01	010		1				30				30						30		31											223.85	25						151.55	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	014	0		29	10	S0522_014_0	4	2	Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								3.00	6.00	9.00					2.00	4.00	6.00					2.00	4.00	6.00																3.00				3.00			0.10	0.06	0.06			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	014	0		29	10	S0522_014_0	4	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								2.00	4.00	6.00					1.00	2.00	3.00					1.00	2.00	3.00																2.00				2.00			0.06	0.03	0.03			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	014	0		29	10	S0522_014_0	4	3	Preferred Brand	1	2	000001	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											16.24	20	20	20				16.64	20	20	20				20	20	20															20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	014	0		29	10	S0522_014_0	4	5	Specialty Tier	1	2	010010	1	1		010	01	010		1				30				30						30		31											236.39	25						234.84	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	014	0		29	10	S0522_014_0	4	4	Non-Preferred Brand	1	2	100000	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											33.09	35	35	35				31.97	35	35	35				35	35	35															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	016	0		29	10	S0522_016_0	4	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								2.00	4.00	6.00					1.00	2.00	3.00					1.00	2.00	3.00																2.00				2.00			0.06	0.03	0.03			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	016	0		29	10	S0522_016_0	4	2	Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								3.00	6.00	9.00					2.00	4.00	6.00					2.00	4.00	6.00																3.00				3.00			0.10	0.06	0.06			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	016	0		29	10	S0522_016_0	4	3	Preferred Brand	1	2	000001	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											16.49	20	20	20				17.05	20	20	20				20	20	20															20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	016	0		29	10	S0522_016_0	4	4	Non-Preferred Brand	1	2	100000	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											34.20	35	35	35				33.36	35	35	35				35	35	35															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	016	0		29	10	S0522_016_0	4	5	Specialty Tier	1	2	010010	1	1		010	01	010		1				30				30						30		31											241.42	25						240.43	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	018	0		29	10	S0522_018_0	4	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								2.00	4.00	6.00					1.00	2.00	3.00					1.00	2.00	3.00																2.00				2.00			0.06	0.03	0.03			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	018	0		29	10	S0522_018_0	4	2	Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								3.00	6.00	9.00					2.00	4.00	6.00					2.00	4.00	6.00																3.00				3.00			0.10	0.06	0.06			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	018	0		29	10	S0522_018_0	4	4	Non-Preferred Brand	1	2	100000	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											35.06	35	35	35				34.86	35	35	35				35	35	35															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	018	0		29	10	S0522_018_0	4	3	Preferred Brand	1	2	000001	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											17.51	20	20	20				19.19	20	20	20				20	20	20															20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	018	0		29	10	S0522_018_0	4	5	Specialty Tier	1	2	010010	1	1		010	01	010		1				30				30						30		31											239.04	25						231.66	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	020	0		29	10	S0522_020_0	7	2	Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								4.00	8.00	12.00					2.00	4.00	6.00					2.00	4.00	6.00																4.00				4.00			0.13	0.06	0.06			0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	020	0		29	10	S0522_020_0	7	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								3.00	6.00	9.00					1.00	2.00	3.00					1.00	2.00	3.00																3.00				3.00			0.10	0.03	0.03			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	020	0		29	10	S0522_020_0	7	3	Preferred Brand	1	2	000001	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											18.23	20	20	20				21.95	20	20	20				20	20	20															20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	020	0		29	10	S0522_020_0	7	4	Non-Preferred Brand	1	2	100000	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											35.39	35	35	35				34.78	35	35	35				35	35	35															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	020	0		29	10	S0522_020_0	7	5	Specialty Tier	1	2	010010	1	1		010	01	010		1				30				30						30		31											182.32	25						101.03	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	022	0		29	10	S0522_022_0	7	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								3.00	6.00	9.00					1.00	2.00	3.00					1.00	2.00	3.00																3.00				3.00			0.10	0.03	0.03			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	022	0		29	10	S0522_022_0	7	2	Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								4.00	8.00	12.00					2.00	4.00	6.00					2.00	4.00	6.00																4.00				4.00			0.13	0.06	0.06			0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	022	0		29	10	S0522_022_0	7	3	Preferred Brand	1	2	000001	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											18.34	20	20	20				21.41	20	20	20				20	20	20															20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	022	0		29	10	S0522_022_0	7	4	Non-Preferred Brand	1	2	100000	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											35.05	34	34	34				32.76	34	34	34				34	34	34															34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	022	0		29	10	S0522_022_0	7	5	Specialty Tier	1	2	010010	1	1		010	01	010		1				30				30						30		31											175.78	25						83.77	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	024	0		29	10	S0522_024_0	7	2	Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								4.00	8.00	12.00					2.00	4.00	6.00					2.00	4.00	6.00																4.00				4.00			0.13	0.06	0.06			0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	024	0		29	10	S0522_024_0	7	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								3.00	6.00	9.00					1.00	2.00	3.00					1.00	2.00	3.00																3.00				3.00			0.10	0.03	0.03			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	024	0		29	10	S0522_024_0	7	3	Preferred Brand	1	2	000001	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											16.28	20	20	20				16.07	20	20	20				20	20	20															20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	024	0		29	10	S0522_024_0	7	5	Specialty Tier	1	2	010010	1	1		010	01	010		1				30				30						30		31											194.17	25						54.38	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	024	0		29	10	S0522_024_0	7	4	Non-Preferred Brand	1	2	100000	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											28.23	34	34	34				25.86	34	34	34				34	34	34															34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	026	0		29	10	S0522_026_0	7	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								3.00	6.00	9.00					1.00	2.00	3.00					1.00	2.00	3.00																3.00				3.00			0.10	0.03	0.03			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	026	0		29	10	S0522_026_0	7	2	Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								4.00	8.00	12.00					2.00	4.00	6.00					2.00	4.00	6.00																4.00				4.00			0.13	0.06	0.06			0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	026	0		29	10	S0522_026_0	7	3	Preferred Brand	1	2	000001	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											21.36	20	20	20				23.53	20	20	20				20	20	20															20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	026	0		29	10	S0522_026_0	7	4	Non-Preferred Brand	1	2	100000	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											31.06	33	33	33				45.10	33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	026	0		29	10	S0522_026_0	7	5	Specialty Tier	1	2	010010	1	1		010	01	010		1				30				30						30		31											181.03	25						131.31	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	028	0		29	10	S0522_028_0	4	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								2.00	4.00	6.00					1.00	2.00	3.00					1.00	2.00	3.00																2.00				2.00			0.06	0.03	0.03			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	028	0		29	10	S0522_028_0	4	2	Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								3.00	6.00	9.00					2.00	4.00	6.00					2.00	4.00	6.00																3.00				3.00			0.10	0.06	0.06			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	028	0		29	10	S0522_028_0	4	4	Non-Preferred Brand	1	2	100000	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											34.63	35	35	35				34.13	35	35	35				35	35	35															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	028	0		29	10	S0522_028_0	4	3	Preferred Brand	1	2	000001	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											16.39	20	20	20				17.41	20	20	20				20	20	20															20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	028	0		29	10	S0522_028_0	4	5	Specialty Tier	1	2	010010	1	1		010	01	010		1				30				30						30		31											244.44	25						246.10	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	030	0		29	10	S0522_030_0	7	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								3.00	6.00	9.00					1.00	2.00	3.00					1.00	2.00	3.00																3.00				3.00			0.10	0.03	0.03			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	030	0		29	10	S0522_030_0	7	2	Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								4.00	8.00	12.00					2.00	4.00	6.00					2.00	4.00	6.00																4.00				4.00			0.13	0.06	0.06			0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	030	0		29	10	S0522_030_0	7	3	Preferred Brand	1	2	000001	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											17.87	20	20	20				17.93	20	20	20				20	20	20															20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	030	0		29	10	S0522_030_0	7	4	Non-Preferred Brand	1	2	100000	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											36.07	34	34	34				25.51	34	34	34				34	34	34															34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	030	0		29	10	S0522_030_0	7	5	Specialty Tier	1	2	010010	1	1		010	01	010		1				30				30						30		31											254.40	25						153.28	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	032	0		29	10	S0522_032_0	4	2	Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								3.00	6.00	9.00					2.00	4.00	6.00					2.00	4.00	6.00																3.00				3.00			0.10	0.06	0.06			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	032	0		29	10	S0522_032_0	4	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								2.00	4.00	6.00					1.00	2.00	3.00					1.00	2.00	3.00																2.00				2.00			0.06	0.03	0.03			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	032	0		29	10	S0522_032_0	4	3	Preferred Brand	1	2	000001	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											16.25	20	20	20				17.12	20	20	20				20	20	20															20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	032	0		29	10	S0522_032_0	4	5	Specialty Tier	1	2	010010	1	1		010	01	010		1				30				30						30		31											243.03	25						243.83	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	032	0		29	10	S0522_032_0	4	4	Non-Preferred Brand	1	2	100000	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											34.24	35	35	35				33.68	35	35	35				35	35	35															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	034	0		29	10	S0522_034_0	7	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								3.00	6.00	9.00					1.00	2.00	3.00					1.00	2.00	3.00																3.00				3.00			0.10	0.03	0.03			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	034	0		29	10	S0522_034_0	7	2	Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								4.00	8.00	12.00					2.00	4.00	6.00					2.00	4.00	6.00																4.00				4.00			0.13	0.06	0.06			0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	034	0		29	10	S0522_034_0	7	4	Non-Preferred Brand	1	2	100000	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											40.16	33	33	33				35.83	33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	034	0		29	10	S0522_034_0	7	3	Preferred Brand	1	2	000001	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											22.75	20	20	20				23.23	20	20	20				20	20	20															20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	034	0		29	10	S0522_034_0	7	5	Specialty Tier	1	2	010010	1	1		010	01	010		1				30				30						30		31											190.61	25						174.69	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	036	0		29	10	S0522_036_0	4	2	Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								3.00	6.00	9.00					2.00	4.00	6.00					2.00	4.00	6.00																3.00				3.00			0.10	0.06	0.06			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	036	0		29	10	S0522_036_0	4	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								2.00	4.00	6.00					1.00	2.00	3.00					1.00	2.00	3.00																2.00				2.00			0.06	0.03	0.03			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	036	0		29	10	S0522_036_0	4	3	Preferred Brand	1	2	000001	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											15.83	20	20	20				17.76	20	20	20				20	20	20															20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	036	0		29	10	S0522_036_0	4	5	Specialty Tier	1	2	010010	1	1		010	01	010		1				30				30						30		31											225.99	25						231.67	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	036	0		29	10	S0522_036_0	4	4	Non-Preferred Brand	1	2	100000	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											34.14	35	35	35				33.60	35	35	35				35	35	35															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	037	0		29	10	S0522_037_0	4	2	Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								3.00	6.00	9.00					2.00	4.00	6.00					2.00	4.00	6.00																3.00				3.00			0.10	0.06	0.06			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	037	0		29	10	S0522_037_0	4	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								2.00	4.00	6.00					1.00	2.00	3.00					1.00	2.00	3.00																2.00				2.00			0.06	0.03	0.03			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	037	0		29	10	S0522_037_0	4	3	Preferred Brand	1	2	000001	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											15.98	20	20	20				17.02	20	20	20				20	20	20															20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	037	0		29	10	S0522_037_0	4	4	Non-Preferred Brand	1	2	100000	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											32.83	35	35	35				31.99	35	35	35				35	35	35															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	037	0		29	10	S0522_037_0	4	5	Specialty Tier	1	2	010010	1	1		010	01	010		1				30				30						30		31											231.08	25						234.87	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	038	0		29	10	S0522_038_0	4	2	Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								3.00	6.00	9.00					2.00	4.00	6.00					2.00	4.00	6.00																3.00				3.00			0.10	0.06	0.06			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	038	0		29	10	S0522_038_0	4	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								2.00	4.00	6.00					1.00	2.00	3.00					1.00	2.00	3.00																2.00				2.00			0.06	0.03	0.03			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	038	0		29	10	S0522_038_0	4	3	Preferred Brand	1	2	000001	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											15.84	20	20	20				15.88	20	20	20				20	20	20															20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	038	0		29	10	S0522_038_0	4	5	Specialty Tier	1	2	010010	1	1		010	01	010		1				30				30						30		31											230.33	25						226.99	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	038	0		29	10	S0522_038_0	4	4	Non-Preferred Brand	1	2	100000	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											31.15	35	35	35				29.56	35	35	35				35	35	35															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	039	0		29	10	S0522_039_0	4	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								2.00	4.00	6.00					1.00	2.00	3.00					1.00	2.00	3.00																2.00				2.00			0.06	0.03	0.03			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	039	0		29	10	S0522_039_0	4	2	Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								3.00	6.00	9.00					2.00	4.00	6.00					2.00	4.00	6.00																3.00				3.00			0.10	0.06	0.06			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	039	0		29	10	S0522_039_0	4	3	Preferred Brand	1	2	000001	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											16.07	20	20	20				16.67	20	20	20				20	20	20															20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	039	0		29	10	S0522_039_0	4	4	Non-Preferred Brand	1	2	100000	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											32.61	35	35	35				31.50	35	35	35				35	35	35															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	039	0		29	10	S0522_039_0	4	5	Specialty Tier	1	2	010010	1	1		010	01	010		1				30				30						30		31											232.09	25						232.60	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	040	0		29	10	S0522_040_0	4	4	Non-Preferred Brand	1	2	100000	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											34.32	36	36	36				33.69	36	36	36				36	36	36															36			36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	040	0		29	10	S0522_040_0	4	3	Preferred Brand	1	2	000001	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											15.24	20	20	20				17.75	20	20	20				20	20	20															20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	040	0		29	10	S0522_040_0	4	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								2.00	4.00	6.00					1.00	2.00	3.00					1.00	2.00	3.00																2.00				2.00			0.06	0.03	0.03			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	040	0		29	10	S0522_040_0	4	2	Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								3.00	6.00	9.00					2.00	4.00	6.00					2.00	4.00	6.00																3.00				3.00			0.10	0.06	0.06			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	040	0		29	10	S0522_040_0	4	5	Specialty Tier	1	2	010010	1	1		010	01	010		1				30				30						30		31											200.59	25						213.58	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	041	0		29	10	S0522_041_0	7	4	Non-Preferred Brand	1	2	100000	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											30.64	34	34	34				30.16	34	34	34				34	34	34															34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	041	0		29	10	S0522_041_0	7	3	Preferred Brand	1	2	000001	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											17.78	20	20	20				16.16	20	20	20				20	20	20															20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	041	0		29	10	S0522_041_0	7	2	Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								4.00	8.00	12.00					2.00	4.00	6.00					2.00	4.00	6.00																4.00				4.00			0.13	0.06	0.06			0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	041	0		29	10	S0522_041_0	7	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								3.00	6.00	9.00					1.00	2.00	3.00					1.00	2.00	3.00																3.00				3.00			0.10	0.03	0.03			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	041	0		29	10	S0522_041_0	7	5	Specialty Tier	1	2	010010	1	1		010	01	010		1				30				30						30		31											153.18	25						64.84	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	042	0		29	10	S0522_042_0	7	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								3.00	6.00	9.00					1.00	2.00	3.00					1.00	2.00	3.00																3.00				3.00			0.10	0.03	0.03			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	042	0		29	10	S0522_042_0	7	2	Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								4.00	8.00	12.00					2.00	4.00	6.00					2.00	4.00	6.00																4.00				4.00			0.13	0.06	0.06			0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	042	0		29	10	S0522_042_0	7	3	Preferred Brand	1	2	000001	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											18.00	20	20	20				20.19	20	20	20				20	20	20															20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	042	0		29	10	S0522_042_0	7	4	Non-Preferred Brand	1	2	100000	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											36.33	35	35	35				30.01	35	35	35				35	35	35															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	042	0		29	10	S0522_042_0	7	5	Specialty Tier	1	2	010010	1	1		010	01	010		1				30				30						30		31											175.70	25						106.06	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	043	0		29	10	S0522_043_0	4	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								2.00	4.00	6.00					1.00	2.00	3.00					1.00	2.00	3.00																2.00				2.00			0.06	0.03	0.03			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	043	0		29	10	S0522_043_0	4	2	Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								3.00	6.00	9.00					2.00	4.00	6.00					2.00	4.00	6.00																3.00				3.00			0.10	0.06	0.06			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	043	0		29	10	S0522_043_0	4	3	Preferred Brand	1	2	000001	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											18.31	20	20	20				19.15	20	20	20				20	20	20															20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	043	0		29	10	S0522_043_0	4	4	Non-Preferred Brand	1	2	100000	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											38.85	35	35	35				38.28	35	35	35				35	35	35															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	043	0		29	10	S0522_043_0	4	5	Specialty Tier	1	2	010010	1	1		010	01	010		1				30				30						30		31											271.43	25						270.39	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	044	0		29	10	S0522_044_0	7	2	Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								4.00	8.00	12.00					2.00	4.00	6.00					2.00	4.00	6.00																4.00				4.00			0.13	0.06	0.06			0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	044	0		29	10	S0522_044_0	7	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								3.00	6.00	9.00					1.00	2.00	3.00					1.00	2.00	3.00																3.00				3.00			0.10	0.03	0.03			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	044	0		29	10	S0522_044_0	7	3	Preferred Brand	1	2	000001	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											17.77	20	20	20				19.99	20	20	20				20	20	20															20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	044	0		29	10	S0522_044_0	7	5	Specialty Tier	1	2	010010	1	1		010	01	010		1				30				30						30		31											250.04	25						124.20	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	044	0		29	10	S0522_044_0	7	4	Non-Preferred Brand	1	2	100000	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											39.08	35	35	35				22.18	35	35	35				35	35	35															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	045	0		29	10	S0522_045_0	4	4	Non-Preferred Brand	1	2	100000	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											35.82	35	35	35				35.15	35	35	35				35	35	35															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	045	0		29	10	S0522_045_0	4	3	Preferred Brand	1	2	000001	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											16.98	20	20	20				17.66	20	20	20				20	20	20															20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	045	0		29	10	S0522_045_0	4	2	Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								3.00	6.00	9.00					2.00	4.00	6.00					2.00	4.00	6.00																3.00				3.00			0.10	0.06	0.06			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	045	0		29	10	S0522_045_0	4	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								2.00	4.00	6.00					1.00	2.00	3.00					1.00	2.00	3.00																2.00				2.00			0.06	0.03	0.03			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	045	0		29	10	S0522_045_0	4	5	Specialty Tier	1	2	010010	1	1		010	01	010		1				30				30						30		31											251.14	25						250.11	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	046	0		29	10	S0522_046_0	4	4	Non-Preferred Brand	1	2	100000	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											35.85	35	35	35				35.35	35	35	35				35	35	35															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	046	0		29	10	S0522_046_0	4	3	Preferred Brand	1	2	000001	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											16.86	20	20	20				17.66	20	20	20				20	20	20															20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	046	0		29	10	S0522_046_0	4	2	Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								3.00	6.00	9.00					2.00	4.00	6.00					2.00	4.00	6.00																3.00				3.00			0.10	0.06	0.06			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	046	0		29	10	S0522_046_0	4	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								2.00	4.00	6.00					1.00	2.00	3.00					1.00	2.00	3.00																2.00				2.00			0.06	0.03	0.03			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	046	0		29	10	S0522_046_0	4	5	Specialty Tier	1	2	010010	1	1		010	01	010		1				30				30						30		31											250.02	25						249.34	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	047	0		29	10	S0522_047_0	4	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								2.00	4.00	6.00					1.00	2.00	3.00					1.00	2.00	3.00																2.00				2.00			0.06	0.03	0.03			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	047	0		29	10	S0522_047_0	4	2	Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								3.00	6.00	9.00					2.00	4.00	6.00					2.00	4.00	6.00																3.00				3.00			0.10	0.06	0.06			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	047	0		29	10	S0522_047_0	4	3	Preferred Brand	1	2	000001	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											16.29	20	20	20				16.82	20	20	20				20	20	20															20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	047	0		29	10	S0522_047_0	4	4	Non-Preferred Brand	1	2	100000	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											34.08	35	35	35				33.21	35	35	35				35	35	35															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	047	0		29	10	S0522_047_0	4	5	Specialty Tier	1	2	010010	1	1		010	01	010		1				30				30						30		31											245.09	25						243.45	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	048	0		29	10	S0522_048_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	048	0		29	10	S0522_048_0	5	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								11.00	22.00	33.00					6.00	12.00	18.00					6.00	12.00	18.00																11.00				11.00			0.36	0.20	0.20			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	048	0		29	10	S0522_048_0	5	4	Non-Preferred Brand	1	4	100000	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											44.92	44	44	44				43.66	40	40	40				40	40	40															44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	048	0		29	10	S0522_048_0	5	3	Preferred Brand	1	4	000001	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											27.36	25	25	25				26.51	20	20	20				20	20	20															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	048	0		29	10	S0522_048_0	5	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											369.13	28						360.69	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	049	0		29	10	S0522_049_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	049	0		29	10	S0522_049_0	5	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								11.00	22.00	33.00					6.00	12.00	18.00					6.00	12.00	18.00																11.00				11.00			0.36	0.20	0.20			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	049	0		29	10	S0522_049_0	5	3	Preferred Brand	1	4	000001	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											26.65	25	25	25				25.82	20	20	20				20	20	20															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	049	0		29	10	S0522_049_0	5	4	Non-Preferred Brand	1	4	100000	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											43.96	43	43	43				42.73	40	40	40				40	40	40															43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	049	0		29	10	S0522_049_0	5	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											357.87	28						349.69	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	050	0		29	10	S0522_050_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	050	0		29	10	S0522_050_0	5	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								11.00	22.00	33.00					6.00	12.00	18.00					6.00	12.00	18.00																11.00				11.00			0.36	0.20	0.20			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	050	0		29	10	S0522_050_0	5	3	Preferred Brand	1	4	000001	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											24.75	24	24	24				23.94	20	20	20				20	20	20															24			24								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	050	0		29	10	S0522_050_0	5	4	Non-Preferred Brand	1	4	100000	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											41.12	42	42	42				39.99	40	40	40				40	40	40															42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	050	0		29	10	S0522_050_0	5	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											326.60	28						319.12	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	051	0		29	10	S0522_051_0	5	4	Non-Preferred Brand	1	4	100000	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											43.22	42	42	42				42.02	40	40	40				40	40	40															42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	051	0		29	10	S0522_051_0	5	3	Preferred Brand	1	4	000001	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											26.13	25	25	25				25.32	20	20	20				20	20	20															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	051	0		29	10	S0522_051_0	5	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								11.00	22.00	33.00					6.00	12.00	18.00					6.00	12.00	18.00																11.00				11.00			0.36	0.20	0.20			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	051	0		29	10	S0522_051_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	051	0		29	10	S0522_051_0	5	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											350.47	28						342.44	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	052	0		29	10	S0522_052_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	052	0		29	10	S0522_052_0	5	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								11.00	22.00	33.00					6.00	12.00	18.00					6.00	12.00	18.00																11.00				11.00			0.36	0.20	0.20			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	052	0		29	10	S0522_052_0	5	3	Preferred Brand	1	4	000001	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											27.24	25	25	25				26.39	20	20	20				20	20	20															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	052	0		29	10	S0522_052_0	5	4	Non-Preferred Brand	1	4	100000	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											44.70	43	43	43				43.45	40	40	40				40	40	40															43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	052	0		29	10	S0522_052_0	5	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											366.82	28						358.40	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	053	0		29	10	S0522_053_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	053	0		29	10	S0522_053_0	5	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								11.00	22.00	33.00					6.00	12.00	18.00					6.00	12.00	18.00																11.00				11.00			0.36	0.20	0.20			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	053	0		29	10	S0522_053_0	5	3	Preferred Brand	1	4	000001	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											26.02	25	25	25				25.21	20	20	20				20	20	20															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	053	0		29	10	S0522_053_0	5	4	Non-Preferred Brand	1	4	100000	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											42.96	42	42	42				41.77	40	40	40				40	40	40															42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	053	0		29	10	S0522_053_0	5	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											349.06	28						341.04	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	054	0		29	10	S0522_054_0	5	4	Non-Preferred Brand	1	4	100000	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											43.76	43	43	43				42.54	40	40	40				40	40	40															43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	054	0		29	10	S0522_054_0	5	3	Preferred Brand	1	4	000001	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											26.52	25	25	25				25.69	20	20	20				20	20	20															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	054	0		29	10	S0522_054_0	5	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								11.00	22.00	33.00					6.00	12.00	18.00					6.00	12.00	18.00																11.00				11.00			0.36	0.20	0.20			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	054	0		29	10	S0522_054_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	054	0		29	10	S0522_054_0	5	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											354.18	28						346.05	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	055	0		29	10	S0522_055_0	5	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								11.00	22.00	33.00					6.00	12.00	18.00					6.00	12.00	18.00																11.00				11.00			0.36	0.20	0.20			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	055	0		29	10	S0522_055_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	055	0		29	10	S0522_055_0	5	3	Preferred Brand	1	4	000001	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											26.62	25	25	25				25.79	20	20	20				20	20	20															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	055	0		29	10	S0522_055_0	5	4	Non-Preferred Brand	1	4	100000	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											43.89	43	43	43				42.66	40	40	40				40	40	40															43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	055	0		29	10	S0522_055_0	5	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											356.54	28						348.37	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	056	0		29	10	S0522_056_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	056	0		29	10	S0522_056_0	5	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								11.00	22.00	33.00					6.00	12.00	18.00					6.00	12.00	18.00																11.00				11.00			0.36	0.20	0.20			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	056	0		29	10	S0522_056_0	5	3	Preferred Brand	1	4	000001	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											26.60	25	25	25				25.77	20	20	20				20	20	20															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	056	0		29	10	S0522_056_0	5	4	Non-Preferred Brand	1	4	100000	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											43.84	43	43	43				42.62	40	40	40				40	40	40															43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	056	0		29	10	S0522_056_0	5	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											356.14	28						347.98	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	057	0		29	10	S0522_057_0	6	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								11.00	22.00	33.00					6.00	12.00	18.00					6.00	12.00	18.00																11.00				11.00			0.36	0.20	0.20			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	057	0		29	10	S0522_057_0	6	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	057	0		29	10	S0522_057_0	6	3	Preferred Brand	1	4	000001	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											26.56	25	25	25				25.73	20	20	20				20	20	20															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	057	0		29	10	S0522_057_0	6	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											355.03	28						346.87	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	057	0		29	10	S0522_057_0	6	4	Non-Preferred Brand	1	4	100000	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											43.79	43	43	43				42.56	40	40	40				40	40	40															43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	058	0		29	10	S0522_058_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	058	0		29	10	S0522_058_0	5	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								11.00	22.00	33.00					6.00	12.00	18.00					6.00	12.00	18.00																11.00				11.00			0.36	0.20	0.20			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	058	0		29	10	S0522_058_0	5	3	Preferred Brand	1	4	000001	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											26.54	25	25	25				25.71	20	20	20				20	20	20															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	058	0		29	10	S0522_058_0	5	4	Non-Preferred Brand	1	4	100000	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											43.76	42	42	42				42.55	40	40	40				40	40	40															42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	058	0		29	10	S0522_058_0	5	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											354.19	28						346.05	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	059	0		29	10	S0522_059_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	059	0		29	10	S0522_059_0	5	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								11.00	22.00	33.00					6.00	12.00	18.00					6.00	12.00	18.00																11.00				11.00			0.36	0.20	0.20			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	059	0		29	10	S0522_059_0	5	4	Non-Preferred Brand	1	4	100000	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											43.48	42	42	42				42.27	40	40	40				40	40	40															42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	059	0		29	10	S0522_059_0	5	3	Preferred Brand	1	4	000001	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											26.32	25	25	25				25.50	20	20	20				20	20	20															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	059	0		29	10	S0522_059_0	5	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											352.14	28						344.04	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	060	0		29	10	S0522_060_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	060	0		29	10	S0522_060_0	5	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								11.00	22.00	33.00					6.00	12.00	18.00					6.00	12.00	18.00																11.00				11.00			0.36	0.20	0.20			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	060	0		29	10	S0522_060_0	5	3	Preferred Brand	1	4	000001	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											26.57	25	25	25				25.75	20	20	20				20	20	20															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	060	0		29	10	S0522_060_0	5	4	Non-Preferred Brand	1	4	100000	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											43.81	43	43	43				42.58	40	40	40				40	40	40															43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	060	0		29	10	S0522_060_0	5	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											355.45	28						347.28	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	061	0		29	10	S0522_061_0	5	4	Non-Preferred Brand	1	4	100000	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											43.38	42	42	42				42.18	40	40	40				40	40	40															42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	061	0		29	10	S0522_061_0	5	3	Preferred Brand	1	4	000001	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											26.24	25	25	25				25.42	20	20	20				20	20	20															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	061	0		29	10	S0522_061_0	5	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								11.00	22.00	33.00					6.00	12.00	18.00					6.00	12.00	18.00																11.00				11.00			0.36	0.20	0.20			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	061	0		29	10	S0522_061_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	061	0		29	10	S0522_061_0	5	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											350.74	28						342.70	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	062	0		29	10	S0522_062_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	062	0		29	10	S0522_062_0	5	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								11.00	22.00	33.00					6.00	12.00	18.00					6.00	12.00	18.00																11.00				11.00			0.36	0.20	0.20			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	062	0		29	10	S0522_062_0	5	3	Preferred Brand	1	4	000001	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											26.47	25	25	25				25.65	20	20	20				20	20	20															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	062	0		29	10	S0522_062_0	5	4	Non-Preferred Brand	1	4	100000	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											43.71	42	42	42				42.49	40	40	40				40	40	40															42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	062	0		29	10	S0522_062_0	5	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											353.98	28						345.85	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	063	0		29	10	S0522_063_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	063	0		29	10	S0522_063_0	5	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								11.00	22.00	33.00					6.00	12.00	18.00					6.00	12.00	18.00																11.00				11.00			0.36	0.20	0.20			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	063	0		29	10	S0522_063_0	5	3	Preferred Brand	1	4	000001	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											27.29	25	25	25				26.44	20	20	20				20	20	20															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	063	0		29	10	S0522_063_0	5	4	Non-Preferred Brand	1	4	100000	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											44.79	43	43	43				43.54	40	40	40				40	40	40															43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	063	0		29	10	S0522_063_0	5	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											367.52	28						359.12	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	064	0		29	10	S0522_064_0	5	4	Non-Preferred Brand	1	4	100000	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											42.77	42	42	42				41.58	40	40	40				40	40	40															42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	064	0		29	10	S0522_064_0	5	3	Preferred Brand	1	4	000001	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											25.89	25	25	25				25.08	20	20	20				20	20	20															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	064	0		29	10	S0522_064_0	5	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								11.00	22.00	33.00					6.00	12.00	18.00					6.00	12.00	18.00																11.00				11.00			0.36	0.20	0.20			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	064	0		29	10	S0522_064_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	064	0		29	10	S0522_064_0	5	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											345.12	28						337.20	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	065	0		29	10	S0522_065_0	5	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								11.00	22.00	33.00					6.00	12.00	18.00					6.00	12.00	18.00																11.00				11.00			0.36	0.20	0.20			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	065	0		29	10	S0522_065_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	065	0		29	10	S0522_065_0	5	3	Preferred Brand	1	4	000001	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											26.48	25	25	25				25.66	20	20	20				20	20	20															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	065	0		29	10	S0522_065_0	5	4	Non-Preferred Brand	1	4	100000	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											43.72	42	42	42				42.51	40	40	40				40	40	40															42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	065	0		29	10	S0522_065_0	5	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											354.17	28						346.03	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	066	0		29	10	S0522_066_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	066	0		29	10	S0522_066_0	5	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								11.00	22.00	33.00					6.00	12.00	18.00					6.00	12.00	18.00																11.00				11.00			0.36	0.20	0.20			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	066	0		29	10	S0522_066_0	5	3	Preferred Brand	1	4	000001	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											26.33	25	25	25				25.51	20	20	20				20	20	20															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	066	0		29	10	S0522_066_0	5	4	Non-Preferred Brand	1	4	100000	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											43.49	42	42	42				42.28	40	40	40				40	40	40															42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	066	0		29	10	S0522_066_0	5	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											352.17	28						344.07	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	067	0		29	10	S0522_067_0	5	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								11.00	22.00	33.00					6.00	12.00	18.00					6.00	12.00	18.00																11.00				11.00			0.36	0.20	0.20			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	067	0		29	10	S0522_067_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	067	0		29	10	S0522_067_0	5	3	Preferred Brand	1	4	000001	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											26.61	25	25	25				25.78	20	20	20				20	20	20															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	067	0		29	10	S0522_067_0	5	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											356.40	28						348.23	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	067	0		29	10	S0522_067_0	5	4	Non-Preferred Brand	1	4	100000	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											43.85	42	42	42				42.63	40	40	40				40	40	40															42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	068	0		29	10	S0522_068_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	068	0		29	10	S0522_068_0	5	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								11.00	22.00	33.00					6.00	12.00	18.00					6.00	12.00	18.00																11.00				11.00			0.36	0.20	0.20			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	068	0		29	10	S0522_068_0	5	3	Preferred Brand	1	4	000001	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											26.86	25	25	25				26.02	20	20	20				20	20	20															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	068	0		29	10	S0522_068_0	5	4	Non-Preferred Brand	1	4	100000	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											44.21	43	43	43				42.97	40	40	40				40	40	40															43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	068	0		29	10	S0522_068_0	5	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											360.97	28						352.70	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	069	0		29	10	S0522_069_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	069	0		29	10	S0522_069_0	5	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								11.00	22.00	33.00					6.00	12.00	18.00					6.00	12.00	18.00																11.00				11.00			0.36	0.20	0.20			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	069	0		29	10	S0522_069_0	5	4	Non-Preferred Brand	1	4	100000	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											44.14	43	43	43				42.91	40	40	40				40	40	40															43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	069	0		29	10	S0522_069_0	5	3	Preferred Brand	1	4	000001	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											26.79	25	25	25				25.95	20	20	20				20	20	20															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	069	0		29	10	S0522_069_0	5	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											358.62	28						350.42	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	070	0		29	10	S0522_070_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	070	0		29	10	S0522_070_0	5	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								11.00	22.00	33.00					6.00	12.00	18.00					6.00	12.00	18.00																11.00				11.00			0.36	0.20	0.20			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	070	0		29	10	S0522_070_0	5	3	Preferred Brand	1	4	000001	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											26.85	25	25	25				26.02	20	20	20				20	20	20															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	070	0		29	10	S0522_070_0	5	4	Non-Preferred Brand	1	4	100000	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											44.21	43	43	43				42.97	40	40	40				40	40	40															43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	070	0		29	10	S0522_070_0	5	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											360.24	28						351.99	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	071	0		29	10	S0522_071_0	5	4	Non-Preferred Brand	1	4	100000	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											42.07	41	41	41				40.91	40	40	40				40	40	40															41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	071	0		29	10	S0522_071_0	5	3	Preferred Brand	1	4	000001	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											25.45	25	25	25				24.65	20	20	20				20	20	20															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	071	0		29	10	S0522_071_0	5	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								11.00	22.00	33.00					6.00	12.00	18.00					6.00	12.00	18.00																11.00				11.00			0.36	0.20	0.20			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	071	0		29	10	S0522_071_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	071	0		29	10	S0522_071_0	5	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											338.87	28						331.11	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	072	0		29	10	S0522_072_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	072	0		29	10	S0522_072_0	5	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								11.00	22.00	33.00					6.00	12.00	18.00					6.00	12.00	18.00																11.00				11.00			0.36	0.20	0.20			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	072	0		29	10	S0522_072_0	5	3	Preferred Brand	1	4	000001	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											26.09	25	25	25				25.27	20	20	20				20	20	20															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	072	0		29	10	S0522_072_0	5	4	Non-Preferred Brand	1	4	100000	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											43.07	42	42	42				41.87	40	40	40				40	40	40															42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	072	0		29	10	S0522_072_0	5	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											350.62	28						342.58	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	073	0		29	10	S0522_073_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	073	0		29	10	S0522_073_0	5	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								11.00	22.00	33.00					6.00	12.00	18.00					6.00	12.00	18.00																11.00				11.00			0.36	0.20	0.20			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	073	0		29	10	S0522_073_0	5	3	Preferred Brand	1	4	000001	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											30.92	24	24	24				29.92	20	20	20				20	20	20															24			24								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	073	0		29	10	S0522_073_0	5	4	Non-Preferred Brand	1	4	100000	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											49.87	43	43	43				48.48	40	40	40				40	40	40															43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	073	0		29	10	S0522_073_0	5	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											411.96	28						402.69	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	074	0		29	10	S0522_074_0	5	4	Non-Preferred Brand	1	4	100000	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											44.48	43	43	43				43.24	40	40	40				40	40	40															43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	074	0		29	10	S0522_074_0	5	3	Preferred Brand	1	4	000001	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											27.02	25	25	25				26.17	20	20	20				20	20	20															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	074	0		29	10	S0522_074_0	5	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								11.00	22.00	33.00					6.00	12.00	18.00					6.00	12.00	18.00																11.00				11.00			0.36	0.20	0.20			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	074	0		29	10	S0522_074_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	074	0		29	10	S0522_074_0	5	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											363.64	28						355.30	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	075	0		29	10	S0522_075_0	5	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								11.00	22.00	33.00					6.00	12.00	18.00					6.00	12.00	18.00																11.00				11.00			0.36	0.20	0.20			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	075	0		29	10	S0522_075_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	075	0		29	10	S0522_075_0	5	3	Preferred Brand	1	4	000001	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											27.39	25	25	25				26.54	20	20	20				20	20	20															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	075	0		29	10	S0522_075_0	5	4	Non-Preferred Brand	1	4	100000	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											44.98	44	44	44				43.71	40	40	40				40	40	40															44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	075	0		29	10	S0522_075_0	5	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											369.68	28						361.22	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	076	0		29	10	S0522_076_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	076	0		29	10	S0522_076_0	5	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								11.00	22.00	33.00					6.00	12.00	18.00					6.00	12.00	18.00																11.00				11.00			0.36	0.20	0.20			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	076	0		29	10	S0522_076_0	5	3	Preferred Brand	1	4	000001	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											26.66	25	25	25				25.83	20	20	20				20	20	20															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	076	0		29	10	S0522_076_0	5	4	Non-Preferred Brand	1	4	100000	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											43.97	43	43	43				42.74	40	40	40				40	40	40															43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	076	0		29	10	S0522_076_0	5	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											358.36	28						350.16	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	077	0		29	10	S0522_077_0	5	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								11.00	22.00	33.00					6.00	12.00	18.00					6.00	12.00	18.00																11.00				11.00			0.36	0.20	0.20			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	077	0		29	10	S0522_077_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	077	0		29	10	S0522_077_0	5	3	Preferred Brand	1	4	000001	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											25.73	25	25	25				24.93	20	20	20				20	20	20															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	077	0		29	10	S0522_077_0	5	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											342.50	28						334.63	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	077	0		29	10	S0522_077_0	5	4	Non-Preferred Brand	1	4	100000	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											42.53	41	41	41				41.36	40	40	40				40	40	40															41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	078	0		29	10	S0522_078_0	5	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								2.00	4.00	6.00					1.00	2.00	3.00					1.00	2.00	3.00																2.00				2.00			0.06	0.03	0.03			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	078	0		29	10	S0522_078_0	5	2	Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								3.00	6.00	9.00					2.00	4.00	6.00					2.00	4.00	6.00																3.00				3.00			0.10	0.06	0.06			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	078	0		29	10	S0522_078_0	5	3	Preferred Brand	1	2	000001	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											16.36	20	20	20				17.24	20	20	20				20	20	20															20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	078	0		29	10	S0522_078_0	5	4	Non-Preferred Brand	1	2	100000	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											34.45	35	35	35				33.92	35	35	35				35	35	35															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	078	0		29	10	S0522_078_0	5	5	Specialty Tier	1	2	010010	1	1		010	01	010		1				30				30						30		31											242.95	25						243.71	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	079	0		29	10	S0522_079_0	5	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								2.00	4.00	6.00					1.00	2.00	3.00					1.00	2.00	3.00																2.00				2.00			0.06	0.03	0.03			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	079	0		29	10	S0522_079_0	5	2	Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								3.00	6.00	9.00					2.00	4.00	6.00					2.00	4.00	6.00																3.00				3.00			0.10	0.06	0.06			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	079	0		29	10	S0522_079_0	5	4	Non-Preferred Brand	1	2	100000	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											34.85	35	35	35				34.31	35	35	35				35	35	35															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	079	0		29	10	S0522_079_0	5	3	Preferred Brand	1	2	000001	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											16.53	20	20	20				17.41	20	20	20				20	20	20															20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	079	0		29	10	S0522_079_0	5	5	Specialty Tier	1	2	010010	1	1		010	01	010		1				30				30						30		31											244.77	25						245.53	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	080	0		29	10	S0522_080_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	080	0		29	10	S0522_080_0	5	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								11.00	22.00	33.00					6.00	12.00	18.00					6.00	12.00	18.00																11.00				11.00			0.36	0.20	0.20			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	080	0		29	10	S0522_080_0	5	3	Preferred Brand	1	4	000001	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											26.06	25	25	25				25.25	20	20	20				20	20	20															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	080	0		29	10	S0522_080_0	5	4	Non-Preferred Brand	1	4	100000	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											43.03	42	42	42				41.84	40	40	40				40	40	40															42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	080	0		29	10	S0522_080_0	5	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											350.61	28						342.56	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	081	0		29	10	S0522_081_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	081	0		29	10	S0522_081_0	5	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								11.00	22.00	33.00					6.00	12.00	18.00					6.00	12.00	18.00																11.00				11.00			0.36	0.20	0.20			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	081	0		29	10	S0522_081_0	5	3	Preferred Brand	1	4	000001	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											26.32	25	25	25				25.50	20	20	20				20	20	20															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	081	0		29	10	S0522_081_0	5	4	Non-Preferred Brand	1	4	100000	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											43.49	43	43	43				42.27	40	40	40				40	40	40															43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S0522	081	0		29	10	S0522_081_0	5	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											351.83	28						343.75	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S1030	001	0		29	10	S1030_001_0	2	2	Generic	1	4	000100	1	2		110	01	110		1				30		90	1	30		90				30		31								13.00		39.00					8.00		16.00					8.00		16.00																13.00				13.00			.43	.26	.26			.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S1030	001	0		29	10	S1030_001_0	2	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				30		90	1	30		90				30		31								7.00		21.00					2.00		4.00					2.00		4.00																7.00				7.00			.23	0.06	.06			.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S1030	001	0		29	10	S1030_001_0	2	3	Preferred Brand	1	4	010001	1	2		110	01	110		1				30		90	1	30		90				30		31								47.00		141.00					42.00		84.00					42.00		84.00																47.00				47.00			1.56	1.40	1.40			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S1030	001	0		29	10	S1030_001_0	2	4	Non-Preferred Brand	1	4	110000	1	2		110	01	110		1				30		90	1	30		90				30		31								100.00		300.00					95.00		190.00					95.00		190.00																100.00				100.00			3.33	3.16	3.16			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S1030	001	0		29	10	S1030_001_0	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S1030	006	0		29	10	S1030_006_0	1	2	Generic	1	2	000100	1	2		110	01	110		1				30		90	1	30		90				30		31								17.00		51.00					12.00		24.00					12.00		24.00																17.00				17.00			0.56	0.40	0.40			0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S1030	006	0		29	10	S1030_006_0	1	1	Preferred Generic	1	2	001000	1	2		110	01	110		1				30		90	1	30		90				30		31								10.00		30.00					5.00		10.00					5.00		10.00																10.00				10.00			0.33	0.16	0.16			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S1030	006	0		29	10	S1030_006_0	1	3	Preferred Brand	1	2	010001	1	2		110	01	110		1				30		90	1	30		90				30		31								47.00		141.00					42.00		84.00					42.00		84.00																47.00				47.00			1.56	1.40	1.40			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S1030	006	0		29	10	S1030_006_0	1	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S1030	006	0		29	10	S1030_006_0	1	4	Non-Preferred Brand	1	2	110000	1	2		110	01	110		1				30		90	1	30		90				30		31								100.00		300.00					95.00		190.00					95.00		190.00																100.00				100.00			3.33	3.16	3.16			3.22	Preferred Generic, 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								15.00		45.00					9.00		27.00					9.00		22.50																	15.00			15.00			0.50	0.30	0.30			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S1140	001	0		29	10	S1140_001_0	1	2	Generic	1	2	000100	1	2		110	10	110		1				30		90	2	30		90					29	31								20.00		60.00					15.00		45.00					15.00		37.50																	20.00			20.00			0.67	0.50	0.50			0.65	Preferred Generic, 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								100.00		300.00					94.00		282.00					94.00		235.00																	100.00			100.00			3.33	3.13	3.13			3.23	Preferred Generic, 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								47.00		141.00					42.00		126.00					42.00		105.00																	47.00			47.00			1.57	1.40	1.40			1.52	Preferred Generic, 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												25		25					25		25				25		25																25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2468	003	0		29	10	S2468_003_0	2	2	Generic	1	3	000100	1	2		111	01	100		1				30	60	90	1			90				30		31								14.00	28.00	42.00					6.00	12.00	12.00							12.00																14.00				14.00			0.47	0.20				0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S2468	003	0		29	10	S2468_003_0	2	3	Preferred Brand	1	3	010001	1	2		111	01	100		1				30	60	90	1			90				30		31								47.00	94.00	141.00					40.00	80.00	80.00							80.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S2468	003	0		29	10	S2468_003_0	2	1	Preferred Generic	1	3	001000	1	2		111	01	100		1				30	60	90	1			90				30		31								7.00	14.00	21.00					0.00	0.00	0.00							0.00																7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S2468	003	0		29	10	S2468_003_0	2	4	Non-Preferred Brand	1	3	110000	1	1		111	01	100		1				30	60	90	1			90				30		31											89.00	35	35	35				84.00	33	33	33						33															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S2468	003	0		29	10	S2468_003_0	2	5	Injectable Drugs	1	3	010010	1	1		111	01	100		1				30	60	90	1			90				30		31											132.00	25	25	25				132.00	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S2468	003	0		29	10	S2468_003_0	2	6	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		31												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S2468	004	0		29	10	S2468_004_0	2	2	Generic	1	4	000100	1	2		111	01	100		1				30	60	90	1			90				30		31								17.00	34.00	51.00					10.00	20.00	20.00							20.00																17.00				17.00			0.57	0.33				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S2468	004	0		29	10	S2468_004_0	2	1	Preferred Generic	1	4	001000	1	2		111	01	100		1				30	60	90	1			90				30		31								13.00	26.00	39.00					4.00	8.00	8.00							8.00																13.00				13.00			0.43	0.13				0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S2468	004	0		29	10	S2468_004_0	2	3	Preferred Brand	1	4	010001	1	2		111	01	100		1				30	60	90	1			90				30		31								47.00	94.00	141.00					40.00	80.00	80.00							80.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S2468	004	0		29	10	S2468_004_0	2	6	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S2468	004	0		29	10	S2468_004_0	2	5	Injectable Drugs	1	4	010010	1	1		111	01	100		1				30	60	90	1			90				30		31											123.00	25	25	25				123.00	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S2468	004	0		29	10	S2468_004_0	2	4	Non-Preferred Brand	1	4	110000	1	1		111	01	100		1				30	60	90	1			90				30		31											85.00	40	40	40				80.00	38	38	38						38															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S2505	001	0		29	10	S2505_001_0	5	1	Preferred Generic	1	2	001000	1	2	110		01		110	1	30		90				1				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	001	0		29	10	S2505_001_0	5	4	Non-Preferred Brand	1	2	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				72.30	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	001	0		29	10	S2505_001_0	5	3	Preferred Brand	1	2	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	001	0		29	10	S2505_001_0	5	2	Generic	1	2	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		12.50				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	001	0		29	10	S2505_001_0	5	5	Specialty Tier	1	2	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	003	0		29	10	S2505_003_0	5	3	Preferred Brand	1	2	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	003	0		29	10	S2505_003_0	5	2	Generic	1	2	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		12.50				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	003	0		29	10	S2505_003_0	5	1	Preferred Generic	1	2	001000	1	2	110		01		110	1	30		90				1				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	003	0		29	10	S2505_003_0	5	4	Non-Preferred Brand	1	2	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				59.40	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	003	0		29	10	S2505_003_0	5	5	Specialty Tier	1	2	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	005	0		29	10	S2505_005_0	5	4	Non-Preferred Brand	1	2	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				57.40	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	005	0		29	10	S2505_005_0	5	3	Preferred Brand	1	2	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	005	0		29	10	S2505_005_0	5	2	Generic	1	2	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	8.00		24.00																									8.00		24.00				8.00		20.00				8.00				8.00		0.27				0.27	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	005	0		29	10	S2505_005_0	5	1	Preferred Generic	1	2	001000	1	2	110		01		110	1	30		90				1				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	005	0		29	10	S2505_005_0	5	5	Specialty Tier	1	2	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	007	0		29	10	S2505_007_0	5	4	Non-Preferred Brand	1	3	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				71.40	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	007	0		29	10	S2505_007_0	5	3	Preferred Brand	1	3	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	007	0		29	10	S2505_007_0	5	2	Generic	1	3	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	18.00		54.00																									18.00		54.00				18.00		45.00				18.00				18.00		0.60				0.60	0.60	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	007	0		29	10	S2505_007_0	5	1	Preferred Generic	1	3	001000	1	2	110		01		110	1	30		90				1				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	007	0		29	10	S2505_007_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	009	0		29	10	S2505_009_0	5	1	Preferred Generic	1	3	001000	1	2	110		01		110	1	30		90				1				30		90	30		31	8.00		24.00																									8.00		24.00				8.00		0.00				8.00				8.00		0.27				0.27	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	009	0		29	10	S2505_009_0	5	2	Generic	1	3	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	009	0		29	10	S2505_009_0	5	3	Preferred Brand	1	3	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	009	0		29	10	S2505_009_0	5	4	Non-Preferred Brand	1	3	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				76.50	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	009	0		29	10	S2505_009_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	010	0		29	10	S2505_010_0	5	1	Preferred Generic	1	2	001000	1	2	110		01		110	1	30		90				1				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	010	0		29	10	S2505_010_0	5	2	Generic	1	2	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		10.00				4.00				4.00		0.13				0.13	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	010	0		29	10	S2505_010_0	5	3	Preferred Brand	1	2	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	010	0		29	10	S2505_010_0	5	4	Non-Preferred Brand	1	2	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				78.60	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2505	010	0		29	10	S2505_010_0	5	5	Specialty Tier	1	2	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2874	001	0		29	10	S2874_001_0	1	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S2874	001	0		29	10	S2874_001_0	1	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.16	3.13		3.16	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S2874	001	0		29	10	S2874_001_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2874	001	0		29	10	S2874_001_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2874	001	0		29	10	S2874_001_0	1	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2874	001	0		29	10	S2874_001_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31											62.00	50		50				55.00	44		44										50		50				44		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2874	001	0		29	10	S2874_001_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2874	004	0		29	10	S2874_004_0	1	3	Preferred Brand	1	2	000101	1	1		110	01		110	1				30		90	2				30		90	30		31											27.00	25		25				18.00	20		20										25		25				20		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2874	004	0		29	10	S2874_004_0	1	2	Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								9.00		27.00					2.00		6.00											9.00		27.00				2.00		0.00				9.00				9.00			0.30	0.06		0.30	0.06	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2874	004	0		29	10	S2874_004_0	1	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								3.00		9.00					1.00		3.00											3.00		9.00				1.00		0.00				3.00				3.00			0.10	0.03		0.10	0.03	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2874	004	0		29	10	S2874_004_0	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31											53.00	50		50				37.00	35		35										50		50				35		30			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2874	004	0		29	10	S2874_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2893	001	0		29	10	S2893_001_0	4	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								45.00	90.00	135.00					35.00	70.00	105.00					35.00	70.00	70.00																45.00				45.00			1.50	1.17	1.17			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2893	001	0		29	10	S2893_001_0	4	2	Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								20.00	40.00	60.00					10.00	20.00	30.00					10.00	20.00	20.00																20.00				20.00			0.67	0.33	0.33			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2893	001	0		29	10	S2893_001_0	4	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								8.00	16.00	24.00					3.00	6.00	9.00					3.00	3.00	3.00																8.00				8.00			0.27	0.10	0.10			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2893	001	0		29	10	S2893_001_0	4	4	Non-Preferred Brand	1	3	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		31											58.92	50	50	50				46.32	40	40	40				40	40	40															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2893	001	0		29	10	S2893_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2893	003	0		29	10	S2893_003_0	4	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								9.00	18.00	27.00					4.00	8.00	12.00					4.00	4.00	4.00																9.00				9.00			0.30	0.13	0.13			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2893	003	0		29	10	S2893_003_0	4	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								14.00	28.00	42.00					9.00	18.00	27.00					9.00	18.00	18.00																14.00				14.00			0.47	0.30	0.30			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2893	003	0		29	10	S2893_003_0	4	3	Preferred Brand	1	4	000001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								40.00	80.00	120.00					30.00	60.00	90.00					30.00	60.00	60.00																40.00				40.00			1.33	1.00	1.00			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2893	003	0		29	10	S2893_003_0	4	4	Non-Preferred Brand	1	4	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								80.00	160.00	240.00					70.00	140.00	210.00					70.00	140.00	140.00																80.00				80.00			2.67	2.33	2.33			2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2893	003	0		29	10	S2893_003_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2893	003	0		29	10	S2893_003_0	4	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								9.00	18.00	27.00					4.00	8.00	12.00					4.00	4.00	4.00																9.00				9.00			0.30	0.13	0.13			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S2893	003	0		29	10	S2893_003_0	4	2	Generic	3	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								14.00	28.00	42.00					9.00	18.00	27.00					9.00	18.00	18.00																14.00				14.00			0.47	0.30	0.30			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S4054	001	0		29	10	S4054_001_0	3	2	Generic	1	2	000100	1	2	110		01	100		1	30		90				1			90				30		31	8.00		20.00																					16.00																8.00				8.00		0.27						0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4054	001	0		29	10	S4054_001_0	3	3	Preferred Brand	1	2	000001	1	2	110		01	100		1	30		90				1			90				30		31	45.00		112.50																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4054	001	0		29	10	S4054_001_0	3	4	Non-Preferred Brand	1	2	100000	1	2	110		01	100		1	30		90				1			90				30		31	90.00		225.00																					180.00																90.00				90.00		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4054	001	0		29	10	S4054_001_0	3	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4054	001	0		29	10	S4054_001_0	3	1	Preferred Generic	1	2	001000	1	2	110		01	100		1	30		90				1			90				30		31	3.00		7.50																					6.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4054	002	0		29	10	S4054_002_0	7	3	Preferred Brand	1	4	000001	1	2	110		01	100		1	30		90				1			90				30		31	45.00		112.50																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4054	002	0		29	10	S4054_002_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4054	002	0		29	10	S4054_002_0	7	1	Preferred Generic	3	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	3.00		7.50																					6.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S4054	002	0		29	10	S4054_002_0	7	2	Generic	3	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	12.00		30.00																					24.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S4054	002	0		29	10	S4054_002_0	7	4	Non-Preferred Brand	1	4	100000	1	2	110		01	100		1	30		90				1			90				30		31	95.00		237.50																					190.00																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4054	002	0		29	10	S4054_002_0	7	2	Generic	1	4	000100	1	2	110		01	100		1	30		90				1			90				30		31	12.00		30.00																					24.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4054	002	0		29	10	S4054_002_0	7	1	Preferred Generic	1	4	001000	1	2	110		01	100		1	30		90				1			90				30		31	3.00		7.50																					6.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	001	0		29	10	S4607_001_0	7	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	001	0		29	10	S4607_001_0	7	5	Specialty Tier	1	2	101101	1	1		010	01	010		1				30				30						30		31												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	001	0		29	10	S4607_001_0	7	3	Preferred Brand	1	2	000001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	001	0		29	10	S4607_001_0	7	2	Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								8.00	16.00	24.00					3.00	6.00	9.00					3.00	6.00	9.00																8.00				8.00			0.27	0.10	0.10			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	001	0		29	10	S4607_001_0	7	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	002	0		29	10	S4607_002_0	2	5	Specialty Tier	1	2	101101	1	1		010	01	010		1				30				30						30		31												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	002	0		29	10	S4607_002_0	2	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	002	0		29	10	S4607_002_0	2	3	Preferred Brand	1	2	000001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	002	0		29	10	S4607_002_0	2	2	Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								11.00	22.00	33.00					6.00	12.00	18.00					6.00	12.00	18.00																11.00				11.00			0.37	0.20	0.20			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	002	0		29	10	S4607_002_0	2	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	003	0		29	10	S4607_003_0	2	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	003	0		29	10	S4607_003_0	2	3	Preferred Brand	1	2	000001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	003	0		29	10	S4607_003_0	2	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	003	0		29	10	S4607_003_0	2	5	Specialty Tier	1	2	101101	1	1		010	01	010		1				30				30						30		31												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	003	0		29	10	S4607_003_0	2	2	Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								8.00	16.00	24.00					3.00	6.00	9.00					3.00	6.00	9.00																8.00				8.00			0.27	0.10	0.10			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	008	0		29	10	S4607_008_0	2	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	008	0		29	10	S4607_008_0	2	5	Specialty Tier	1	2	101101	1	1		010	01	010		1				30				30						30		31												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	008	0		29	10	S4607_008_0	2	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	008	0		29	10	S4607_008_0	2	3	Preferred Brand	1	2	000001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								41.00	82.00	123.00					41.00	82.00	123.00					41.00	82.00	123.00																41.00				41.00			1.37	1.37	1.37			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	008	0		29	10	S4607_008_0	2	2	Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								8.00	16.00	24.00					3.00	6.00	9.00					3.00	6.00	9.00																8.00				8.00			0.27	0.10	0.10			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	009	0		29	10	S4607_009_0	2	5	Specialty Tier	1	2	101101	1	1		010	01	010		1				30				30						30		31												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	009	0		29	10	S4607_009_0	2	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	009	0		29	10	S4607_009_0	2	3	Preferred Brand	1	2	000001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	009	0		29	10	S4607_009_0	2	2	Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								8.00	16.00	24.00					3.00	6.00	9.00					3.00	6.00	9.00																8.00				8.00			0.27	0.10	0.10			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	009	0		29	10	S4607_009_0	2	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	010	0		29	10	S4607_010_0	2	5	Specialty Tier	1	2	101101	1	1		010	01	010		1				30				30						30		31												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	010	0		29	10	S4607_010_0	2	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	010	0		29	10	S4607_010_0	2	3	Preferred Brand	1	2	000001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	010	0		29	10	S4607_010_0	2	2	Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								9.00	18.00	27.00					4.00	8.00	12.00					4.00	8.00	12.00																9.00				9.00			0.30	0.13	0.13			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	010	0		29	10	S4607_010_0	2	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	011	0		29	10	S4607_011_0	2	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	011	0		29	10	S4607_011_0	2	2	Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								8.00	16.00	24.00					3.00	6.00	9.00					3.00	6.00	9.00																8.00				8.00			0.27	0.10	0.10			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	011	0		29	10	S4607_011_0	2	3	Preferred Brand	1	2	000001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	011	0		29	10	S4607_011_0	2	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	011	0		29	10	S4607_011_0	2	5	Specialty Tier	1	2	101101	1	1		010	01	010		1				30				30						30		31												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	012	0		29	10	S4607_012_0	2	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	012	0		29	10	S4607_012_0	2	2	Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								8.00	16.00	24.00					3.00	6.00	9.00					3.00	6.00	9.00																8.00				8.00			0.27	0.10	0.10			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	012	0		29	10	S4607_012_0	2	3	Preferred Brand	1	2	000001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								40.00	80.00	120.00					40.00	80.00	120.00					40.00	80.00	120.00																40.00				40.00			1.33	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	012	0		29	10	S4607_012_0	2	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								99.00	198.00	297.00					99.00	198.00	297.00					99.00	198.00	297.00																99.00				99.00			3.30	3.30	3.30			3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	012	0		29	10	S4607_012_0	2	5	Specialty Tier	1	2	101101	1	1		010	01	010		1				30				30						30		31												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	013	0		29	10	S4607_013_0	2	5	Specialty Tier	1	2	101101	1	1		010	01	010		1				30				30						30		31												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	013	0		29	10	S4607_013_0	2	3	Preferred Brand	1	2	000001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	013	0		29	10	S4607_013_0	2	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	013	0		29	10	S4607_013_0	2	2	Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								8.00	16.00	24.00					3.00	6.00	9.00					3.00	6.00	9.00																8.00				8.00			0.27	0.10	0.10			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	013	0		29	10	S4607_013_0	2	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	014	0		29	10	S4607_014_0	2	5	Specialty Tier	1	2	101101	1	1		010	01	010		1				30				30						30		31												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	014	0		29	10	S4607_014_0	2	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	014	0		29	10	S4607_014_0	2	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	014	0		29	10	S4607_014_0	2	2	Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								8.00	16.00	24.00					3.00	6.00	9.00					3.00	6.00	9.00																8.00				8.00			0.27	0.10	0.10			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	014	0		29	10	S4607_014_0	2	3	Preferred Brand	1	2	000001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	015	0		29	10	S4607_015_0	2	3	Preferred Brand	1	2	000001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	015	0		29	10	S4607_015_0	2	2	Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								8.00	16.00	24.00					3.00	6.00	9.00					3.00	6.00	9.00																8.00				8.00			0.27	0.10	0.10			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	015	0		29	10	S4607_015_0	2	5	Specialty Tier	1	2	101101	1	1		010	01	010		1				30				30						30		31												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	015	0		29	10	S4607_015_0	2	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	015	0		29	10	S4607_015_0	2	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	016	0		29	10	S4607_016_0	2	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	016	0		29	10	S4607_016_0	2	2	Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								8.00	16.00	24.00					3.00	6.00	9.00					3.00	6.00	9.00																8.00				8.00			0.27	0.10	0.10			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	016	0		29	10	S4607_016_0	2	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	016	0		29	10	S4607_016_0	2	5	Specialty Tier	1	2	101101	1	1		010	01	010		1				30				30						30		31												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	016	0		29	10	S4607_016_0	2	3	Preferred Brand	1	2	000001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	017	0		29	10	S4607_017_0	2	2	Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								8.00	16.00	24.00					3.00	6.00	9.00					3.00	6.00	9.00																8.00				8.00			0.27	0.10	0.10			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	017	0		29	10	S4607_017_0	2	3	Preferred Brand	1	2	000001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								45.00	90.00	135.00					45.00	90.00	135.00					45.00	90.00	135.00																45.00				45.00			1.50	1.50	1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	017	0		29	10	S4607_017_0	2	5	Specialty Tier	1	2	101101	1	1		010	01	010		1				30				30						30		31												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	017	0		29	10	S4607_017_0	2	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	017	0		29	10	S4607_017_0	2	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	018	0		29	10	S4607_018_0	2	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	018	0		29	10	S4607_018_0	2	3	Preferred Brand	1	2	000001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								41.00	82.00	123.00					41.00	82.00	123.00					41.00	82.00	123.00																41.00				41.00			1.37	1.37	1.37			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	018	0		29	10	S4607_018_0	2	5	Specialty Tier	1	2	101101	1	1		010	01	010		1				30				30						30		31												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	018	0		29	10	S4607_018_0	2	2	Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								8.00	16.00	24.00					3.00	6.00	9.00					3.00	6.00	9.00																8.00				8.00			0.27	0.10	0.10			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	018	0		29	10	S4607_018_0	2	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	019	0		29	10	S4607_019_0	2	3	Preferred Brand	1	2	000001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	019	0		29	10	S4607_019_0	2	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	019	0		29	10	S4607_019_0	2	5	Specialty Tier	1	2	101101	1	1		010	01	010		1				30				30						30		31												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	019	0		29	10	S4607_019_0	2	2	Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	15.00																10.00				10.00			0.33	0.17	0.17			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	019	0		29	10	S4607_019_0	2	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	020	0		29	10	S4607_020_0	2	5	Specialty Tier	1	2	101101	1	1		010	01	010		1				30				30						30		31												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	020	0		29	10	S4607_020_0	2	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	020	0		29	10	S4607_020_0	2	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	020	0		29	10	S4607_020_0	2	2	Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								8.00	16.00	24.00					3.00	6.00	9.00					3.00	6.00	9.00																8.00				8.00			0.27	0.10	0.10			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	020	0		29	10	S4607_020_0	2	3	Preferred Brand	1	2	000001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								40.00	80.00	120.00					40.00	80.00	120.00					40.00	80.00	120.00																40.00				40.00			1.33	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	021	0		29	10	S4607_021_0	2	3	Preferred Brand	1	2	000001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								43.00	86.00	129.00					43.00	86.00	129.00					43.00	86.00	129.00																43.00				43.00			1.43	1.43	1.43			1.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	021	0		29	10	S4607_021_0	2	2	Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								8.00	16.00	24.00					3.00	6.00	9.00					3.00	6.00	9.00																8.00				8.00			0.27	0.10	0.10			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	021	0		29	10	S4607_021_0	2	5	Specialty Tier	1	2	101101	1	1		010	01	010		1				30				30						30		31												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	021	0		29	10	S4607_021_0	2	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	021	0		29	10	S4607_021_0	2	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	022	0		29	10	S4607_022_0	2	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	022	0		29	10	S4607_022_0	2	2	Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								8.00	16.00	24.00					3.00	6.00	9.00					3.00	6.00	9.00																8.00				8.00			0.27	0.10	0.10			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	022	0		29	10	S4607_022_0	2	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	022	0		29	10	S4607_022_0	2	5	Specialty Tier	1	2	101101	1	1		010	01	010		1				30				30						30		31												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	022	0		29	10	S4607_022_0	2	3	Preferred Brand	1	2	000001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	023	0		29	10	S4607_023_0	2	2	Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								8.00	16.00	24.00					3.00	6.00	9.00					3.00	6.00	9.00																8.00				8.00			0.27	0.10	0.10			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	023	0		29	10	S4607_023_0	2	3	Preferred Brand	1	2	000001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								43.00	86.00	129.00					43.00	86.00	129.00					43.00	86.00	129.00																43.00				43.00			1.43	1.43	1.43			1.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	023	0		29	10	S4607_023_0	2	5	Specialty Tier	1	2	101101	1	1		010	01	010		1				30				30						30		31												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	023	0		29	10	S4607_023_0	2	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	023	0		29	10	S4607_023_0	2	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	024	0		29	10	S4607_024_0	2	4	Non-Preferred Brand	1	2	100000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	024	0		29	10	S4607_024_0	2	3	Preferred Brand	1	2	000001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								41.00	82.00	123.00					41.00	82.00	123.00					41.00	82.00	123.00																41.00				41.00			1.37	1.37	1.37			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	024	0		29	10	S4607_024_0	2	5	Specialty Tier	1	2	101101	1	1		010	01	010		1				30				30						30		31												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	024	0		29	10	S4607_024_0	2	2	Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								8.00	16.00	24.00					3.00	6.00	9.00					3.00	6.00	9.00																8.00				8.00			0.27	0.10	0.10			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	024	0		29	10	S4607_024_0	2	1	Preferred Generic	1	2	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	012	0		29	10	S4802_012_0	7	2	Generic	1	2	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		15.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	012	0		29	10	S4802_012_0	7	1	Preferred Generic	1	2	001000	1	2	110		01		110	1	30		90				1				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	012	0		29	10	S4802_012_0	7	3	Preferred Brand	1	2	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	012	0		29	10	S4802_012_0	7	4	Non-Preferred Brand	1	2	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				77.30	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	012	0		29	10	S4802_012_0	7	5	Specialty Tier	1	2	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	013	0		29	10	S4802_013_0	6	1	Preferred Generic	1	2	001000	1	2	110		01		110	1	30		90				1				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	013	0		29	10	S4802_013_0	6	2	Generic	1	2	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	11.00		33.00																									11.00		33.00				11.00		27.50				11.00				11.00		0.37				0.37	0.37	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	013	0		29	10	S4802_013_0	6	3	Preferred Brand	1	2	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	013	0		29	10	S4802_013_0	6	4	Non-Preferred Brand	1	2	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				72.10	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	013	0		29	10	S4802_013_0	6	5	Specialty Tier	1	2	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	014	0		29	10	S4802_014_0	6	2	Generic	1	2	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		15.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	014	0		29	10	S4802_014_0	6	1	Preferred Generic	1	2	001000	1	2	110		01		110	1	30		90				1				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	014	0		29	10	S4802_014_0	6	3	Preferred Brand	1	2	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	014	0		29	10	S4802_014_0	6	5	Specialty Tier	1	2	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	014	0		29	10	S4802_014_0	6	4	Non-Preferred Brand	1	2	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				54.80	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	020	0		29	10	S4802_020_0	6	1	Preferred Generic	1	2	001000	1	2	110		01		110	1	30		90				1				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	020	0		29	10	S4802_020_0	6	2	Generic	1	2	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	2.00		6.00																									2.00		6.00				2.00		5.00				2.00				2.00		0.07				0.07	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	020	0		29	10	S4802_020_0	6	3	Preferred Brand	1	2	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	020	0		29	10	S4802_020_0	6	4	Non-Preferred Brand	1	2	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				72.50	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	020	0		29	10	S4802_020_0	6	5	Specialty Tier	1	2	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	021	0		29	10	S4802_021_0	6	1	Preferred Generic	1	2	001000	1	2	110		01		110	1	30		90				1				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	021	0		29	10	S4802_021_0	6	2	Generic	1	2	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		10.00				4.00				4.00		0.13				0.13	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	021	0		29	10	S4802_021_0	6	4	Non-Preferred Brand	1	2	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				74.50	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	021	0		29	10	S4802_021_0	6	3	Preferred Brand	1	2	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	021	0		29	10	S4802_021_0	6	5	Specialty Tier	1	2	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5540	002	0		29	10	S5540_002_0	5	5	Specialty Tier	1	3	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5540	002	0		29	10	S5540_002_0	5	4	Non-Preferred Brand	1	3	110000	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31								95.00	190.00	285.00					85.00	170.00	255.00											95.00	190.00	285.00				85.00	170.00	255.00				95.00				95.00			3.17	2.83		3.17	2.83	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5540	002	0		29	10	S5540_002_0	5	3	Preferred Brand	1	3	000001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31								45.00	90.00	135.00					40.00	80.00	120.00											45.00	90.00	135.00				40.00	80.00	120.00				45.00				45.00			1.50	1.33		1.50	1.33	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5540	002	0		29	10	S5540_002_0	5	2	Generic	1	3	000100	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31								20.00	40.00	60.00					8.00	16.00	24.00											20.00	40.00	60.00				8.00	16.00	24.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5540	002	0		29	10	S5540_002_0	5	1	Preferred Generic	1	3	001000	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31								9.00	18.00	27.00					4.00	8.00	12.00											9.00	18.00	27.00				4.00	8.00	12.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5540	004	0		29	10	S5540_004_0	5	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5540	004	0		29	10	S5540_004_0	5	4	Non-Preferred Brand	1	4	110000	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31								95.00	190.00	285.00					70.00	140.00	210.00											95.00	190.00	285.00				70.00	140.00	210.00				95.00				95.00			3.17	2.33		3.17	2.33	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5540	004	0		29	10	S5540_004_0	5	3	Preferred Brand	1	4	000001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31								45.00	90.00	135.00					30.00	60.00	90.00											45.00	90.00	135.00				30.00	60.00	90.00				45.00				45.00			1.50	1.00		1.50	1.00	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5540	004	0		29	10	S5540_004_0	5	2	Generic	1	4	000100	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31								20.00	40.00	60.00					6.00	12.00	18.00											20.00	40.00	60.00				6.00	12.00	18.00				20.00				20.00			.67	.20		.67	.20	.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5540	004	0		29	10	S5540_004_0	5	1	Preferred Generic	3	4	001000	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				8.00			.27	.10		.27	.10	.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5540	004	0		29	10	S5540_004_0	5	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				8.00			.27	.10		.27	.10	.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5552	003	0		29	10	S5552_003_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5552	003	0		29	10	S5552_003_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5552	003	0		29	10	S5552_003_0	1	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5552	003	0		29	10	S5552_003_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31											79.00	50		50				68.00	44		44										50		50				44		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5552	003	0		29	10	S5552_003_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5552	003	0		29	10	S5552_003_0	1	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5552	003	0		29	10	S5552_003_0	1	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.16	3.13		3.16	3.13	3.06	Preferred Generic, 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								2.00		6.00					1.00		3.00											2.00		6.00				1.00		0.00				2.00				2.00			0.06	0.03		0.06	0.03	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5552	004	0		29	10	S5552_004_0	1	2	Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								3.00		9.00					2.00		6.00											3.00		9.00				2.00		0.00				3.00				3.00			0.10	0.06		0.10	0.06	0.09	Preferred Generic, 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, 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											59.00	36		36				56.00	35		35										36		36				35		30			36			36								Preferred Generic, 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											31.00	25		25				22.00	20		20										25		25				20		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5552	005	0		29	10	S5552_005_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5552	005	0		29	10	S5552_005_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31											77.00	47		47				56.00	35		35										47		47				35		35			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5552	005	0		29	10	S5552_005_0	1	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31											33.00	25		25				26.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5552	005	0		29	10	S5552_005_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		0.00				20.00				20.00			0.66	0.13		0.66	0.13	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5552	005	0		29	10	S5552_005_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31												25							25												25						25					25			25								Preferred Generic, 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								9.00		27.00					0.00		0.00													27.00						0.00				9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5580	003	0		29	10	S5580_003_0	4	2	Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31								15.00		45.00					7.00		21.00													45.00						39.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, 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								47.00		118.00					37.00		93.00													118.00						90.00				47.00				47.00			1.57	1.23				1.52	Preferred Generic, 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		110	01		100	1				30		90	1						90	30		31											97.25	50		50				71.84	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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											393.86	27						361.00	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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											167.12	65		65				152.41	60		60												65						60			65			65								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5580	003	0		29	10	S5580_003_0	4	4	Non-Preferred Brand	3	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											183.50	65		65				167.38	60		60												65						60			65			65								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5580	006	0		29	10	S5580_006_0	5	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31								9.00		27.00					0.00		0.00													27.00						0.00				9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5580	006	0		29	10	S5580_006_0	5	2	Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31								11.00		33.00					3.00		9.00													33.00						33.00				11.00				11.00			0.37	0.10				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5580	006	0		29	10	S5580_006_0	5	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31											25.67	21		21				20.76	16		16												21						21			21			21								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5580	006	0		29	10	S5580_006_0	5	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											54.09	31		31				36.79	26		26												31						31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5580	006	0		29	10	S5580_006_0	5	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31											386.28	25						335.45	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5580	007	0		29	10	S5580_007_0	6	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31								19.00		57.00					0.00		0.00													57.00						0.00				19.00				19.00			0.63	0.00				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5580	007	0		29	10	S5580_007_0	6	2	Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31								20.00		60.00					5.00		15.00													60.00						60.00				20.00				20.00			0.67	0.17				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5580	007	0		29	10	S5580_007_0	6	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31											187.79	27						213.29	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5580	007	0		29	10	S5580_007_0	6	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											58.48	50		50				46.79	40		40												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5580	007	0		29	10	S5580_007_0	6	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								47.00		141.00					39.00		117.00													141.00						141.00				47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5584	001	0		29	10	S5584_001_0	3	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5584	001	0		29	10	S5584_001_0	3	4	Non-Preferred Brand	1	3	100000	1	2		110	01	110		1				31		90	1	31		90				31		31								95.00		285.00					95.00		237.50					95.00		237.50																95.00				95.00			3.06	3.06	3.06			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5584	001	0		29	10	S5584_001_0	3	3	Preferred Brand	1	3	000001	1	2		110	01	110		1				31		90	1	31		90				31		31								45.00		135.00					45.00		112.50					45.00		112.50																45.00				45.00			1.45	1.45	1.45			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5584	001	0		29	10	S5584_001_0	3	2	Generic	1	3	000100	1	2		110	01	110		1				31		90	1	31		90				31		31								18.00		54.00					18.00		45.00					18.00		45.00																18.00				18.00			0.58	0.58	0.58			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5584	001	0		29	10	S5584_001_0	3	1	Preferred Generic	1	3	001000	1	2		110	01	110		1				31		90	1	31		90				31		31								4.00		12.00					4.00		10.00					4.00		10.00																4.00				4.00			0.12	0.12	0.12			0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5584	002	0		29	10	S5584_002_0	3	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				31		90	1	31		90				31		31								45.00		135.00					45.00		112.50					45.00		112.50																45.00				45.00			1.45	1.45	1.45			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5584	002	0		29	10	S5584_002_0	3	4	Non-Preferred Brand	1	4	100000	1	2		110	01	110		1				31		90	1	31		90				31		31								90.00		270.00					90.00		225.00					90.00		225.00																90.00				90.00			2.90	2.90	2.90			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5584	002	0		29	10	S5584_002_0	3	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				31				31						31		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5584	002	0		29	10	S5584_002_0	3	2	Generic	1	4	000100	1	2		110	01	110		1				31		90	1	31		90				31		31								7.00		21.00					7.00		17.50					7.00		17.50																7.00				7.00			0.22	0.22	0.22			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5584	002	0		29	10	S5584_002_0	3	1	Preferred Generic	3	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31								3.00		9.00					3.00		7.50					3.00		7.50																3.00				3.00			0.09	0.09	0.09			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5584	002	0		29	10	S5584_002_0	3	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31								3.00		9.00					3.00		7.50					3.00		7.50																3.00				3.00			0.09	0.09	0.09			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5593	002	0		29	10	S5593_002_0	5	5	Specialty Tier	1	2	010010	1	1	010		01	010		1	31							31						31		31				694.32	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5593	002	0		29	10	S5593_002_0	5	1	Preferred Generic	1	2	001000	1	2	110		01	100		1	31		90				1			90				31		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5593	002	0		29	10	S5593_002_0	5	2	Generic	1	2	000100	1	2	110		01	100		1	31		90				1			90				31		31	11.00		33.00																					27.50																11.00				11.00		0.35						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5593	002	0		29	10	S5593_002_0	5	3	Preferred Brand	1	2	010001	1	1	110		01	100		1	31		90				1			90				31		31				51.52	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5593	002	0		29	10	S5593_002_0	5	4	Non-Preferred Brand	1	2	110000	1	1	110		01	100		1	31		90				1			90				31		31				88.81	50		50																				50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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				9.09	38		38																				38															38			38								Preferred Generic, 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	010		01	010		1	31							31						31		31				981.03	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5593	003	0		29	10	S5593_003_0	5	4	Non-Preferred Brand	1	4	110000	1	1	110		01	100		1	31		90				1			90				31		31				99.68	50		50																				50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5593	003	0		29	10	S5593_003_0	5	3	Preferred Brand	1	4	010001	1	2	110		01	100		1	31		90				1			90				31		31	47.00		141.00																					117.50																47.00				47.00		1.52						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5593	003	0		29	10	S5593_003_0	5	2	Generic	1	4	000100	1	2	110		01	100		1	31		90				1			90				31		31	12.00		36.00																					30.00																12.00				12.00		0.39						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5593	003	0		29	10	S5593_003_0	5	2	Generic	3	4	000100	1	1	110		01	100		1	31		90				1			90				31		31				33.99	38		38																				38															38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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	2.00		6.00																					5.00																2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5596	001	0		29	10	S5596_001_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	001	0		29	10	S5596_001_0	4	4	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34											79.16	50	50	50				60.16	38	38	38				38	38	38															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	001	0		29	10	S5596_001_0	4	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	120.00	120.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	001	0		29	10	S5596_001_0	4	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	001	0		29	10	S5596_001_0	4	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	001	0		29	10	S5596_001_0	4	6	Select Care Drugs	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	001	0		29	10	S5596_001_0	4	6	Select Care Drugs	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5596	001	0		29	10	S5596_001_0	4	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5596	003	0		29	10	S5596_003_0	4	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	003	0		29	10	S5596_003_0	4	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	003	0		29	10	S5596_003_0	4	6	Select Care Drugs	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5596	003	0		29	10	S5596_003_0	4	3	Preferred Brand	3	4	000101	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34											80.20	65	65	65				78.97	64	64	64				65	65	65															65			65								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	1	
S5596	003	0		29	10	S5596_003_0	4	2	Generic	3	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5596	003	0		29	10	S5596_003_0	4	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5596	003	0		29	10	S5596_003_0	4	6	Select Care Drugs	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	003	0		29	10	S5596_003_0	4	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								45.00	90.00	135.00					25.00	50.00	75.00					25.00	75.00	75.00																45.00				45.00			1.50	0.83	0.83			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	003	0		29	10	S5596_003_0	4	4	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34											79.89	40	40	40				69.90	35	35	35				35	35	35															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	003	0		29	10	S5596_003_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	005	0		29	10	S5596_005_0	4	2	Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								16.00	32.00	48.00					5.00	10.00	15.00					5.00	15.00	15.00																16.00				16.00			0.53	0.17	0.17			0.47	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	005	0		29	10	S5596_005_0	4	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	005	0		29	10	S5596_005_0	4	4	Non-Preferred Brand	1	3	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34											72.08	50	50	50				57.67	40	40	40				40	40	40															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	005	0		29	10	S5596_005_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	005	0		29	10	S5596_005_0	4	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					32.00	64.00	96.00					32.00	96.00	96.00																47.00				47.00			1.57	1.07	1.07			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	005	0		29	10	S5596_005_0	4	6	Select Care Drugs	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			.17	0.00	0.00			.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	006	0		29	10	S5596_006_0	4	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	006	0		29	10	S5596_006_0	4	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	006	0		29	10	S5596_006_0	4	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	120.00	120.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	006	0		29	10	S5596_006_0	4	4	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34											85.44	50	50	50				64.93	38	38	38				38	38	38															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	006	0		29	10	S5596_006_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	006	0		29	10	S5596_006_0	4	6	Select Care Drugs	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	006	0		29	10	S5596_006_0	4	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5596	006	0		29	10	S5596_006_0	4	6	Select Care Drugs	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5596	007	0		29	10	S5596_007_0	4	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5596	007	0		29	10	S5596_007_0	4	6	Select Care Drugs	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	007	0		29	10	S5596_007_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	007	0		29	10	S5596_007_0	4	4	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34											77.08	40	40	40				67.45	35	35	35				35	35	35															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	007	0		29	10	S5596_007_0	4	6	Select Care Drugs	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5596	007	0		29	10	S5596_007_0	4	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	007	0		29	10	S5596_007_0	4	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	007	0		29	10	S5596_007_0	4	2	Generic	3	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5596	007	0		29	10	S5596_007_0	4	3	Preferred Brand	3	4	000101	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34											80.67	65	65	65				79.42	64	64	64				65	65	65															65			65								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	1	
S5596	007	0		29	10	S5596_007_0	4	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								45.00	90.00	135.00					25.00	50.00	75.00					25.00	75.00	75.00																45.00				45.00			1.50	0.83	0.83			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	009	0		29	10	S5596_009_0	4	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	009	0		29	10	S5596_009_0	4	2	Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								14.00	28.00	42.00					5.00	10.00	15.00					5.00	15.00	15.00																14.00				14.00			0.47	0.17	0.17			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	009	0		29	10	S5596_009_0	4	6	Select Care Drugs	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			.17	0.00	0.00			.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	009	0		29	10	S5596_009_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	009	0		29	10	S5596_009_0	4	4	Non-Preferred Brand	1	3	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34											59.38	45	45	45				46.19	35	35	35				35	35	35															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	009	0		29	10	S5596_009_0	4	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								44.00	88.00	132.00					29.00	58.00	87.00					29.00	87.00	87.00																44.00				44.00			1.47	.97	.97			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	010	0		29	10	S5596_010_0	4	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	010	0		29	10	S5596_010_0	4	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	010	0		29	10	S5596_010_0	4	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	120.00	120.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	010	0		29	10	S5596_010_0	4	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5596	010	0		29	10	S5596_010_0	4	6	Select Care Drugs	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	010	0		29	10	S5596_010_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	010	0		29	10	S5596_010_0	4	4	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34											87.94	50	50	50				66.83	38	38	38				38	38	38															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	010	0		29	10	S5596_010_0	4	6	Select Care Drugs	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5596	011	0		29	10	S5596_011_0	4	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5596	011	0		29	10	S5596_011_0	4	6	Select Care Drugs	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	011	0		29	10	S5596_011_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	011	0		29	10	S5596_011_0	4	4	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34											78.05	40	40	40				68.30	35	35	35				35	35	35															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	011	0		29	10	S5596_011_0	4	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								45.00	90.00	135.00					25.00	50.00	75.00					25.00	75.00	75.00																45.00				45.00			1.50	0.83	0.83			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	011	0		29	10	S5596_011_0	4	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	011	0		29	10	S5596_011_0	4	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	011	0		29	10	S5596_011_0	4	2	Generic	3	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5596	011	0		29	10	S5596_011_0	4	6	Select Care Drugs	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5596	011	0		29	10	S5596_011_0	4	3	Preferred Brand	3	4	000101	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34											73.17	65	65	65				72.04	64	64	64				65	65	65															65			65								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	1	
S5596	013	0		29	10	S5596_013_0	4	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								6.00	12.00	18.00					1.00	2.00	3.00					1.00	3.00	3.00																6.00				6.00			0.20	0.03	0.03			0.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	013	0		29	10	S5596_013_0	4	6	Select Care Drugs	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			.17	0.00	0.00			.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	013	0		29	10	S5596_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	013	0		29	10	S5596_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											62.43	45	45	45				48.56	35	35	35				35	35	35															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	013	0		29	10	S5596_013_0	4	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								44.00	88.00	132.00					29.00	58.00	87.00					29.00	87.00	87.00																44.00				44.00			1.47	.97	.97			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	013	0		29	10	S5596_013_0	4	2	Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								14.00	28.00	42.00					5.00	10.00	15.00					5.00	15.00	15.00																14.00				14.00			0.47	0.17	0.17			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	014	0		29	10	S5596_014_0	4	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5596	014	0		29	10	S5596_014_0	4	6	Select Care Drugs	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	014	0		29	10	S5596_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	014	0		29	10	S5596_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											84.89	50	50	50				64.52	38	38	38				38	38	38															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	014	0		29	10	S5596_014_0	4	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	120.00	120.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	014	0		29	10	S5596_014_0	4	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	014	0		29	10	S5596_014_0	4	6	Select Care Drugs	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5596	014	0		29	10	S5596_014_0	4	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	015	0		29	10	S5596_015_0	4	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	015	0		29	10	S5596_015_0	4	6	Select Care Drugs	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5596	015	0		29	10	S5596_015_0	4	3	Preferred Brand	3	4	000101	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34											79.67	65	65	65				78.45	64	64	64				65	65	65															65			65								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	1	
S5596	015	0		29	10	S5596_015_0	4	2	Generic	3	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5596	015	0		29	10	S5596_015_0	4	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5596	015	0		29	10	S5596_015_0	4	6	Select Care Drugs	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	015	0		29	10	S5596_015_0	4	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	015	0		29	10	S5596_015_0	4	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								45.00	90.00	135.00					25.00	50.00	75.00					25.00	75.00	75.00																45.00				45.00			1.50	0.83	0.83			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	015	0		29	10	S5596_015_0	4	4	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34											73.84	40	40	40				64.61	35	35	35				35	35	35															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	015	0		29	10	S5596_015_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	017	0		29	10	S5596_017_0	4	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								6.00	12.00	18.00					1.00	2.00	3.00					1.00	3.00	3.00																6.00				6.00			0.20	0.03	0.03			0.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	017	0		29	10	S5596_017_0	4	4	Non-Preferred Brand	1	3	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34											60.83	45	45	45				47.31	35	35	35				35	35	35															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	017	0		29	10	S5596_017_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	017	0		29	10	S5596_017_0	4	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								44.00	88.00	132.00					29.00	58.00	87.00					29.00	87.00	87.00																44.00				44.00			1.47	.97	.97			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	017	0		29	10	S5596_017_0	4	2	Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								11.00	22.00	33.00					5.00	10.00	15.00					5.00	15.00	15.00																11.00				11.00			0.37	0.17	0.17			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	017	0		29	10	S5596_017_0	4	6	Select Care Drugs	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			.17	0.00	0.00			.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	018	0		29	10	S5596_018_0	4	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	018	0		29	10	S5596_018_0	4	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	018	0		29	10	S5596_018_0	4	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	120.00	120.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	018	0		29	10	S5596_018_0	4	4	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34											73.70	50	50	50				56.01	38	38	38				38	38	38															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	018	0		29	10	S5596_018_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	018	0		29	10	S5596_018_0	4	6	Select Care Drugs	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	018	0		29	10	S5596_018_0	4	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5596	018	0		29	10	S5596_018_0	4	6	Select Care Drugs	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										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								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	019	0		29	10	S5596_019_0	5	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
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								45.00	90.00	135.00					25.00	50.00	75.00					25.00	75.00	75.00																45.00				45.00			1.50	0.83	0.83			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
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											66.18	40	40	40				57.91	35	35	35				35	35	35															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	019	0		29	10	S5596_019_0	5	6	Select Care Drugs	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5596	019	0		29	10	S5596_019_0	5	6	Select Care Drugs	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
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								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5596	019	0		29	10	S5596_019_0	5	2	Generic	3	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
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											73.27	65	65	65				72.15	64	64	64				65	65	65															65			65								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	1	
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
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								7.00	14.00	21.00					1.00	2.00	3.00					1.00	3.00	3.00																7.00				7.00			0.23	0.03	0.03			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	033	0		29	10	S5596_033_0	5	2	Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								12.00	24.00	36.00					5.00	10.00	15.00					5.00	15.00	15.00																12.00				12.00			0.40	0.17	0.17			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
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								43.00	86.00	129.00					29.00	58.00	87.00					29.00	87.00	87.00																43.00				43.00			1.43	0.97	0.97			1.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
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											74.02	45	45	45				57.57	35	35	35				35	35	35															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	033	0		29	10	S5596_033_0	5	6	Select Care Drugs	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	034	0		29	10	S5596_034_0	4	6	Select Care Drugs	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5596	034	0		29	10	S5596_034_0	4	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5596	034	0		29	10	S5596_034_0	4	4	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34											95.60	50	50	50				72.66	38	38	38				38	38	38															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	034	0		29	10	S5596_034_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	034	0		29	10	S5596_034_0	4	6	Select Care Drugs	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	034	0		29	10	S5596_034_0	4	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	120.00	120.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	034	0		29	10	S5596_034_0	4	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	034	0		29	10	S5596_034_0	4	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	035	0		29	10	S5596_035_0	4	6	Select Care Drugs	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	035	0		29	10	S5596_035_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	035	0		29	10	S5596_035_0	4	4	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34											84.42	40	40	40				73.87	35	35	35				35	35	35															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	035	0		29	10	S5596_035_0	4	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								45.00	90.00	135.00					25.00	50.00	75.00					25.00	75.00	75.00																45.00				45.00			1.50	0.83	0.83			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	035	0		29	10	S5596_035_0	4	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5596	035	0		29	10	S5596_035_0	4	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	035	0		29	10	S5596_035_0	4	6	Select Care Drugs	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5596	035	0		29	10	S5596_035_0	4	3	Preferred Brand	3	4	000101	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34											76.76	65	65	65				75.58	64	64	64				65	65	65															65			65								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	1	
S5596	035	0		29	10	S5596_035_0	4	2	Generic	3	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5596	035	0		29	10	S5596_035_0	4	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	043	0		29	10	S5596_043_0	4	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								6.00	12.00	18.00					1.00	2.00	3.00					1.00	3.00	3.00																6.00				6.00			0.20	0.03	0.03			0.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	043	0		29	10	S5596_043_0	4	6	Select Care Drugs	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			.17	0.00	0.00			.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	043	0		29	10	S5596_043_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	043	0		29	10	S5596_043_0	4	4	Non-Preferred Brand	1	3	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34											63.37	45	45	45				49.29	35	35	35				35	35	35															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	043	0		29	10	S5596_043_0	4	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								40.00	80.00	120.00					29.00	58.00	87.00					29.00	87.00	87.00																40.00				40.00			1.33	0.97	.97			1.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	043	0		29	10	S5596_043_0	4	2	Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								11.00	22.00	33.00					5.00	10.00	15.00					5.00	15.00	15.00																11.00				11.00			0.37	0.17	0.17			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	044	0		29	10	S5596_044_0	4	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5596	044	0		29	10	S5596_044_0	4	6	Select Care Drugs	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	044	0		29	10	S5596_044_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	044	0		29	10	S5596_044_0	4	4	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34											82.02	50	50	50				62.34	38	38	38				38	38	38															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	044	0		29	10	S5596_044_0	4	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	120.00	120.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	044	0		29	10	S5596_044_0	4	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	044	0		29	10	S5596_044_0	4	6	Select Care Drugs	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5596	044	0		29	10	S5596_044_0	4	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	045	0		29	10	S5596_045_0	4	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	045	0		29	10	S5596_045_0	4	6	Select Care Drugs	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5596	045	0		29	10	S5596_045_0	4	3	Preferred Brand	3	4	000101	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34											73.98	65	65	65				72.84	64	64	64				65	65	65															65			65								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	1	
S5596	045	0		29	10	S5596_045_0	4	2	Generic	3	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5596	045	0		29	10	S5596_045_0	4	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5596	045	0		29	10	S5596_045_0	4	6	Select Care Drugs	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	045	0		29	10	S5596_045_0	4	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	045	0		29	10	S5596_045_0	4	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								45.00	90.00	135.00					25.00	50.00	75.00					25.00	75.00	75.00																45.00				45.00			1.50	0.83	0.83			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	045	0		29	10	S5596_045_0	4	4	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34											73.13	40	40	40				63.99	35	35	35				35	35	35															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	045	0		29	10	S5596_045_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	046	0		29	10	S5596_046_0	4	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								7.00	14.00	21.00					1.00	2.00	3.00					1.00	3.00	3.00																7.00				7.00			0.23	0.03	0.03			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	046	0		29	10	S5596_046_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	046	0		29	10	S5596_046_0	4	4	Non-Preferred Brand	1	3	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34											62.43	45	45	45				48.56	35	35	35				35	35	35															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	046	0		29	10	S5596_046_0	4	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								44.00	88.00	132.00					29.00	58.00	87.00					29.00	87.00	87.00																44.00				44.00			1.47	0.97	0.97			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	046	0		29	10	S5596_046_0	4	2	Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								13.00	26.00	39.00					5.00	10.00	15.00					5.00	15.00	15.00																13.00				13.00			0.43	0.17	0.17			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	046	0		29	10	S5596_046_0	4	6	Select Care Drugs	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	056	0		29	10	S5596_056_0	4	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								39.00	78.00	117.00					29.00	58.00	87.00					29.00	87.00	87.00																39.00				39.00			1.30	0.97	0.97			1.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	056	0		29	10	S5596_056_0	4	2	Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								12.00	24.00	36.00					5.00	10.00	15.00					5.00	15.00	15.00																12.00				12.00			0.40	0.17	0.17			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	056	0		29	10	S5596_056_0	4	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								8.00	16.00	24.00					1.00	2.00	3.00					1.00	3.00	3.00																8.00				8.00			0.27	0.03	0.03			0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	056	0		29	10	S5596_056_0	4	4	Non-Preferred Brand	1	3	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34											58.91	40	40	40				51.55	35	35	35				35	35	35															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	056	0		29	10	S5596_056_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	056	0		29	10	S5596_056_0	4	6	Select Care Drugs	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	057	0		29	10	S5596_057_0	4	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	120.00	120.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	057	0		29	10	S5596_057_0	4	4	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34											80.26	50	50	50				61.00	38	38	38				38	38	38															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	057	0		29	10	S5596_057_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	057	0		29	10	S5596_057_0	4	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5596	057	0		29	10	S5596_057_0	4	6	Select Care Drugs	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5596	057	0		29	10	S5596_057_0	4	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	057	0		29	10	S5596_057_0	4	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	057	0		29	10	S5596_057_0	4	6	Select Care Drugs	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	058	0		29	10	S5596_058_0	4	6	Select Care Drugs	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5596	058	0		29	10	S5596_058_0	4	3	Preferred Brand	3	4	000101	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34											76.59	65	65	65				75.41	64	64	64				65	65	65															65			65								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	1	
S5596	058	0		29	10	S5596_058_0	4	6	Select Care Drugs	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	058	0		29	10	S5596_058_0	4	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5596	058	0		29	10	S5596_058_0	4	2	Generic	3	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5596	058	0		29	10	S5596_058_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	058	0		29	10	S5596_058_0	4	4	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34											68.91	40	40	40				60.30	35	35	35				35	35	35															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	058	0		29	10	S5596_058_0	4	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								45.00	90.00	135.00					25.00	50.00	75.00					25.00	75.00	75.00																45.00				45.00			1.50	0.83	0.83			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	058	0		29	10	S5596_058_0	4	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	058	0		29	10	S5596_058_0	4	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	059	0		29	10	S5596_059_0	4	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	059	0		29	10	S5596_059_0	4	2	Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								16.00	32.00	48.00					5.00	10.00	15.00					5.00	15.00	15.00																16.00				16.00			0.53	0.17	0.17			0.47	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	059	0		29	10	S5596_059_0	4	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								44.00	88.00	132.00					29.00	58.00	87.00					29.00	87.00	87.00																44.00				44.00			1.47	0.97	0.97			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	059	0		29	10	S5596_059_0	4	4	Non-Preferred Brand	1	3	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34											73.82	48	48	48				58.44	38	38	38				38	38	38															48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	059	0		29	10	S5596_059_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	059	0		29	10	S5596_059_0	4	6	Select Care Drugs	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			.17	0.00	0.00			.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	060	0		29	10	S5596_060_0	4	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	060	0		29	10	S5596_060_0	4	6	Select Care Drugs	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5596	060	0		29	10	S5596_060_0	4	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5596	060	0		29	10	S5596_060_0	4	6	Select Care Drugs	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	060	0		29	10	S5596_060_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	060	0		29	10	S5596_060_0	4	4	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34											94.08	50	50	50				71.50	38	38	38				38	38	38															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	060	0		29	10	S5596_060_0	4	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	120.00	120.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	060	0		29	10	S5596_060_0	4	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	061	0		29	10	S5596_061_0	4	3	Preferred Brand	3	4	000101	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34											69.45	65	65	65				68.38	64	64	64				65	65	65															65			65								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	1	
S5596	061	0		29	10	S5596_061_0	4	2	Generic	3	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5596	061	0		29	10	S5596_061_0	4	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5596	061	0		29	10	S5596_061_0	4	6	Select Care Drugs	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	061	0		29	10	S5596_061_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	061	0		29	10	S5596_061_0	4	4	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34											82.02	40	40	40				71.77	35	35	35				35	35	35															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	061	0		29	10	S5596_061_0	4	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								45.00	90.00	135.00					25.00	50.00	75.00					25.00	75.00	75.00																45.00				45.00			1.50	0.83	0.83			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	061	0		29	10	S5596_061_0	4	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	061	0		29	10	S5596_061_0	4	6	Select Care Drugs	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5596	061	0		29	10	S5596_061_0	4	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	062	0		29	10	S5596_062_0	4	2	Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								18.00	36.00	54.00					7.00	14.00	21.00					7.00	21.00	21.00																18.00				18.00			0.60	0.23	0.23			0.53	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	062	0		29	10	S5596_062_0	4	1	Preferred Generic	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	062	0		29	10	S5596_062_0	4	3	Preferred Brand	1	3	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								47.00	94.00	141.00					35.00	70.00	105.00					35.00	105.00	105.00																47.00				47.00			1.57	1.17	1.17			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	062	0		29	10	S5596_062_0	4	6	Select Care Drugs	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			.17	0.00	0.00			.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	062	0		29	10	S5596_062_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	062	0		29	10	S5596_062_0	4	4	Non-Preferred Brand	1	3	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34											63.04	48	48	48				45.97	35	35	35				35	35	35															48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	063	0		29	10	S5596_063_0	5	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	063	0		29	10	S5596_063_0	5	6	Select Care Drugs	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5596	063	0		29	10	S5596_063_0	5	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5596	063	0		29	10	S5596_063_0	5	6	Select Care Drugs	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	063	0		29	10	S5596_063_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	063	0		29	10	S5596_063_0	5	4	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34											77.25	50	50	50				58.71	38	38	38				38	38	38															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	063	0		29	10	S5596_063_0	5	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	120.00	120.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	063	0		29	10	S5596_063_0	5	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	064	0		29	10	S5596_064_0	4	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5596	064	0		29	10	S5596_064_0	4	2	Generic	3	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5596	064	0		29	10	S5596_064_0	4	3	Preferred Brand	3	4	000101	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34											84.30	65	65	65				83.00	64	64	64				65	65	65															65			65								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	1	
S5596	064	0		29	10	S5596_064_0	4	6	Select Care Drugs	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	064	0		29	10	S5596_064_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	064	0		29	10	S5596_064_0	4	4	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34											84.57	40	40	40				74.00	35	35	35				35	35	35															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	064	0		29	10	S5596_064_0	4	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								45.00	90.00	135.00					25.00	50.00	75.00					25.00	75.00	75.00																45.00				45.00			1.50	0.83	0.83			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	064	0		29	10	S5596_064_0	4	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5596	064	0		29	10	S5596_064_0	4	6	Select Care Drugs	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5596	064	0		29	10	S5596_064_0	4	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5601	002	0		29	10	S5601_002_0	6	4	Non-Preferred Brand	1	3	100100	1	1	111		01		111	1	30	60	90				2				30	60	90	30		34				49.80	42	42	42																								42	42	42				42	42	42			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	002	0		29	10	S5601_002_0	6	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		34				536.83	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	002	0		29	10	S5601_002_0	6	1	Preferred Generic	1	3	001001	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	3.00	6.00	7.50																									3.00	6.00	9.00				3.00	6.00	7.50				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	002	0		29	10	S5601_002_0	6	3	Preferred Brand	1	3	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	46.00	92.00	115.00																									46.00	92.00	138.00				46.00	92.00	115.00				46.00				46.00		1.53				1.53	1.53	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	002	0		29	10	S5601_002_0	6	2	Generic	1	3	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	16.00	32.00	40.00																									16.00	32.00	48.00				16.00	32.00	40.00				16.00				16.00		0.53				0.53	0.53	0.47	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	003	0		29	10	S5601_003_0	6	3	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								29.00	58.00	87.00					22.00	44.00	55.00											29.00	58.00	87.00				22.00	44.00	55.00				29.00				29.00			0.97	0.73		0.97	0.73	0.85	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	003	0		29	10	S5601_003_0	6	2	Generic	1	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								10.00	20.00	30.00					3.00	6.00	7.50											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	003	0		29	10	S5601_003_0	6	1	Preferred Generic	1	4	001001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	003	0		29	10	S5601_003_0	6	4	Non-Preferred Brand	1	4	100100	1	1		111	01		111	1				30	60	90	2				30	60	90	30		34											50.01	45	45	45				38.89	35	35	35										45	45	45				35	35	35			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	003	0		29	10	S5601_003_0	6	2	Generic	3	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								10.00	20.00	30.00					3.00	6.00	7.50											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	003	0		29	10	S5601_003_0	6	1	Preferred Generic	3	4	001001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	003	0		29	10	S5601_003_0	6	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34											576.31	33						576.31	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	004	0		29	10	S5601_004_0	5	1	Preferred Generic	1	3	001001	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	3.00	6.00	7.50																									3.00	6.00	9.00				3.00	6.00	7.50				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	004	0		29	10	S5601_004_0	5	4	Non-Preferred Brand	1	3	100100	1	1	111		01		111	1	30	60	90				2				30	60	90	30		34				50.00	43	43	43																								43	43	43				43	43	43			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	004	0		29	10	S5601_004_0	5	3	Preferred Brand	1	3	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	41.00	82.00	102.50																									41.00	82.00	123.00				41.00	82.00	102.50				41.00				41.00		1.37				1.37	1.37	1.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	004	0		29	10	S5601_004_0	5	2	Generic	1	3	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	13.00	26.00	32.50																									13.00	26.00	39.00				13.00	26.00	32.50				13.00				13.00		0.43				0.43	0.43	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	004	0		29	10	S5601_004_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		34				544.73	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	005	0		29	10	S5601_005_0	5	1	Preferred Generic	3	4	001001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	005	0		29	10	S5601_005_0	5	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34											498.20	33						498.20	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	005	0		29	10	S5601_005_0	5	4	Non-Preferred Brand	1	4	100100	1	1		111	01		111	1				30	60	90	2				30	60	90	30		34											53.80	45	45	45				41.85	35	35	35										45	45	45				35	35	35			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	005	0		29	10	S5601_005_0	5	3	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								29.00	58.00	87.00					22.00	44.00	55.00											29.00	58.00	87.00				22.00	44.00	55.00				29.00				29.00			0.97	0.73		0.97	0.73	0.85	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	005	0		29	10	S5601_005_0	5	2	Generic	1	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								10.00	20.00	30.00					3.00	6.00	7.50											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	005	0		29	10	S5601_005_0	5	1	Preferred Generic	1	4	001001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	005	0		29	10	S5601_005_0	5	2	Generic	3	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								10.00	20.00	30.00					3.00	6.00	7.50											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	006	0		29	10	S5601_006_0	5	1	Preferred Generic	1	3	001001	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	3.00	6.00	7.50																									3.00	6.00	9.00				3.00	6.00	7.50				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	006	0		29	10	S5601_006_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		34				490.75	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	006	0		29	10	S5601_006_0	5	4	Non-Preferred Brand	1	3	100100	1	1	111		01		111	1	30	60	90				2				30	60	90	30		34				55.87	46	46	46																								46	46	46				46	46	46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	006	0		29	10	S5601_006_0	5	3	Preferred Brand	1	3	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	46.00	92.00	115.00																									46.00	92.00	138.00				46.00	92.00	115.00				46.00				46.00		1.53				1.53	1.53	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	006	0		29	10	S5601_006_0	5	2	Generic	1	3	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	12.00	24.00	30.00																									12.00	24.00	36.00				12.00	24.00	30.00				12.00				12.00		0.40				0.40	0.40	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	007	0		29	10	S5601_007_0	5	1	Preferred Generic	3	4	001001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	007	0		29	10	S5601_007_0	5	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34											598.96	33						598.96	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	007	0		29	10	S5601_007_0	5	4	Non-Preferred Brand	1	4	100100	1	1		111	01		111	1				30	60	90	2				30	60	90	30		34											57.20	45	45	45				44.49	35	35	35										45	45	45				35	35	35			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	007	0		29	10	S5601_007_0	5	3	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								29.00	58.00	87.00					22.00	44.00	55.00											29.00	58.00	87.00				22.00	44.00	55.00				29.00				29.00			0.97	0.73		0.97	0.73	0.85	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	007	0		29	10	S5601_007_0	5	2	Generic	1	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								10.00	20.00	30.00					3.00	6.00	7.50											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	007	0		29	10	S5601_007_0	5	1	Preferred Generic	1	4	001001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	007	0		29	10	S5601_007_0	5	2	Generic	3	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								10.00	20.00	30.00					3.00	6.00	7.50											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	008	0		29	10	S5601_008_0	5	1	Preferred Generic	1	3	001001	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	3.00	6.00	7.50																									3.00	6.00	9.00				3.00	6.00	7.50				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	008	0		29	10	S5601_008_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		34				504.45	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	008	0		29	10	S5601_008_0	5	4	Non-Preferred Brand	1	3	100100	1	1	111		01		111	1	30	60	90				2				30	60	90	30		34				58.34	46	46	46																								46	46	46				46	46	46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	008	0		29	10	S5601_008_0	5	3	Preferred Brand	1	3	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	47.00	94.00	117.50																									47.00	94.00	141.00				47.00	94.00	117.50				47.00				47.00		1.57				1.57	1.57	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	008	0		29	10	S5601_008_0	5	2	Generic	1	3	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	15.00	30.00	37.50																									15.00	30.00	45.00				15.00	30.00	37.50				15.00				15.00		0.50				0.50	0.50	0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	009	0		29	10	S5601_009_0	5	1	Preferred Generic	3	4	001001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	009	0		29	10	S5601_009_0	5	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34											577.39	33						577.39	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	009	0		29	10	S5601_009_0	5	4	Non-Preferred Brand	1	4	100100	1	1		111	01		111	1				30	60	90	2				30	60	90	30		34											60.26	45	45	45				46.87	35	35	35										45	45	45				35	35	35			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	009	0		29	10	S5601_009_0	5	3	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								29.00	58.00	87.00					22.00	44.00	55.00											29.00	58.00	87.00				22.00	44.00	55.00				29.00				29.00			0.97	0.73		0.97	0.73	0.85	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	009	0		29	10	S5601_009_0	5	2	Generic	1	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								10.00	20.00	30.00					3.00	6.00	7.50											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	009	0		29	10	S5601_009_0	5	2	Generic	3	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								10.00	20.00	30.00					3.00	6.00	7.50											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	009	0		29	10	S5601_009_0	5	1	Preferred Generic	1	4	001001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	010	0		29	10	S5601_010_0	5	1	Preferred Generic	1	3	001001	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	3.00	6.00	7.50																									3.00	6.00	9.00				3.00	6.00	7.50				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	010	0		29	10	S5601_010_0	5	2	Generic	1	3	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	17.00	34.00	42.50																									17.00	34.00	51.00				17.00	34.00	42.50				17.00				17.00		0.57				0.57	0.57	0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	010	0		29	10	S5601_010_0	5	3	Preferred Brand	1	3	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	47.00	94.00	117.50																									47.00	94.00	141.00				47.00	94.00	117.50				47.00				47.00		1.57				1.57	1.57	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	010	0		29	10	S5601_010_0	5	4	Non-Preferred Brand	1	3	100100	1	1	111		01		111	1	30	60	90				2				30	60	90	30		34				54.74	46	46	46																								46	46	46				46	46	46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	010	0		29	10	S5601_010_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		34				516.90	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	011	0		29	10	S5601_011_0	5	1	Preferred Generic	1	4	001001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	011	0		29	10	S5601_011_0	5	3	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								29.00	58.00	87.00					22.00	44.00	55.00											29.00	58.00	87.00				22.00	44.00	55.00				29.00				29.00			0.97	0.73		0.97	0.73	0.85	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	011	0		29	10	S5601_011_0	5	2	Generic	1	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								10.00	20.00	30.00					3.00	6.00	7.50											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	011	0		29	10	S5601_011_0	5	4	Non-Preferred Brand	1	4	100100	1	1		111	01		111	1				30	60	90	2				30	60	90	30		34											54.25	45	45	45				42.19	35	35	35										45	45	45				35	35	35			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	011	0		29	10	S5601_011_0	5	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34											487.71	33						487.71	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	011	0		29	10	S5601_011_0	5	1	Preferred Generic	3	4	001001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	011	0		29	10	S5601_011_0	5	2	Generic	3	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								10.00	20.00	30.00					3.00	6.00	7.50											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	012	0		29	10	S5601_012_0	5	1	Preferred Generic	1	3	001001	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	3.00	6.00	7.50																									3.00	6.00	9.00				3.00	6.00	7.50				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	012	0		29	10	S5601_012_0	5	2	Generic	1	3	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	12.00	24.00	30.00																									12.00	24.00	36.00				12.00	24.00	30.00				12.00				12.00		0.40				0.40	0.40	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	012	0		29	10	S5601_012_0	5	3	Preferred Brand	1	3	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	44.00	88.00	110.00																									44.00	88.00	132.00				44.00	88.00	110.00				44.00				44.00		1.47				1.47	1.47	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	012	0		29	10	S5601_012_0	5	4	Non-Preferred Brand	1	3	100100	1	1	111		01		111	1	30	60	90				2				30	60	90	30		34				55.92	47	47	47																								47	47	47				47	47	47			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	012	0		29	10	S5601_012_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		34				528.40	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	013	0		29	10	S5601_013_0	5	2	Generic	3	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								10.00	20.00	30.00					3.00	6.00	7.50											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	013	0		29	10	S5601_013_0	5	1	Preferred Generic	3	4	001001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	013	0		29	10	S5601_013_0	5	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34											592.65	33						592.65	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	013	0		29	10	S5601_013_0	5	4	Non-Preferred Brand	1	4	100100	1	1		111	01		111	1				30	60	90	2				30	60	90	30		34											52.17	45	45	45				40.58	35	35	35										45	45	45				35	35	35			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	013	0		29	10	S5601_013_0	5	3	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								29.00	58.00	87.00					22.00	44.00	55.00											29.00	58.00	87.00				22.00	44.00	55.00				29.00				29.00			0.97	0.73		0.97	0.73	0.85	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	013	0		29	10	S5601_013_0	5	2	Generic	1	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								10.00	20.00	30.00					3.00	6.00	7.50											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	013	0		29	10	S5601_013_0	5	1	Preferred Generic	1	4	001001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	014	0		29	10	S5601_014_0	5	1	Preferred Generic	1	3	001001	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	3.00	6.00	7.50																									3.00	6.00	9.00				3.00	6.00	7.50				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	014	0		29	10	S5601_014_0	5	2	Generic	1	3	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	15.00	30.00	37.50																									15.00	30.00	45.00				15.00	30.00	37.50				15.00				15.00		0.50				0.50	0.50	0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	014	0		29	10	S5601_014_0	5	3	Preferred Brand	1	3	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	46.00	92.00	115.00																									46.00	92.00	138.00				46.00	92.00	115.00				46.00				46.00		1.53				1.53	1.53	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	014	0		29	10	S5601_014_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		34				503.48	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	014	0		29	10	S5601_014_0	5	4	Non-Preferred Brand	1	3	100100	1	1	111		01		111	1	30	60	90				2				30	60	90	30		34				52.24	46	46	46																								46	46	46				46	46	46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	015	0		29	10	S5601_015_0	5	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34											503.81	33						503.81	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	015	0		29	10	S5601_015_0	5	1	Preferred Generic	3	4	001001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	015	0		29	10	S5601_015_0	5	2	Generic	3	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								10.00	20.00	30.00					3.00	6.00	7.50											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	015	0		29	10	S5601_015_0	5	3	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								29.00	58.00	87.00					22.00	44.00	55.00											29.00	58.00	87.00				22.00	44.00	55.00				29.00				29.00			0.97	0.73		0.97	0.73	0.85	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	015	0		29	10	S5601_015_0	5	4	Non-Preferred Brand	1	4	100100	1	1		111	01		111	1				30	60	90	2				30	60	90	30		34											50.64	45	45	45				39.38	35	35	35										45	45	45				35	35	35			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	015	0		29	10	S5601_015_0	5	2	Generic	1	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								10.00	20.00	30.00					3.00	6.00	7.50											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	015	0		29	10	S5601_015_0	5	1	Preferred Generic	1	4	001001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	016	0		29	10	S5601_016_0	5	1	Preferred Generic	1	3	001001	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	3.00	6.00	7.50																									3.00	6.00	9.00				3.00	6.00	7.50				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	016	0		29	10	S5601_016_0	5	2	Generic	1	3	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	12.00	24.00	30.00																									12.00	24.00	36.00				12.00	24.00	30.00				12.00				12.00		0.40				0.40	0.40	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	016	0		29	10	S5601_016_0	5	3	Preferred Brand	1	3	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	45.00	90.00	112.50																									45.00	90.00	135.00				45.00	90.00	112.50				45.00				45.00		1.50				1.50	1.50	1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	016	0		29	10	S5601_016_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		34				547.60	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	016	0		29	10	S5601_016_0	5	4	Non-Preferred Brand	1	3	100100	1	1	111		01		111	1	30	60	90				2				30	60	90	30		34				56.75	48	48	48																								48	48	48				48	48	48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	017	0		29	10	S5601_017_0	5	2	Generic	3	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								10.00	20.00	30.00					3.00	6.00	7.50											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	017	0		29	10	S5601_017_0	5	1	Preferred Generic	3	4	001001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	017	0		29	10	S5601_017_0	5	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34											474.91	33						474.91	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	017	0		29	10	S5601_017_0	5	4	Non-Preferred Brand	1	4	100100	1	1		111	01		111	1				30	60	90	2				30	60	90	30		34											50.29	45	45	45				39.12	35	35	35										45	45	45				35	35	35			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	017	0		29	10	S5601_017_0	5	3	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								29.00	58.00	87.00					22.00	44.00	55.00											29.00	58.00	87.00				22.00	44.00	55.00				29.00				29.00			0.97	0.73		0.97	0.73	0.85	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	017	0		29	10	S5601_017_0	5	2	Generic	1	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								10.00	20.00	30.00					3.00	6.00	7.50											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	017	0		29	10	S5601_017_0	5	1	Preferred Generic	1	4	001001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	018	0		29	10	S5601_018_0	6	1	Preferred Generic	1	3	001001	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	3.00	6.00	7.50																									3.00	6.00	9.00				3.00	6.00	7.50				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	018	0		29	10	S5601_018_0	6	2	Generic	1	3	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	14.00	28.00	35.00																									14.00	28.00	42.00				14.00	28.00	35.00				14.00				14.00		0.47				0.47	0.47	0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	018	0		29	10	S5601_018_0	6	3	Preferred Brand	1	3	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	45.00	90.00	112.50																									45.00	90.00	135.00				45.00	90.00	112.50				45.00				45.00		1.50				1.50	1.50	1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	018	0		29	10	S5601_018_0	6	4	Non-Preferred Brand	1	3	100100	1	1	111		01		111	1	30	60	90				2				30	60	90	30		34				51.50	46	46	46																								46	46	46				46	46	46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	018	0		29	10	S5601_018_0	6	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		34				578.73	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	019	0		29	10	S5601_019_0	5	2	Generic	3	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								10.00	20.00	30.00					3.00	6.00	7.50											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	019	0		29	10	S5601_019_0	5	2	Generic	1	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								10.00	20.00	30.00					3.00	6.00	7.50											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	019	0		29	10	S5601_019_0	5	3	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								29.00	58.00	87.00					22.00	44.00	55.00											29.00	58.00	87.00				22.00	44.00	55.00				29.00				29.00			0.97	0.73		0.97	0.73	0.85	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	019	0		29	10	S5601_019_0	5	4	Non-Preferred Brand	1	4	100100	1	1		111	01		111	1				30	60	90	2				30	60	90	30		34											49.98	45	45	45				38.88	35	35	35										45	45	45				35	35	35			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	019	0		29	10	S5601_019_0	5	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34											567.69	33						567.69	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	019	0		29	10	S5601_019_0	5	1	Preferred Generic	3	4	001001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	019	0		29	10	S5601_019_0	5	1	Preferred Generic	1	4	001001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	020	0		29	10	S5601_020_0	5	1	Preferred Generic	1	3	001001	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	3.00	6.00	7.50																									3.00	6.00	9.00				3.00	6.00	7.50				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	020	0		29	10	S5601_020_0	5	2	Generic	1	3	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	11.00	22.00	27.50																									11.00	22.00	33.00				11.00	22.00	27.50				11.00				11.00		0.37				0.37	0.37	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	020	0		29	10	S5601_020_0	5	3	Preferred Brand	1	3	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	46.00	92.00	115.00																									46.00	92.00	138.00				46.00	92.00	115.00				46.00				46.00		1.53				1.53	1.53	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	020	0		29	10	S5601_020_0	5	4	Non-Preferred Brand	1	3	100100	1	1	111		01		111	1	30	60	90				2				30	60	90	30		34				50.48	46	46	46																								46	46	46				46	46	46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	020	0		29	10	S5601_020_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		34				506.90	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	021	0		29	10	S5601_021_0	5	1	Preferred Generic	1	4	001001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	021	0		29	10	S5601_021_0	5	2	Generic	1	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								10.00	20.00	30.00					3.00	6.00	7.50											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	021	0		29	10	S5601_021_0	5	3	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								29.00	58.00	87.00					22.00	44.00	55.00											29.00	58.00	87.00				22.00	44.00	55.00				29.00				29.00			0.97	0.73		0.97	0.73	0.85	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	021	0		29	10	S5601_021_0	5	4	Non-Preferred Brand	1	4	100100	1	1		111	01		111	1				30	60	90	2				30	60	90	30		34											50.51	45	45	45				39.28	35	35	35										45	45	45				35	35	35			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	021	0		29	10	S5601_021_0	5	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34											551.65	33						551.65	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	021	0		29	10	S5601_021_0	5	2	Generic	3	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								10.00	20.00	30.00					3.00	6.00	7.50											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	021	0		29	10	S5601_021_0	5	1	Preferred Generic	3	4	001001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	022	0		29	10	S5601_022_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		34				566.80	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	022	0		29	10	S5601_022_0	5	1	Preferred Generic	1	3	001001	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	3.00	6.00	7.50																									3.00	6.00	9.00				3.00	6.00	7.50				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	022	0		29	10	S5601_022_0	5	2	Generic	1	3	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	16.00	32.00	40.00																									16.00	32.00	48.00				16.00	32.00	40.00				16.00				16.00		0.53				0.53	0.53	0.47	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	022	0		29	10	S5601_022_0	5	3	Preferred Brand	1	3	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	47.00	94.00	117.50																									47.00	94.00	141.00				47.00	94.00	117.50				47.00				47.00		1.57				1.57	1.57	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	022	0		29	10	S5601_022_0	5	4	Non-Preferred Brand	1	3	100100	1	1	111		01		111	1	30	60	90				2				30	60	90	30		34				53.85	44	44	44																								44	44	44				44	44	44			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	023	0		29	10	S5601_023_0	5	2	Generic	3	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								10.00	20.00	30.00					3.00	6.00	7.50											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	023	0		29	10	S5601_023_0	5	1	Preferred Generic	3	4	001001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	023	0		29	10	S5601_023_0	5	3	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								29.00	58.00	87.00					22.00	44.00	55.00											29.00	58.00	87.00				22.00	44.00	55.00				29.00				29.00			0.97	0.73		0.97	0.73	0.85	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	023	0		29	10	S5601_023_0	5	4	Non-Preferred Brand	1	4	100100	1	1		111	01		111	1				30	60	90	2				30	60	90	30		34											56.78	45	45	45				44.17	35	35	35										45	45	45				35	35	35			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	023	0		29	10	S5601_023_0	5	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34											636.03	33						636.03	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	023	0		29	10	S5601_023_0	5	2	Generic	1	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								10.00	20.00	30.00					3.00	6.00	7.50											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	023	0		29	10	S5601_023_0	5	1	Preferred Generic	1	4	001001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	024	0		29	10	S5601_024_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		34				572.82	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	024	0		29	10	S5601_024_0	5	4	Non-Preferred Brand	1	3	100100	1	1	111		01		111	1	30	60	90				2				30	60	90	30		34				49.58	47	47	47																								47	47	47				47	47	47			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	024	0		29	10	S5601_024_0	5	3	Preferred Brand	1	3	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	45.00	90.00	112.50																									45.00	90.00	135.00				45.00	90.00	112.50				45.00				45.00		1.50				1.50	1.50	1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	024	0		29	10	S5601_024_0	5	2	Generic	1	3	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	11.00	22.00	27.50																									11.00	22.00	33.00				11.00	22.00	27.50				11.00				11.00		0.37				0.37	0.37	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	024	0		29	10	S5601_024_0	5	1	Preferred Generic	1	3	001001	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	3.00	6.00	7.50																									3.00	6.00	9.00				3.00	6.00	7.50				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	025	0		29	10	S5601_025_0	5	2	Generic	3	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								10.00	20.00	30.00					3.00	6.00	7.50											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	025	0		29	10	S5601_025_0	5	1	Preferred Generic	3	4	001001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	025	0		29	10	S5601_025_0	5	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34											540.88	33						540.88	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	025	0		29	10	S5601_025_0	5	4	Non-Preferred Brand	1	4	100100	1	1		111	01		111	1				30	60	90	2				30	60	90	30		34											48.71	45	45	45				37.89	35	35	35										45	45	45				35	35	35			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	025	0		29	10	S5601_025_0	5	3	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								29.00	58.00	87.00					22.00	44.00	55.00											29.00	58.00	87.00				22.00	44.00	55.00				29.00				29.00			0.97	0.73		0.97	0.73	0.85	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	025	0		29	10	S5601_025_0	5	1	Preferred Generic	1	4	001001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	025	0		29	10	S5601_025_0	5	2	Generic	1	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								10.00	20.00	30.00					3.00	6.00	7.50											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	026	0		29	10	S5601_026_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		34				538.87	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	026	0		29	10	S5601_026_0	5	1	Preferred Generic	1	3	001001	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	3.00	6.00	7.50																									3.00	6.00	9.00				3.00	6.00	7.50				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	026	0		29	10	S5601_026_0	5	2	Generic	1	3	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	12.00	24.00	30.00																									12.00	24.00	36.00				12.00	24.00	30.00				12.00				12.00		0.40				0.40	0.40	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	026	0		29	10	S5601_026_0	5	3	Preferred Brand	1	3	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	44.00	88.00	110.00																									44.00	88.00	132.00				44.00	88.00	110.00				44.00				44.00		1.47				1.47	1.47	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	026	0		29	10	S5601_026_0	5	4	Non-Preferred Brand	1	3	100100	1	1	111		01		111	1	30	60	90				2				30	60	90	30		34				54.96	45	45	45																								45	45	45				45	45	45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	027	0		29	10	S5601_027_0	5	2	Generic	3	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								10.00	20.00	30.00					3.00	6.00	7.50											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	027	0		29	10	S5601_027_0	5	1	Preferred Generic	3	4	001001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	027	0		29	10	S5601_027_0	5	1	Preferred Generic	1	4	001001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	027	0		29	10	S5601_027_0	5	4	Non-Preferred Brand	1	4	100100	1	1		111	01		111	1				30	60	90	2				30	60	90	30		34											53.36	45	45	45				41.50	35	35	35										45	45	45				35	35	35			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	027	0		29	10	S5601_027_0	5	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34											483.04	33						483.04	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	027	0		29	10	S5601_027_0	5	2	Generic	1	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								10.00	20.00	30.00					3.00	6.00	7.50											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	027	0		29	10	S5601_027_0	5	3	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								29.00	58.00	87.00					22.00	44.00	55.00											29.00	58.00	87.00				22.00	44.00	55.00				29.00				29.00			0.97	0.73		0.97	0.73	0.85	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	028	0		29	10	S5601_028_0	5	4	Non-Preferred Brand	1	3	100100	1	1	111		01		111	1	30	60	90				2				30	60	90	30		34				52.19	44	44	44																								44	44	44				44	44	44			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	028	0		29	10	S5601_028_0	5	1	Preferred Generic	1	3	001001	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	3.00	6.00	7.50																									3.00	6.00	9.00				3.00	6.00	0.00				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	028	0		29	10	S5601_028_0	5	2	Generic	1	3	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	13.00	26.00	32.50																									13.00	26.00	39.00				13.00	26.00	32.50				13.00				13.00		0.43				0.43	0.43	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	028	0		29	10	S5601_028_0	5	3	Preferred Brand	1	3	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	41.00	82.00	102.50																									41.00	82.00	123.00				41.00	82.00	102.50				41.00				41.00		1.37				1.37	1.37	1.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	028	0		29	10	S5601_028_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		34				515.19	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	029	0		29	10	S5601_029_0	5	2	Generic	3	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								10.00	20.00	30.00					3.00	6.00	7.50											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	029	0		29	10	S5601_029_0	5	1	Preferred Generic	3	4	001001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	029	0		29	10	S5601_029_0	5	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34											434.97	33						434.97	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	029	0		29	10	S5601_029_0	5	1	Preferred Generic	1	4	001001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	029	0		29	10	S5601_029_0	5	2	Generic	1	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								10.00	20.00	30.00					3.00	6.00	7.50											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	029	0		29	10	S5601_029_0	5	3	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								29.00	58.00	87.00					22.00	44.00	55.00											29.00	58.00	87.00				22.00	44.00	55.00				29.00				29.00			0.97	0.73		0.97	0.73	0.85	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	029	0		29	10	S5601_029_0	5	4	Non-Preferred Brand	1	4	100100	1	1		111	01		111	1				30	60	90	2				30	60	90	30		34											51.85	45	45	45				40.33	35	35	35										45	45	45				35	35	35			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	030	0		29	10	S5601_030_0	5	1	Preferred Generic	1	3	001001	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	3.00	6.00	7.50																									3.00	6.00	9.00				3.00	6.00	7.50				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	030	0		29	10	S5601_030_0	5	2	Generic	1	3	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	12.00	24.00	30.00																									12.00	24.00	36.00				12.00	24.00	30.00				12.00				12.00		0.40				0.40	0.40	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	030	0		29	10	S5601_030_0	5	3	Preferred Brand	1	3	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	44.00	88.00	110.00																									44.00	88.00	132.00				44.00	88.00	110.00				44.00				44.00		1.47				1.47	1.47	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	030	0		29	10	S5601_030_0	5	4	Non-Preferred Brand	1	3	100100	1	1	111		01		111	1	30	60	90				2				30	60	90	30		34				53.10	46	46	46																								46	46	46				46	46	46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	030	0		29	10	S5601_030_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		34				558.93	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	031	0		29	10	S5601_031_0	5	1	Preferred Generic	1	4	001001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	031	0		29	10	S5601_031_0	5	2	Generic	1	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								10.00	20.00	30.00					3.00	6.00	7.50											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	031	0		29	10	S5601_031_0	5	3	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								29.00	58.00	87.00					22.00	44.00	55.00											29.00	58.00	87.00				22.00	44.00	55.00				29.00				29.00			0.97	0.73		0.97	0.73	0.85	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	031	0		29	10	S5601_031_0	5	4	Non-Preferred Brand	1	4	100100	1	1		111	01		111	1				30	60	90	2				30	60	90	30		34											53.96	45	45	45				41.97	35	35	35										45	45	45				35	35	35			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	031	0		29	10	S5601_031_0	5	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34											499.46	33						499.46	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	031	0		29	10	S5601_031_0	5	1	Preferred Generic	3	4	001001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	031	0		29	10	S5601_031_0	5	2	Generic	3	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								10.00	20.00	30.00					3.00	6.00	7.50											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	032	0		29	10	S5601_032_0	5	4	Non-Preferred Brand	1	3	100100	1	1	111		01		111	1	30	60	90				2				30	60	90	30		34				49.77	42	42	42																								42	42	42				42	42	42			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	032	0		29	10	S5601_032_0	5	3	Preferred Brand	1	3	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	41.00	82.00	102.50																									41.00	82.00	123.00				41.00	82.00	102.50				41.00				41.00		1.37				1.37	1.37	1.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	032	0		29	10	S5601_032_0	5	2	Generic	1	3	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	12.00	24.00	30.00																									12.00	24.00	36.00				12.00	24.00	30.00				12.00				12.00		0.40				0.40	0.40	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	032	0		29	10	S5601_032_0	5	1	Preferred Generic	1	3	001001	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	3.00	6.00	7.50																									3.00	6.00	9.00				3.00	6.00	7.50				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	032	0		29	10	S5601_032_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		34				491.45	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	033	0		29	10	S5601_033_0	5	1	Preferred Generic	3	4	001001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	033	0		29	10	S5601_033_0	5	1	Preferred Generic	1	4	001001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	033	0		29	10	S5601_033_0	5	2	Generic	1	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								10.00	20.00	30.00					3.00	6.00	7.50											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	033	0		29	10	S5601_033_0	5	3	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								29.00	58.00	87.00					22.00	44.00	55.00											29.00	58.00	87.00				22.00	44.00	55.00				29.00				29.00			0.97	0.73		0.97	0.73	0.85	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	033	0		29	10	S5601_033_0	5	4	Non-Preferred Brand	1	4	100100	1	1		111	01		111	1				30	60	90	2				30	60	90	30		34											53.43	45	45	45				41.55	35	35	35										45	45	45				35	35	35			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	033	0		29	10	S5601_033_0	5	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34											548.48	33						548.48	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	033	0		29	10	S5601_033_0	5	2	Generic	3	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								10.00	20.00	30.00					3.00	6.00	7.50											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	034	0		29	10	S5601_034_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		34				491.69	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	034	0		29	10	S5601_034_0	5	4	Non-Preferred Brand	1	3	100100	1	1	111		01		111	1	30	60	90				2				30	60	90	30		34				50.62	44	44	44																								44	44	44				44	44	44			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	034	0		29	10	S5601_034_0	5	3	Preferred Brand	1	3	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	46.00	92.00	115.00																									46.00	92.00	138.00				46.00	92.00	115.00				46.00				46.00		1.53				1.53	1.53	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	034	0		29	10	S5601_034_0	5	1	Preferred Generic	1	3	001001	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	3.00	6.00	7.50																									3.00	6.00	9.00				3.00	6.00	7.50				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	034	0		29	10	S5601_034_0	5	2	Generic	1	3	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	16.00	32.00	40.00																									16.00	32.00	48.00				16.00	32.00	40.00				16.00				16.00		0.53				0.53	0.53	0.47	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	035	0		29	10	S5601_035_0	5	1	Preferred Generic	1	4	001001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	035	0		29	10	S5601_035_0	5	2	Generic	1	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								10.00	20.00	30.00					3.00	6.00	7.50											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	035	0		29	10	S5601_035_0	5	3	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								29.00	58.00	87.00					22.00	44.00	55.00											29.00	58.00	87.00				22.00	44.00	55.00				29.00				29.00			0.97	0.73		0.97	0.73	0.85	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	035	0		29	10	S5601_035_0	5	4	Non-Preferred Brand	1	4	100100	1	1		111	01		111	1				30	60	90	2				30	60	90	30		34											55.57	45	45	45				43.22	35	35	35										45	45	45				35	35	35			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	035	0		29	10	S5601_035_0	5	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34											511.04	33						511.04	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	035	0		29	10	S5601_035_0	5	1	Preferred Generic	3	4	001001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	035	0		29	10	S5601_035_0	5	2	Generic	3	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								10.00	20.00	30.00					3.00	6.00	7.50											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	036	0		29	10	S5601_036_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		34				571.80	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	036	0		29	10	S5601_036_0	5	1	Preferred Generic	1	3	001001	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	3.00	6.00	7.50																									3.00	6.00	9.00				3.00	6.00	7.50				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	036	0		29	10	S5601_036_0	5	2	Generic	1	3	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	11.00	22.00	27.50																									11.00	22.00	33.00				11.00	22.00	27.50				11.00				11.00		0.37				0.37	0.37	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	036	0		29	10	S5601_036_0	5	3	Preferred Brand	1	3	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	40.00	80.00	100.00																									40.00	80.00	120.00				40.00	80.00	100.00				40.00				40.00		1.33				1.33	1.33	1.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	036	0		29	10	S5601_036_0	5	4	Non-Preferred Brand	1	3	100100	1	1	111		01		111	1	30	60	90				2				30	60	90	30		34				49.20	42	42	42																								42	42	42				42	42	42			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	037	0		29	10	S5601_037_0	5	1	Preferred Generic	3	4	001001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	037	0		29	10	S5601_037_0	5	3	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								29.00	58.00	87.00					22.00	44.00	55.00											29.00	58.00	87.00				22.00	44.00	55.00				29.00				29.00			0.97	0.73		0.97	0.73	0.85	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	037	0		29	10	S5601_037_0	5	2	Generic	1	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								10.00	20.00	30.00					3.00	6.00	7.50											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	037	0		29	10	S5601_037_0	5	1	Preferred Generic	1	4	001001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	037	0		29	10	S5601_037_0	5	2	Generic	3	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								10.00	20.00	30.00					3.00	6.00	7.50											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	037	0		29	10	S5601_037_0	5	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34											525.58	33						525.58	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	037	0		29	10	S5601_037_0	5	4	Non-Preferred Brand	1	4	100100	1	1		111	01		111	1				30	60	90	2				30	60	90	30		34											53.41	45	45	45				41.54	35	35	35										45	45	45				35	35	35			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	038	0		29	10	S5601_038_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		34				570.06	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	038	0		29	10	S5601_038_0	5	4	Non-Preferred Brand	1	3	100100	1	1	111		01		111	1	30	60	90				2				30	60	90	30		34				46.34	45	45	45																								45	45	45				45	45	45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	038	0		29	10	S5601_038_0	5	3	Preferred Brand	1	3	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	43.00	86.00	107.50																									43.00	86.00	129.00				43.00	86.00	107.50				43.00				43.00		1.43				1.43	1.43	1.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	038	0		29	10	S5601_038_0	5	2	Generic	1	3	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	11.00	22.00	27.50																									11.00	22.00	33.00				11.00	22.00	27.50				11.00				11.00		0.37				0.37	0.37	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	038	0		29	10	S5601_038_0	5	1	Preferred Generic	1	3	001001	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	3.00	6.00	7.50																									3.00	6.00	9.00				3.00	6.00	7.50				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	040	0		29	10	S5601_040_0	5	2	Generic	1	3	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	12.00	24.00	30.00																									12.00	24.00	36.00				12.00	24.00	30.00				12.00				12.00		0.40				0.40	0.40	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	040	0		29	10	S5601_040_0	5	3	Preferred Brand	1	3	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	45.00	90.00	112.50																									45.00	90.00	135.00				45.00	90.00	112.50				45.00				45.00		1.50				1.50	1.50	1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	040	0		29	10	S5601_040_0	5	4	Non-Preferred Brand	1	3	100100	1	1	111		01		111	1	30	60	90				2				30	60	90	30		34				51.46	48	48	48																								48	48	48				48	48	48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	040	0		29	10	S5601_040_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		34				547.08	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	040	0		29	10	S5601_040_0	5	1	Preferred Generic	1	3	001001	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	3.00	6.00	7.50																									3.00	6.00	9.00				3.00	6.00	7.50				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	041	0		29	10	S5601_041_0	5	1	Preferred Generic	1	4	001001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	041	0		29	10	S5601_041_0	5	3	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								29.00	58.00	87.00					22.00	44.00	55.00											29.00	58.00	87.00				22.00	44.00	55.00				29.00				29.00			0.97	0.73		0.97	0.73	0.85	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	041	0		29	10	S5601_041_0	5	4	Non-Preferred Brand	1	4	100100	1	1		111	01		111	1				30	60	90	2				30	60	90	30		34											49.28	45	45	45				38.33	35	35	35										45	45	45				35	35	35			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	041	0		29	10	S5601_041_0	5	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34											589.35	33						589.35	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	041	0		29	10	S5601_041_0	5	1	Preferred Generic	3	4	001001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	041	0		29	10	S5601_041_0	5	2	Generic	3	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								10.00	20.00	30.00					3.00	6.00	7.50											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	041	0		29	10	S5601_041_0	5	2	Generic	1	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								10.00	20.00	30.00					3.00	6.00	7.50											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	042	0		29	10	S5601_042_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		34				512.38	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	042	0		29	10	S5601_042_0	5	4	Non-Preferred Brand	1	3	100100	1	1	111		01		111	1	30	60	90				2				30	60	90	30		34				49.89	43	43	43																								43	43	43				43	43	43			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	042	0		29	10	S5601_042_0	5	3	Preferred Brand	1	3	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	43.00	86.00	107.50																									43.00	86.00	129.00				43.00	86.00	107.50				43.00				43.00		1.43				1.43	1.43	1.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	042	0		29	10	S5601_042_0	5	2	Generic	1	3	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	12.00	24.00	30.00																									12.00	24.00	36.00				12.00	24.00	30.00				12.00				12.00		0.40				0.40	0.40	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	042	0		29	10	S5601_042_0	5	1	Preferred Generic	1	3	001001	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	3.00	6.00	7.50																									3.00	6.00	9.00				3.00	6.00	7.50				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	044	0		29	10	S5601_044_0	5	3	Preferred Brand	1	3	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	46.00	92.00	115.00																									46.00	92.00	138.00				46.00	92.00	115.00				46.00				46.00		1.53				1.53	1.53	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	044	0		29	10	S5601_044_0	5	4	Non-Preferred Brand	1	3	100100	1	1	111		01		111	1	30	60	90				2				30	60	90	30		34				57.96	48	48	48																								48	48	48				48	48	48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	044	0		29	10	S5601_044_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		34				556.03	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	044	0		29	10	S5601_044_0	5	2	Generic	1	3	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	15.00	30.00	37.50																									15.00	30.00	45.00				15.00	30.00	37.50				15.00				15.00		0.50				0.50	0.50	0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	044	0		29	10	S5601_044_0	5	1	Preferred Generic	1	3	001001	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	3.00	6.00	7.50																									3.00	6.00	9.00				3.00	6.00	7.50				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	045	0		29	10	S5601_045_0	5	1	Preferred Generic	1	4	001001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	045	0		29	10	S5601_045_0	5	1	Preferred Generic	3	4	001001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	045	0		29	10	S5601_045_0	5	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34											535.77	33						535.77	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	045	0		29	10	S5601_045_0	5	4	Non-Preferred Brand	1	4	100100	1	1		111	01		111	1				30	60	90	2				30	60	90	30		34											55.36	45	45	45				43.06	35	35	35										45	45	45				35	35	35			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	045	0		29	10	S5601_045_0	5	3	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								29.00	58.00	87.00					22.00	44.00	55.00											29.00	58.00	87.00				22.00	44.00	55.00				29.00				29.00			0.97	0.73		0.97	0.73	0.85	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	045	0		29	10	S5601_045_0	5	2	Generic	1	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								10.00	20.00	30.00					3.00	6.00	7.50											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	045	0		29	10	S5601_045_0	5	2	Generic	3	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								10.00	20.00	30.00					3.00	6.00	7.50											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	046	0		29	10	S5601_046_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		34				595.59	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	046	0		29	10	S5601_046_0	5	4	Non-Preferred Brand	1	3	100100	1	1	111		01		111	1	30	60	90				2				30	60	90	30		34				53.32	46	46	46																								46	46	46				46	46	46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	046	0		29	10	S5601_046_0	5	3	Preferred Brand	1	3	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	42.00	84.00	105.00																									42.00	84.00	126.00				42.00	84.00	105.00				42.00				42.00		1.40				1.40	1.40	1.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	046	0		29	10	S5601_046_0	5	2	Generic	1	3	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	11.00	22.00	27.50																									11.00	22.00	33.00				11.00	22.00	27.50				11.00				11.00		0.37				0.37	0.37	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	046	0		29	10	S5601_046_0	5	1	Preferred Generic	1	3	001001	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	3.00	6.00	7.50																									3.00	6.00	9.00				3.00	6.00	7.50				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	048	0		29	10	S5601_048_0	5	2	Generic	1	3	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	12.00	24.00	30.00																									12.00	24.00	36.00				12.00	24.00	30.00				12.00				12.00		0.40				0.40	0.40	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	048	0		29	10	S5601_048_0	5	1	Preferred Generic	1	3	001001	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	3.00	6.00	7.50																									3.00	6.00	9.00				3.00	6.00	7.50				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	048	0		29	10	S5601_048_0	5	3	Preferred Brand	1	3	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	45.00	90.00	112.50																									45.00	90.00	135.00				45.00	90.00	112.50				45.00				45.00		1.50				1.50	1.50	1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	048	0		29	10	S5601_048_0	5	4	Non-Preferred Brand	1	3	100100	1	1	111		01		111	1	30	60	90				2				30	60	90	30		34				49.45	43	43	43																								43	43	43				43	43	43			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	048	0		29	10	S5601_048_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		34				564.42	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	049	0		29	10	S5601_049_0	5	2	Generic	3	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								10.00	20.00	30.00					3.00	6.00	7.50											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	049	0		29	10	S5601_049_0	5	1	Preferred Generic	3	4	001001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	049	0		29	10	S5601_049_0	5	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34											571.80	33						571.80	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	049	0		29	10	S5601_049_0	5	4	Non-Preferred Brand	1	4	100100	1	1		111	01		111	1				30	60	90	2				30	60	90	30		34											52.53	45	45	45				40.86	35	35	35										45	45	45				35	35	35			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	049	0		29	10	S5601_049_0	5	3	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								29.00	58.00	87.00					22.00	44.00	55.00											29.00	58.00	87.00				22.00	44.00	55.00				29.00				29.00			0.97	0.73		0.97	0.73	0.85	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	049	0		29	10	S5601_049_0	5	1	Preferred Generic	1	4	001001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	049	0		29	10	S5601_049_0	5	2	Generic	1	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								10.00	20.00	30.00					3.00	6.00	7.50											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	050	0		29	10	S5601_050_0	5	4	Non-Preferred Brand	1	3	100100	1	1	111		01		111	1	30	60	90				2				30	60	90	30		34				49.71	43	43	43																								43	43	43				43	43	43			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	050	0		29	10	S5601_050_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		34				515.53	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	050	0		29	10	S5601_050_0	5	1	Preferred Generic	1	3	001001	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	3.00	6.00	7.50																									3.00	6.00	9.00				3.00	6.00	7.50				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	050	0		29	10	S5601_050_0	5	3	Preferred Brand	1	3	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	37.00	74.00	92.50																									37.00	74.00	111.00				37.00	74.00	92.50				37.00				37.00		1.23				1.23	1.23	1.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	050	0		29	10	S5601_050_0	5	2	Generic	1	3	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	13.00	26.00	32.50																									13.00	26.00	39.00				13.00	26.00	32.50				13.00				13.00		0.43				0.43	0.43	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	051	0		29	10	S5601_051_0	5	3	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								29.00	58.00	87.00					22.00	44.00	55.00											29.00	58.00	87.00				22.00	44.00	55.00				29.00				29.00			0.97	0.73		0.97	0.73	0.85	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	051	0		29	10	S5601_051_0	5	2	Generic	1	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								10.00	20.00	30.00					3.00	6.00	7.50											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	051	0		29	10	S5601_051_0	5	1	Preferred Generic	1	4	001001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	051	0		29	10	S5601_051_0	5	4	Non-Preferred Brand	1	4	100100	1	1		111	01		111	1				30	60	90	2				30	60	90	30		34											52.54	45	45	45				40.86	35	35	35										45	45	45				35	35	35			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	051	0		29	10	S5601_051_0	5	2	Generic	3	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								10.00	20.00	30.00					3.00	6.00	7.50											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	051	0		29	10	S5601_051_0	5	1	Preferred Generic	3	4	001001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	051	0		29	10	S5601_051_0	5	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34											490.77	33						490.77	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	052	0		29	10	S5601_052_0	5	1	Preferred Generic	1	3	001001	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	3.00	6.00	7.50																									3.00	6.00	9.00				3.00	6.00	7.50				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	052	0		29	10	S5601_052_0	5	4	Non-Preferred Brand	1	3	100100	1	1	111		01		111	1	30	60	90				2				30	60	90	30		34				49.41	47	47	47																								47	47	47				47	47	47			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	052	0		29	10	S5601_052_0	5	3	Preferred Brand	1	3	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	46.00	92.00	115.00																									46.00	92.00	138.00				46.00	92.00	115.00				46.00				46.00		1.53				1.53	1.53	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	052	0		29	10	S5601_052_0	5	2	Generic	1	3	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	15.00	30.00	37.50																									15.00	30.00	45.00				15.00	30.00	37.50				15.00				15.00		0.50				0.50	0.50	0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	052	0		29	10	S5601_052_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		34				552.73	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	053	0		29	10	S5601_053_0	5	1	Preferred Generic	3	4	001001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	053	0		29	10	S5601_053_0	5	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34											684.96	33						684.96	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	053	0		29	10	S5601_053_0	5	4	Non-Preferred Brand	1	4	100100	1	1		111	01		111	1				30	60	90	2				30	60	90	30		34											52.65	45	45	45				40.95	35	35	35										45	45	45				35	35	35			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	053	0		29	10	S5601_053_0	5	3	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								29.00	58.00	87.00					22.00	44.00	55.00											29.00	58.00	87.00				22.00	44.00	55.00				29.00				29.00			0.97	0.73		0.97	0.73	0.85	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	053	0		29	10	S5601_053_0	5	2	Generic	1	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								10.00	20.00	30.00					3.00	6.00	7.50											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	053	0		29	10	S5601_053_0	5	1	Preferred Generic	1	4	001001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	053	0		29	10	S5601_053_0	5	2	Generic	3	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								10.00	20.00	30.00					3.00	6.00	7.50											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	054	0		29	10	S5601_054_0	5	1	Preferred Generic	1	3	001001	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	3.00	6.00	7.50																									3.00	6.00	9.00				3.00	6.00	7.50				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	054	0		29	10	S5601_054_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		34				542.52	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	054	0		29	10	S5601_054_0	5	4	Non-Preferred Brand	1	3	100100	1	1	111		01		111	1	30	60	90				2				30	60	90	30		34				52.65	46	46	46																								46	46	46				46	46	46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	054	0		29	10	S5601_054_0	5	3	Preferred Brand	1	3	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	46.00	92.00	115.00																									46.00	92.00	138.00				46.00	92.00	115.00				46.00				46.00		1.53				1.53	1.53	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	054	0		29	10	S5601_054_0	5	2	Generic	1	3	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	15.00	30.00	37.50																									15.00	30.00	45.00				15.00	30.00	37.50				15.00				15.00		0.50				0.50	0.50	0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	055	0		29	10	S5601_055_0	5	1	Preferred Generic	3	4	001001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	055	0		29	10	S5601_055_0	5	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34											558.77	33						558.77	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	055	0		29	10	S5601_055_0	5	4	Non-Preferred Brand	1	4	100100	1	1		111	01		111	1				30	60	90	2				30	60	90	30		34											52.67	45	45	45				40.97	35	35	35										45	45	45				35	35	35			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	055	0		29	10	S5601_055_0	5	3	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								29.00	58.00	87.00					22.00	44.00	55.00											29.00	58.00	87.00				22.00	44.00	55.00				29.00				29.00			0.97	0.73		0.97	0.73	0.85	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	055	0		29	10	S5601_055_0	5	2	Generic	1	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								10.00	20.00	30.00					3.00	6.00	7.50											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	055	0		29	10	S5601_055_0	5	1	Preferred Generic	1	4	001001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	055	0		29	10	S5601_055_0	5	2	Generic	3	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								10.00	20.00	30.00					3.00	6.00	7.50											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	056	0		29	10	S5601_056_0	5	1	Preferred Generic	1	3	001001	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	5.00	10.00	12.50																									5.00	10.00	15.00				5.00	10.00	12.50				5.00				5.00		0.17				0.17	0.17	0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	056	0		29	10	S5601_056_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		34				508.75	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	056	0		29	10	S5601_056_0	5	4	Non-Preferred Brand	1	3	100100	1	1	111		01		111	1	30	60	90				2				30	60	90	30		34				52.96	48	48	48																								48	48	48				48	48	48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	056	0		29	10	S5601_056_0	5	3	Preferred Brand	1	3	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	46.00	92.00	115.00																									46.00	92.00	138.00				46.00	92.00	115.00				46.00				46.00		1.53				1.53	1.53	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	056	0		29	10	S5601_056_0	5	2	Generic	1	3	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	16.00	32.00	40.00																									16.00	32.00	48.00				16.00	32.00	40.00				16.00				16.00		0.53				0.53	0.53	0.47	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	057	0		29	10	S5601_057_0	5	1	Preferred Generic	3	4	001001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	057	0		29	10	S5601_057_0	5	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34											640.97	33						640.97	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	057	0		29	10	S5601_057_0	5	4	Non-Preferred Brand	1	4	100100	1	1		111	01		111	1				30	60	90	2				30	60	90	30		34											56.24	45	45	45				43.75	35	35	35										45	45	45				35	35	35			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	057	0		29	10	S5601_057_0	5	3	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								29.00	58.00	87.00					22.00	44.00	55.00											29.00	58.00	87.00				22.00	44.00	55.00				29.00				29.00			0.97	0.73		0.97	0.73	0.85	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	057	0		29	10	S5601_057_0	5	2	Generic	1	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								10.00	20.00	30.00					3.00	6.00	7.50											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	057	0		29	10	S5601_057_0	5	2	Generic	3	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								10.00	20.00	30.00					3.00	6.00	7.50											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	057	0		29	10	S5601_057_0	5	1	Preferred Generic	1	4	001001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	058	0		29	10	S5601_058_0	5	1	Preferred Generic	1	3	001001	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	3.00	6.00	7.50																									3.00	6.00	9.00				3.00	6.00	7.50				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	058	0		29	10	S5601_058_0	5	2	Generic	1	3	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	16.00	32.00	40.00																									16.00	32.00	48.00				16.00	32.00	40.00				16.00				16.00		0.53				0.53	0.53	0.47	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	058	0		29	10	S5601_058_0	5	3	Preferred Brand	1	3	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	47.00	94.00	117.50																									47.00	94.00	141.00				47.00	94.00	117.50				47.00				47.00		1.57				1.57	1.57	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	058	0		29	10	S5601_058_0	5	4	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	45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	058	0		29	10	S5601_058_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		34				576.71	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	059	0		29	10	S5601_059_0	5	3	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								29.00	58.00	87.00					22.00	44.00	55.00											29.00	58.00	87.00				22.00	44.00	55.00				29.00				29.00			0.97	0.73		0.97	0.73	0.85	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	059	0		29	10	S5601_059_0	5	2	Generic	1	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								10.00	20.00	30.00					3.00	6.00	7.50											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	059	0		29	10	S5601_059_0	5	1	Preferred Generic	1	4	001001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	059	0		29	10	S5601_059_0	5	4	Non-Preferred Brand	1	4	100100	1	1		111	01		111	1				30	60	90	2				30	60	90	30		34											52.10	45	45	45				40.52	35	35	35										45	45	45				35	35	35			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	059	0		29	10	S5601_059_0	5	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34											493.32	33						493.32	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	059	0		29	10	S5601_059_0	5	1	Preferred Generic	3	4	001001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	059	0		29	10	S5601_059_0	5	2	Generic	3	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								10.00	20.00	30.00					3.00	6.00	7.50											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	060	0		29	10	S5601_060_0	5	1	Preferred Generic	1	3	001001	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	3.00	6.00	7.50																									3.00	6.00	9.00				3.00	6.00	7.50				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	060	0		29	10	S5601_060_0	5	2	Generic	1	3	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	12.00	24.00	30.00																									12.00	24.00	36.00				12.00	24.00	30.00				12.00				12.00		0.40				0.40	0.40	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	060	0		29	10	S5601_060_0	5	3	Preferred Brand	1	3	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	44.00	88.00	110.00																									44.00	88.00	132.00				44.00	88.00	110.00				44.00				44.00		1.47				1.47	1.47	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	060	0		29	10	S5601_060_0	5	4	Non-Preferred Brand	1	3	100100	1	1	111		01		111	1	30	60	90				2				30	60	90	30		34				47.74	44	44	44																								44	44	44				44	44	44			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	060	0		29	10	S5601_060_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		34				515.43	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	061	0		29	10	S5601_061_0	5	3	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								29.00	58.00	87.00					22.00	44.00	55.00											29.00	58.00	87.00				22.00	44.00	55.00				29.00				29.00			0.97	0.73		0.97	0.73	0.85	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	061	0		29	10	S5601_061_0	5	2	Generic	1	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								10.00	20.00	30.00					3.00	6.00	7.50											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	061	0		29	10	S5601_061_0	5	1	Preferred Generic	1	4	001001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	061	0		29	10	S5601_061_0	5	4	Non-Preferred Brand	1	4	100100	1	1		111	01		111	1				30	60	90	2				30	60	90	30		34											50.11	45	45	45				38.97	35	35	35										45	45	45				35	35	35			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	061	0		29	10	S5601_061_0	5	2	Generic	3	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								10.00	20.00	30.00					3.00	6.00	7.50											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	061	0		29	10	S5601_061_0	5	1	Preferred Generic	3	4	001001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	061	0		29	10	S5601_061_0	5	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34											427.29	33						427.29	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	062	0		29	10	S5601_062_0	5	1	Preferred Generic	1	3	001001	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	3.00	6.00	7.50																									3.00	6.00	9.00				3.00	6.00	7.50				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	062	0		29	10	S5601_062_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		34				521.23	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	062	0		29	10	S5601_062_0	5	4	Non-Preferred Brand	1	3	100100	1	1	111		01		111	1	30	60	90				2				30	60	90	30		34				48.16	42	42	42																								42	42	42				42	42	42			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	062	0		29	10	S5601_062_0	5	3	Preferred Brand	1	3	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	45.00	90.00	112.50																									45.00	90.00	135.00				45.00	90.00	112.50				45.00				45.00		1.50				1.50	1.50	1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	062	0		29	10	S5601_062_0	5	2	Generic	1	3	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	13.00	26.00	32.50																									13.00	26.00	39.00				13.00	26.00	32.50				13.00				13.00		0.43				0.43	0.43	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	063	0		29	10	S5601_063_0	5	4	Non-Preferred Brand	1	4	100100	1	1		111	01		111	1				30	60	90	2				30	60	90	30		34											48.79	45	45	45				37.94	35	35	35										45	45	45				35	35	35			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	063	0		29	10	S5601_063_0	5	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34											521.95	33						521.95	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	063	0		29	10	S5601_063_0	5	1	Preferred Generic	3	4	001001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	063	0		29	10	S5601_063_0	5	3	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								29.00	58.00	87.00					22.00	44.00	55.00											29.00	58.00	87.00				22.00	44.00	55.00				29.00				29.00			0.97	0.73		0.97	0.73	0.85	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	063	0		29	10	S5601_063_0	5	2	Generic	1	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								10.00	20.00	30.00					3.00	6.00	7.50											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	063	0		29	10	S5601_063_0	5	2	Generic	3	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								10.00	20.00	30.00					3.00	6.00	7.50											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	063	0		29	10	S5601_063_0	5	1	Preferred Generic	1	4	001001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	064	0		29	10	S5601_064_0	5	3	Preferred Brand	1	3	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	46.00	92.00	115.00																									46.00	92.00	138.00				46.00	92.00	115.00				46.00				46.00		1.53				1.53	1.53	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	064	0		29	10	S5601_064_0	5	4	Non-Preferred Brand	1	3	100100	1	1	111		01		111	1	30	60	90				2				30	60	90	30		34				57.45	47	47	47																								47	47	47				47	47	47			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	064	0		29	10	S5601_064_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		34				518.78	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	064	0		29	10	S5601_064_0	5	1	Preferred Generic	1	3	001001	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	3.00	6.00	7.50																									3.00	6.00	9.00				3.00	6.00	7.50				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	064	0		29	10	S5601_064_0	5	2	Generic	1	3	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	17.00	34.00	42.50																									17.00	34.00	51.00				17.00	34.00	42.50				17.00				17.00		0.57				0.57	0.57	0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	065	0		29	10	S5601_065_0	5	2	Generic	1	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								10.00	20.00	30.00					3.00	6.00	7.50											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	065	0		29	10	S5601_065_0	5	3	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								29.00	58.00	87.00					22.00	44.00	55.00											29.00	58.00	87.00				22.00	44.00	55.00				29.00				29.00			0.97	0.73		0.97	0.73	0.85	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	065	0		29	10	S5601_065_0	5	4	Non-Preferred Brand	1	4	100100	1	1		111	01		111	1				30	60	90	2				30	60	90	30		34											57.41	45	45	45				44.66	35	35	35										45	45	45				35	35	35			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	065	0		29	10	S5601_065_0	5	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34											497.83	33						497.83	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	065	0		29	10	S5601_065_0	5	1	Preferred Generic	1	4	001001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	065	0		29	10	S5601_065_0	5	1	Preferred Generic	3	4	001001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	065	0		29	10	S5601_065_0	5	2	Generic	3	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								10.00	20.00	30.00					3.00	6.00	7.50											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	066	0		29	10	S5601_066_0	6	4	Non-Preferred Brand	1	3	100100	1	1	111		01		111	1	30	60	90				2				30	60	90	30		34				60.59	47	47	47																								47	47	47				47	47	47			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	066	0		29	10	S5601_066_0	6	3	Preferred Brand	1	3	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	46.00	92.00	115.00																									46.00	92.00	138.00				46.00	92.00	115.00				46.00				46.00		1.53				1.53	1.53	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	066	0		29	10	S5601_066_0	6	2	Generic	1	3	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	16.00	32.00	40.00																									16.00	32.00	48.00				16.00	32.00	40.00				16.00				16.00		0.53				0.53	0.53	0.47	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	066	0		29	10	S5601_066_0	6	1	Preferred Generic	1	3	001001	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	5.00	10.00	12.50																									5.00	10.00	15.00				5.00	10.00	12.50				5.00				5.00		0.17				0.17	0.17	0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	066	0		29	10	S5601_066_0	6	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		34				469.92	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	067	0		29	10	S5601_067_0	6	1	Preferred Generic	1	4	001001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	067	0		29	10	S5601_067_0	6	2	Generic	1	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								10.00	20.00	30.00					3.00	6.00	7.50											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	067	0		29	10	S5601_067_0	6	3	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								29.00	58.00	87.00					22.00	44.00	55.00											29.00	58.00	87.00				22.00	44.00	55.00				29.00				29.00			0.97	0.73		0.97	0.73	0.85	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	067	0		29	10	S5601_067_0	6	4	Non-Preferred Brand	1	4	100100	1	1		111	01		111	1				30	60	90	2				30	60	90	30		34											47.33	45	45	45				36.81	35	35	35										45	45	45				35	35	35			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	067	0		29	10	S5601_067_0	6	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34											495.08	33						495.08	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	067	0		29	10	S5601_067_0	6	1	Preferred Generic	3	4	001001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	067	0		29	10	S5601_067_0	6	2	Generic	3	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								10.00	20.00	30.00					3.00	6.00	7.50											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	068	0		29	10	S5601_068_0	5	1	Preferred Generic	1	2	001001	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	1.00	2.00	2.50																									1.00	2.00	3.00				1.00	2.00	2.50				1.00				1.00		0.03				0.03	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	068	0		29	10	S5601_068_0	5	2	Generic	1	2	000101	1	2	111		01		111	1	30	60	90				2				30	60	90	30		34	4.00	8.00	10.00																									4.00	8.00	12.00				4.00	8.00	10.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	068	0		29	10	S5601_068_0	5	3	Preferred Brand	1	2	000101	1	1	111		01		111	1	30	60	90				2				30	60	90	30		34				10.50	15	15	15																								15	15	15				15	15	15			15			15								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	068	0		29	10	S5601_068_0	5	4	Non-Preferred Brand	1	2	100100	1	1	111		01		111	1	30	60	90				2				30	60	90	30		34				32.56	35	35	35																								35	35	35				35	35	35			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	068	0		29	10	S5601_068_0	5	5	Specialty Tier	1	2	010010	1	1	010		01		010	1	30										30			30		34				239.92	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	107	0		29	10	S5601_107_0	5	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34											565.67	33						565.67	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	107	0		29	10	S5601_107_0	5	4	Non-Preferred Brand	1	4	100100	1	1		111	01		111	1				30	60	90	2				30	60	90	30		34											48.23	45	45	45				37.51	35	35	35										45	45	45				35	35	35			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	107	0		29	10	S5601_107_0	5	3	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								29.00	58.00	87.00					22.00	44.00	55.00											29.00	58.00	87.00				22.00	44.00	55.00				29.00				29.00			0.97	0.73		0.97	0.73	0.85	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	107	0		29	10	S5601_107_0	5	2	Generic	1	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								10.00	20.00	30.00					3.00	6.00	7.50											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	107	0		29	10	S5601_107_0	5	1	Preferred Generic	1	4	001001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	107	0		29	10	S5601_107_0	5	1	Preferred Generic	3	4	001001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	107	0		29	10	S5601_107_0	5	2	Generic	3	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								10.00	20.00	30.00					3.00	6.00	7.50											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	108	0		29	10	S5601_108_0	5	1	Preferred Generic	3	4	001001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	108	0		29	10	S5601_108_0	5	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34											538.04	33						538.04	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	108	0		29	10	S5601_108_0	5	4	Non-Preferred Brand	1	4	100100	1	1		111	01		111	1				30	60	90	2				30	60	90	30		34											51.41	45	45	45				39.99	35	35	35										45	45	45				35	35	35			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	108	0		29	10	S5601_108_0	5	3	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								29.00	58.00	87.00					22.00	44.00	55.00											29.00	58.00	87.00				22.00	44.00	55.00				29.00				29.00			0.97	0.73		0.97	0.73	0.85	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	108	0		29	10	S5601_108_0	5	2	Generic	1	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								10.00	20.00	30.00					3.00	6.00	7.50											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	108	0		29	10	S5601_108_0	5	1	Preferred Generic	1	4	001001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	108	0		29	10	S5601_108_0	5	2	Generic	3	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								10.00	20.00	30.00					3.00	6.00	7.50											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	109	0		29	10	S5601_109_0	4	1	Preferred Generic	3	4	001001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5601	109	0		29	10	S5601_109_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		34											531.02	33						531.02	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	109	0		29	10	S5601_109_0	4	4	Non-Preferred Brand	1	4	100100	1	1		111	01		111	1				30	60	90	2				30	60	90	30		34											52.70	45	45	45				40.99	35	35	35										45	45	45				35	35	35			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	109	0		29	10	S5601_109_0	4	3	Preferred Brand	1	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								29.00	58.00	87.00					22.00	44.00	55.00											29.00	58.00	87.00				22.00	44.00	55.00				29.00				29.00			0.97	0.73		0.97	0.73	0.85	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	109	0		29	10	S5601_109_0	4	2	Generic	1	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								10.00	20.00	30.00					3.00	6.00	7.50											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	109	0		29	10	S5601_109_0	4	1	Preferred Generic	1	4	001001	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5601	109	0		29	10	S5601_109_0	4	2	Generic	3	4	000101	1	2		111	01		111	1				30	60	90	2				30	60	90	30		34								10.00	20.00	30.00					3.00	6.00	7.50											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5609	001	0		29	10	S5609_001_0	3	1	Preferred Generic	1	3	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	10.00	20.00	20.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5609	001	0		29	10	S5609_001_0	3	6	Select Care Drugs	1	3	010000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5609	001	0		29	10	S5609_001_0	3	5	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		31					26																				26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5609	001	0		29	10	S5609_001_0	3	4	Non-Preferred Brand	1	3	110000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	100.00	200.00	250.00																			100.00	200.00	250.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5609	001	0		29	10	S5609_001_0	3	3	Preferred Brand	1	3	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	94.00	117.50																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5609	001	0		29	10	S5609_001_0	3	2	Generic	1	3	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	15.00	30.00	30.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5609	002	0		29	10	S5609_002_0	4	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	5.00	10.00	10.00																			5.00	10.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5609	002	0		29	10	S5609_002_0	4	6	Select Care Drugs	1	4	010000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5609	002	0		29	10	S5609_002_0	4	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5609	002	0		29	10	S5609_002_0	4	4	Non-Preferred Brand	1	4	110000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	100.00	200.00	250.00																			100.00	200.00	250.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5609	002	0		29	10	S5609_002_0	4	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	94.00	117.50																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5609	002	0		29	10	S5609_002_0	4	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	12.00	24.00	24.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5609	002	0		29	10	S5609_002_0	4	6	Select Care Drugs	3	4	010000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5609	002	0		29	10	S5609_002_0	4	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	5.00	10.00	10.00																			5.00	10.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5617	003	0		29	10	S5617_003_0	5	5	Specialty Tier	1	2	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31												25	25	25					25	25	25										25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	003	0		29	10	S5617_003_0	5	2	Generic	1	2	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								11.00	22.00	33.00					5.00	10.00	15.00											11.00		33.00				5.00		15.00				11.00				11.00			0.37	0.17		0.37	0.17	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	003	0		29	10	S5617_003_0	5	3	Preferred Brand	1	2	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											45.79	20	20	20				35.40	16	16	16										20		20				16		16			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	003	0		29	10	S5617_003_0	5	4	Non-Preferred Brand	1	2	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31											82.70	50	50	50				76.10	48	48	48										50		50				48		48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	003	0		29	10	S5617_003_0	5	1	Preferred Generic	1	2	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00		21.00				2.00		6.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, 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												25	25	25					25	25	25										25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	008	0		29	10	S5617_008_0	4	3	Preferred Brand	1	2	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											44.65	19	19	19				38.53	17	17	17										19		19				17		17			19			19								Preferred Generic, 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											81.55	50	50	50				75.51	48	48	48										50		50				48		48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	008	0		29	10	S5617_008_0	4	2	Generic	1	2	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								11.00	22.00	33.00					6.00	12.00	18.00											11.00		33.00				6.00		18.00				11.00				11.00			0.37	0.20		0.37	0.20	0.35	Preferred Generic, 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								7.00	14.00	21.00					2.00	4.00	6.00											7.00		21.00				2.00		6.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	013	0		29	10	S5617_013_0	4	3	Preferred Brand	1	2	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											46.85	19	19	19				40.37	17	17	17										19		19				17		17			19			19								Preferred Generic, 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											55.79	50	50	50				50.04	47	47	47										50		50				47		47			50			50								Preferred Generic, 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												25	25	25					25	25	25										25		25				25		25			25			25								Preferred Generic, 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								5.00	10.00	15.00					0.00	0.00	0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	013	0		29	10	S5617_013_0	4	2	Generic	1	2	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								14.00	28.00	42.00					7.00	14.00	21.00											14.00		42.00				7.00		21.00				14.00				14.00			0.47	0.23		0.47	0.23	0.45	Preferred Generic, 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											96.61	50	50	50				88.10	47	47	47										50		50				47		47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	018	0		29	10	S5617_018_0	4	3	Preferred Brand	1	2	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											42.42	18	18	18				34.14	15	15	15										18		18				15		15			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	018	0		29	10	S5617_018_0	4	2	Generic	1	2	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00		30.00				5.00		15.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, 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								7.00	14.00	21.00					2.00	4.00	6.00											7.00		21.00				2.00		6.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, 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												25	25	25					25	25	25										25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	053	0		29	10	S5617_053_0	4	5	Specialty Tier	1	2	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31												25	25	25					25	25	25										25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	053	0		29	10	S5617_053_0	4	4	Non-Preferred Brand	1	2	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31											62.58	50	50	50				57.00	47	47	47										50		50				47		47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	053	0		29	10	S5617_053_0	4	2	Generic	1	2	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00		30.00				5.00		15.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	053	0		29	10	S5617_053_0	4	1	Preferred Generic	1	2	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00		21.00				2.00		6.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	053	0		29	10	S5617_053_0	4	3	Preferred Brand	1	2	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											37.81	20	20	20				29.20	16	16	16										20		20				16		16			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	068	0		29	10	S5617_068_0	4	3	Preferred Brand	1	2	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											45.31	18	18	18				36.41	15	15	15										18		18				15		15			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	068	0		29	10	S5617_068_0	4	1	Preferred Generic	1	2	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31								10.00	20.00	30.00					3.00	6.00	9.00											10.00		30.00				3.00		9.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	068	0		29	10	S5617_068_0	4	2	Generic	1	2	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								12.00	24.00	36.00					6.00	12.00	18.00											12.00		36.00				6.00		18.00				12.00				12.00			0.40	0.20		0.40	0.20	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	068	0		29	10	S5617_068_0	4	5	Specialty Tier	1	2	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31												25	25	25					25	25	25										25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	068	0		29	10	S5617_068_0	4	4	Non-Preferred Brand	1	2	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31											75.48	50	50	50				69.37	48	48	48										50		50				48		48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	088	0		29	10	S5617_088_0	4	4	Non-Preferred Brand	1	2	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31											59.03	50	50	50				53.17	47	47	47										50		50				47		47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	088	0		29	10	S5617_088_0	4	5	Specialty Tier	1	2	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31												25	25	25					25	25	25										25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	088	0		29	10	S5617_088_0	4	3	Preferred Brand	1	2	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											46.49	20	20	20				33.55	15	15	15										20		20				15		15			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	088	0		29	10	S5617_088_0	4	2	Generic	1	2	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								12.00	24.00	36.00					6.00	12.00	18.00											12.00		36.00				6.00		18.00				12.00				12.00			0.40	0.20		0.40	0.20	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	088	0		29	10	S5617_088_0	4	1	Preferred Generic	1	2	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31								10.00	20.00	30.00					4.00	8.00	12.00											10.00		30.00				4.00		12.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	103	0		29	10	S5617_103_0	4	4	Non-Preferred Brand	1	2	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31											47.35	50	50	50				41.81	46	46	46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	103	0		29	10	S5617_103_0	4	3	Preferred Brand	1	2	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											45.47	17	17	17				38.89	15	15	15										17		17				15		15			17			17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	103	0		29	10	S5617_103_0	4	5	Specialty Tier	1	2	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31												25	25	25					25	25	25										25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	103	0		29	10	S5617_103_0	4	2	Generic	1	2	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								16.00	32.00	48.00					6.00	12.00	18.00											16.00		48.00				6.00		18.00				16.00				16.00			0.53	0.20		0.53	0.20	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	103	0		29	10	S5617_103_0	4	1	Preferred Generic	1	2	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31								11.00	22.00	33.00					2.00	4.00	6.00											11.00		33.00				2.00		6.00				11.00				11.00			0.37	0.07		0.37	0.07	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	108	0		29	10	S5617_108_0	4	4	Non-Preferred Brand	1	2	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31											49.98	50	50	50				44.59	47	47	47										50		50				47		47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	108	0		29	10	S5617_108_0	4	1	Preferred Generic	1	2	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31								12.00	24.00	36.00					2.00	4.00	6.00											12.00		36.00				2.00		6.00				12.00				12.00			0.40	0.07		0.40	0.07	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	108	0		29	10	S5617_108_0	4	5	Specialty Tier	1	2	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31												25	25	25					25	25	25										25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	108	0		29	10	S5617_108_0	4	2	Generic	1	2	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								18.00	36.00	54.00					6.00	12.00	18.00											18.00		54.00				6.00		18.00				18.00				18.00			0.60	0.20		0.60	0.20	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	108	0		29	10	S5617_108_0	4	3	Preferred Brand	1	2	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											46.19	17	17	17				39.16	15	15	15										17		17				15		15			17			17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	113	0		29	10	S5617_113_0	4	4	Non-Preferred Brand	1	2	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31											72.15	50	50	50				64.81	46	46	46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	113	0		29	10	S5617_113_0	4	1	Preferred Generic	1	2	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00		21.00				2.00		6.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	113	0		29	10	S5617_113_0	4	5	Specialty Tier	1	2	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31												25	25	25					25	25	25										25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	113	0		29	10	S5617_113_0	4	2	Generic	1	2	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00		30.00				5.00		15.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	113	0		29	10	S5617_113_0	4	3	Preferred Brand	1	2	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											44.80	19	19	19				34.68	15	15	15										19		19				15		15			19			19								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	118	0		29	10	S5617_118_0	4	4	Non-Preferred Brand	1	2	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31											65.55	50	50	50				58.24	47	47	47										50		50				47		47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	118	0		29	10	S5617_118_0	4	1	Preferred Generic	1	2	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31								11.00	22.00	33.00					2.00	4.00	6.00											11.00		33.00				2.00		6.00				11.00				11.00			0.37	0.07		0.37	0.07	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	118	0		29	10	S5617_118_0	4	5	Specialty Tier	1	2	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31												25	25	25					25	25	25										25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	118	0		29	10	S5617_118_0	4	2	Generic	1	2	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								15.00	30.00	45.00					6.00	12.00	18.00											15.00		45.00				6.00		18.00				15.00				15.00			0.50	0.20		0.50	0.20	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	118	0		29	10	S5617_118_0	4	3	Preferred Brand	1	2	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											45.51	18	18	18				38.61	16	16	16										18		18				16		16			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	123	0		29	10	S5617_123_0	4	4	Non-Preferred Brand	1	2	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31											72.38	50	50	50				66.63	48	48	48										50		50				48		48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	123	0		29	10	S5617_123_0	4	1	Preferred Generic	1	2	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31								10.00	20.00	30.00					3.00	6.00	9.00											10.00		30.00				3.00		9.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	123	0		29	10	S5617_123_0	4	5	Specialty Tier	1	2	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31												25	25	25					25	25	25										25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	123	0		29	10	S5617_123_0	4	2	Generic	1	2	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								12.00	24.00	36.00					6.00	12.00	18.00											12.00		36.00				6.00		18.00				12.00				12.00			0.40	0.20		0.40	0.20	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	123	0		29	10	S5617_123_0	4	3	Preferred Brand	1	2	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											45.43	20	20	20				39.43	18	18	18										20		20				18		18			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	128	0		29	10	S5617_128_0	4	4	Non-Preferred Brand	1	2	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31											78.44	50	50	50				71.96	48	48	48										50		50				48		48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	128	0		29	10	S5617_128_0	4	1	Preferred Generic	1	2	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31								10.00	20.00	30.00					3.00	6.00	9.00											10.00		30.00				3.00		9.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	128	0		29	10	S5617_128_0	4	5	Specialty Tier	1	2	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31												25	25	25					25	25	25										25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	128	0		29	10	S5617_128_0	4	2	Generic	1	2	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								12.00	24.00	36.00					6.00	12.00	18.00											12.00		36.00				6.00		18.00				12.00				12.00			0.40	0.20		0.40	0.20	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	128	0		29	10	S5617_128_0	4	3	Preferred Brand	1	2	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											45.92	18	18	18				39.45	16	16	16										18		18				16		16			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	133	0		29	10	S5617_133_0	4	4	Non-Preferred Brand	1	2	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31											86.91	50	50	50				78.14	47	47	47										50		50				47		47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	133	0		29	10	S5617_133_0	4	1	Preferred Generic	1	2	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31								10.00	20.00	30.00					3.00	6.00	9.00											10.00		30.00				3.00		9.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	133	0		29	10	S5617_133_0	4	5	Specialty Tier	1	2	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31												25	25	25					25	25	25										25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	133	0		29	10	S5617_133_0	4	2	Generic	1	2	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								13.00	26.00	39.00					6.00	12.00	18.00											13.00		39.00				6.00		18.00				13.00				13.00			0.43	0.20		0.43	0.20	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	133	0		29	10	S5617_133_0	4	3	Preferred Brand	1	2	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											46.86	18	18	18				39.92	16	16	16										18		18				16		16			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	138	0		29	10	S5617_138_0	4	4	Non-Preferred Brand	1	2	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31											53.62	50	50	50				48.32	47	47	47										50		50				47		47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	138	0		29	10	S5617_138_0	4	1	Preferred Generic	1	2	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31								19.00	38.00	57.00					2.00	4.00	6.00											19.00		57.00				2.00		6.00				19.00				19.00			0.63	0.07		0.63	0.07	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	138	0		29	10	S5617_138_0	4	5	Specialty Tier	1	2	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31												25	25	25					25	25	25										25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	138	0		29	10	S5617_138_0	4	2	Generic	1	2	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								20.00	40.00	60.00					8.00	16.00	24.00											20.00		60.00				8.00		24.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	138	0		29	10	S5617_138_0	4	3	Preferred Brand	1	2	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											46.01	17	17	17				39.58	15	15	15										17		17				15		15			17			17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	143	0		29	10	S5617_143_0	4	4	Non-Preferred Brand	1	2	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31											68.40	50	50	50				61.27	47	47	47										50		50				47		47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	143	0		29	10	S5617_143_0	4	1	Preferred Generic	1	2	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31								12.00	24.00	36.00					5.00	10.00	15.00											12.00		36.00				5.00		15.00				12.00				12.00			0.40	0.17		0.40	0.17	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	143	0		29	10	S5617_143_0	4	5	Specialty Tier	1	2	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31												25	25	25					25	25	25										25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	143	0		29	10	S5617_143_0	4	2	Generic	1	2	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								14.00	28.00	42.00					7.00	14.00	21.00											14.00		42.00				7.00		21.00				14.00				14.00			0.47	0.23		0.47	0.23	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	143	0		29	10	S5617_143_0	4	3	Preferred Brand	1	2	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											46.57	17	17	17				39.77	15	15	15										17		17				15		15			17			17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	148	0		29	10	S5617_148_0	4	4	Non-Preferred Brand	1	2	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31											59.15	50	50	50				53.15	47	47	47										50		50				47		47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	148	0		29	10	S5617_148_0	4	1	Preferred Generic	1	2	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31								19.00	38.00	57.00					2.00	4.00	6.00											19.00		57.00				2.00		6.00				19.00				19.00			0.63	0.07		0.63	0.07	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	148	0		29	10	S5617_148_0	4	5	Specialty Tier	1	2	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31												25	25	25					25	25	25										25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	148	0		29	10	S5617_148_0	4	2	Generic	1	2	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								20.00	40.00	60.00					6.00	12.00	18.00											20.00		60.00				6.00		18.00				20.00				20.00			0.67	0.20		0.67	0.20	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	148	0		29	10	S5617_148_0	4	3	Preferred Brand	1	2	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											46.04	18	18	18				39.68	16	16	16										18		18				16		16			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	153	0		29	10	S5617_153_0	4	2	Generic	1	2	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								19.00	38.00	57.00					6.00	12.00	18.00											19.00		57.00				6.00		18.00				19.00				19.00			0.63	0.20		0.63	0.20	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	153	0		29	10	S5617_153_0	4	3	Preferred Brand	1	2	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											46.62	17	17	17				39.34	15	15	15										17		17				15		15			17			17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	153	0		29	10	S5617_153_0	4	5	Specialty Tier	1	2	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31												25	25	25					25	25	25										25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	153	0		29	10	S5617_153_0	4	4	Non-Preferred Brand	1	2	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31											71.44	50	50	50				64.62	48	48	48										50		50				48		48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	153	0		29	10	S5617_153_0	4	1	Preferred Generic	1	2	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31								16.00	32.00	48.00					2.00	4.00	6.00											16.00		48.00				2.00		6.00				16.00				16.00			0.53	0.07		0.53	0.07	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	158	0		29	10	S5617_158_0	4	5	Specialty Tier	1	2	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31												25	25	25					25	25	25										25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	158	0		29	10	S5617_158_0	4	4	Non-Preferred Brand	1	2	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31											67.79	50	50	50				61.66	47	47	47										50		50				47		47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	158	0		29	10	S5617_158_0	4	2	Generic	1	2	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								12.00	24.00	36.00					5.00	10.00	15.00											12.00		36.00				5.00		15.00				12.00				12.00			0.40	0.17		0.40	0.17	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	158	0		29	10	S5617_158_0	4	1	Preferred Generic	1	2	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31								10.00	20.00	30.00					3.00	6.00	9.00											10.00		30.00				3.00		9.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	158	0		29	10	S5617_158_0	4	3	Preferred Brand	1	2	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											46.65	18	18	18				37.81	15	15	15										18		18				15		15			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	163	0		29	10	S5617_163_0	4	5	Specialty Tier	1	2	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31												25	25	25					25	25	25										25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	163	0		29	10	S5617_163_0	4	1	Preferred Generic	1	2	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31								19.00	38.00	57.00					7.00	14.00	21.00											19.00		57.00				7.00		21.00				19.00				19.00			0.63	0.23		0.63	0.23	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	163	0		29	10	S5617_163_0	4	2	Generic	1	2	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00		60.00				15.00		45.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	163	0		29	10	S5617_163_0	4	3	Preferred Brand	1	2	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											44.04	14	14	14				35.23	13	13	13										14		14				13		13			14			14								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	163	0		29	10	S5617_163_0	4	4	Non-Preferred Brand	1	2	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31											65.58	50	50	50				60.07	48	48	48										50		50				48		48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	214	0		29	10	S5617_214_0	4	3	Preferred Brand	1	2	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											45.66	18	18	18				39.00	16	16	16										18		18				16		16			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	214	0		29	10	S5617_214_0	4	4	Non-Preferred Brand	1	2	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31											59.45	50	50	50				54.32	48	48	48										50		50				48		48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	214	0		29	10	S5617_214_0	4	5	Specialty Tier	1	2	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31												25	25	25					25	25	25										25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	214	0		29	10	S5617_214_0	4	1	Preferred Generic	1	2	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31								12.00	24.00	36.00					2.00	4.00	6.00											12.00		36.00				2.00		6.00				12.00				12.00			0.40	0.07		0.40	0.07	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	214	0		29	10	S5617_214_0	4	2	Generic	1	2	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								16.00	32.00	48.00					6.00	12.00	18.00											16.00		48.00				6.00		18.00				16.00				16.00			0.53	0.20		0.53	0.20	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	215	0		29	10	S5617_215_0	4	2	Generic	1	2	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								13.00	26.00	39.00					5.00	10.00	15.00											13.00		39.00				5.00		15.00				13.00				13.00			0.43	0.17		0.43	0.17	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	215	0		29	10	S5617_215_0	4	1	Preferred Generic	1	2	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31								8.00	16.00	24.00					2.00	4.00	6.00											8.00		24.00				2.00		6.00				8.00				8.00			0.27	0.07		0.27	0.07	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	215	0		29	10	S5617_215_0	4	3	Preferred Brand	1	2	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											45.18	18	18	18				36.25	15	15	15										18		18				15		15			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	215	0		29	10	S5617_215_0	4	4	Non-Preferred Brand	1	2	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31											67.60	50	50	50				62.03	48	48	48										50		50				48		48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	215	0		29	10	S5617_215_0	4	5	Specialty Tier	1	2	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31												25	25	25					25	25	25										25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	216	0		29	10	S5617_216_0	4	1	Preferred Generic	1	2	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31								9.00	18.00	27.00					3.00	6.00	9.00											9.00		27.00				3.00		9.00				9.00				9.00			0.30	0.10		0.30	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	216	0		29	10	S5617_216_0	4	2	Generic	1	2	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								11.00	22.00	33.00					5.00	10.00	15.00											11.00		33.00				5.00		15.00				11.00				11.00			0.37	0.17		0.37	0.17	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	216	0		29	10	S5617_216_0	4	3	Preferred Brand	1	2	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											46.24	19	19	19				36.93	16	16	16										19		19				16		16			19			19								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	216	0		29	10	S5617_216_0	4	4	Non-Preferred Brand	1	2	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31											77.37	50	50	50				70.03	48	48	48										50		50				48		48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	216	0		29	10	S5617_216_0	4	5	Specialty Tier	1	2	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31												25	25	25					25	25	25										25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	217	0		29	10	S5617_217_0	4	2	Generic	1	2	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								11.00	22.00	33.00					5.00	10.00	15.00											11.00		33.00				5.00		15.00				11.00				11.00			0.37	0.17		0.37	0.17	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	217	0		29	10	S5617_217_0	4	1	Preferred Generic	1	2	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31								9.00	18.00	27.00					3.00	6.00	9.00											9.00		27.00				3.00		9.00				9.00				9.00			0.30	0.10		0.30	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	217	0		29	10	S5617_217_0	4	3	Preferred Brand	1	2	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											45.48	19	19	19				36.02	16	16	16										19		19				16		16			19			19								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	217	0		29	10	S5617_217_0	4	5	Specialty Tier	1	2	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31												25	25	25					25	25	25										25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	217	0		29	10	S5617_217_0	4	4	Non-Preferred Brand	1	2	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31											79.04	50	50	50				71.22	48	48	48										50		50				48		48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	218	0		29	10	S5617_218_0	4	1	Preferred Generic	1	2	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31								9.00	18.00	27.00					3.00	6.00	9.00											9.00		27.00				3.00		9.00				9.00				9.00			0.30	0.10		0.30	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	218	0		29	10	S5617_218_0	4	2	Generic	1	2	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								11.00	22.00	33.00					5.00	10.00	15.00											11.00		33.00				5.00		15.00				11.00				11.00			0.37	0.17		0.37	0.17	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	218	0		29	10	S5617_218_0	4	3	Preferred Brand	1	2	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											46.13	19	19	19				36.79	16	16	16										19		19				16		16			19			19								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	218	0		29	10	S5617_218_0	4	4	Non-Preferred Brand	1	2	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31											68.34	50	50	50				61.70	48	48	48										50		50				48		48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	218	0		29	10	S5617_218_0	4	5	Specialty Tier	1	2	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31												25	25	25					25	25	25										25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	219	0		29	10	S5617_219_0	4	1	Preferred Generic	1	2	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31								9.00	18.00	27.00					3.00	6.00	9.00											9.00		27.00				3.00		9.00				9.00				9.00			0.30	0.10		0.30	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	219	0		29	10	S5617_219_0	4	2	Generic	1	2	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								11.00	22.00	33.00					5.00	10.00	15.00											11.00		33.00				5.00		15.00				11.00				11.00			0.37	0.17		0.37	0.17	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	219	0		29	10	S5617_219_0	4	4	Non-Preferred Brand	1	2	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31											61.71	50	50	50				56.38	48	48	48										50		50				48		48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	219	0		29	10	S5617_219_0	4	3	Preferred Brand	1	2	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											46.08	19	19	19				34.70	15	15	15										19		19				15		15			19			19								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	219	0		29	10	S5617_219_0	4	5	Specialty Tier	1	2	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31												25	25	25					25	25	25										25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	220	0		29	10	S5617_220_0	4	3	Preferred Brand	1	2	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											46.41	18	18	18				39.82	16	16	16										18		18				16		16			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	220	0		29	10	S5617_220_0	4	4	Non-Preferred Brand	1	2	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31											56.30	50	50	50				50.60	47	47	47										50		50				47		47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	220	0		29	10	S5617_220_0	4	2	Generic	1	2	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								13.00	26.00	39.00					5.00	10.00	15.00											13.00		39.00				5.00		15.00				13.00				13.00			0.43	0.17		0.43	0.17	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	220	0		29	10	S5617_220_0	4	1	Preferred Generic	1	2	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31								8.00	16.00	24.00					2.00	4.00	6.00											8.00		24.00				2.00		6.00				8.00				8.00			0.27	0.07		0.27	0.07	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	220	0		29	10	S5617_220_0	4	5	Specialty Tier	1	2	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31												25	25	25					25	25	25										25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	221	0		29	10	S5617_221_0	4	2	Generic	1	2	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								14.00	28.00	42.00					5.00	10.00	15.00											14.00		42.00				5.00		15.00				14.00				14.00			0.47	0.17		0.47	0.17	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	221	0		29	10	S5617_221_0	4	1	Preferred Generic	1	2	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31								10.00	20.00	30.00					2.00	4.00	6.00											10.00		30.00				2.00		6.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	221	0		29	10	S5617_221_0	4	3	Preferred Brand	1	2	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											45.58	19	19	19				39.36	17	17	17										19		19				17		17			19			19								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	221	0		29	10	S5617_221_0	4	5	Specialty Tier	1	2	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31												25	25	25					25	25	25										25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	221	0		29	10	S5617_221_0	4	4	Non-Preferred Brand	1	2	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31											81.42	50	50	50				73.27	47	47	47										50		50				47		47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	222	0		29	10	S5617_222_0	4	1	Preferred Generic	1	2	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31								8.00	16.00	24.00					2.00	4.00	6.00											8.00		24.00				2.00		6.00				8.00				8.00			0.27	0.07		0.27	0.07	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	222	0		29	10	S5617_222_0	4	2	Generic	1	2	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								12.00	24.00	36.00					5.00	10.00	15.00											12.00		36.00				5.00		15.00				12.00				12.00			0.40	0.17		0.40	0.17	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	222	0		29	10	S5617_222_0	4	4	Non-Preferred Brand	1	2	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31											74.98	50	50	50				65.58	47	47	47										50		50				47		47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	222	0		29	10	S5617_222_0	4	3	Preferred Brand	1	2	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											45.85	18	18	18				38.75	16	16	16										18		18				16		16			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	222	0		29	10	S5617_222_0	4	5	Specialty Tier	1	2	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31												25	25	25					25	25	25										25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	223	0		29	10	S5617_223_0	4	4	Non-Preferred Brand	1	2	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31											88.04	50	50	50				78.87	47	47	47										50		50				47		47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	223	0		29	10	S5617_223_0	4	3	Preferred Brand	1	2	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											46.11	19	19	19				39.73	17	17	17										19		19				17		17			19			19								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	223	0		29	10	S5617_223_0	4	2	Generic	1	2	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	223	0		29	10	S5617_223_0	4	1	Preferred Generic	1	2	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31								11.00	22.00	33.00					2.00	4.00	6.00											11.00		33.00				2.00		6.00				11.00				11.00			0.37	0.07		0.37	0.07	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	223	0		29	10	S5617_223_0	4	5	Specialty Tier	1	2	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31												25	25	25					25	25	25										25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	224	0		29	10	S5617_224_0	4	4	Non-Preferred Brand	1	2	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31											55.94	50	50	50				49.47	47	47	47										50		50				47		47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	224	0		29	10	S5617_224_0	4	3	Preferred Brand	1	2	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											45.31	18	18	18				38.58	16	16	16										18		18				16		16			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	224	0		29	10	S5617_224_0	4	2	Generic	1	2	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								20.00	40.00	60.00					6.00	12.00	18.00											20.00		60.00				6.00		18.00				20.00				20.00			0.67	0.20		0.67	0.20	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	224	0		29	10	S5617_224_0	4	1	Preferred Generic	1	2	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31								10.00	20.00	30.00					2.00	4.00	6.00											10.00		30.00				2.00		6.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	224	0		29	10	S5617_224_0	4	5	Specialty Tier	1	2	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31												25	25	25					25	25	25										25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	225	0		29	10	S5617_225_0	4	4	Non-Preferred Brand	1	2	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31											53.56	50	50	50				48.47	47	47	47										50		50				47		47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	225	0		29	10	S5617_225_0	4	3	Preferred Brand	1	2	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											45.91	18	18	18				39.64	16	16	16										18		18				16		16			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	225	0		29	10	S5617_225_0	4	2	Generic	1	2	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								16.00	32.00	48.00					6.00	12.00	18.00											16.00		48.00				6.00		18.00				16.00				16.00			0.53	0.20		0.53	0.20	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	225	0		29	10	S5617_225_0	4	1	Preferred Generic	1	2	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31								10.00	20.00	30.00					2.00	4.00	6.00											10.00		30.00				2.00		6.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	225	0		29	10	S5617_225_0	4	5	Specialty Tier	1	2	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31												25	25	25					25	25	25										25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	226	0		29	10	S5617_226_0	4	1	Preferred Generic	1	2	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31								10.00	20.00	30.00					2.00	4.00	6.00											10.00		30.00				2.00		6.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	226	0		29	10	S5617_226_0	4	2	Generic	1	2	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								16.00	32.00	48.00					6.00	12.00	18.00											16.00		48.00				6.00		18.00				16.00				16.00			0.53	0.20		0.53	0.20	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	226	0		29	10	S5617_226_0	4	3	Preferred Brand	1	2	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											46.38	18	18	18				39.75	16	16	16										18		18				16		16			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	226	0		29	10	S5617_226_0	4	4	Non-Preferred Brand	1	2	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31											57.99	50	50	50				52.11	47	47	47										50		50				47		47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	226	0		29	10	S5617_226_0	4	5	Specialty Tier	1	2	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31												25	25	25					25	25	25										25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	227	0		29	10	S5617_227_0	6	1	Preferred Generic	1	2	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31								9.00	18.00	27.00					2.00	4.00	6.00											9.00		27.00				2.00		6.00				9.00				9.00			0.30	0.07		0.30	0.07	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	227	0		29	10	S5617_227_0	6	2	Generic	1	2	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								12.00	24.00	36.00					5.00	10.00	15.00											12.00		36.00				5.00		15.00				12.00				12.00			0.40	0.17		0.40	0.17	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	227	0		29	10	S5617_227_0	6	3	Preferred Brand	1	2	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											45.83	18	18	18				37.57	15	15	15										18		18				15		15			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	227	0		29	10	S5617_227_0	6	4	Non-Preferred Brand	1	2	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31											53.70	50	50	50				48.40	46	46	46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	227	0		29	10	S5617_227_0	6	5	Specialty Tier	1	2	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31												25	25	25					25	25	25										25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	246	0		29	10	S5617_246_0	5	4	Non-Preferred Brand	1	4	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31											79.70	50	50	50				66.02	43	43	43										50		50				43		43			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	246	0		29	10	S5617_246_0	5	3	Preferred Brand	1	4	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											24.32	25	25	25				18.19	20	20	20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	246	0		29	10	S5617_246_0	5	2	Generic	1	4	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00		60.00				5.00		15.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	246	0		29	10	S5617_246_0	5	1	Preferred Generic	1	4	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00		45.00				1.00		3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	246	0		29	10	S5617_246_0	5	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31												27	27	27					27	27	27										27		27				27		27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	247	0		29	10	S5617_247_0	4	4	Non-Preferred Brand	1	4	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31											62.17	30	30	30				57.77	29	29	29										30		30				29		29			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	247	0		29	10	S5617_247_0	4	3	Preferred Brand	1	4	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											28.44	25	25	25				21.30	20	20	20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	247	0		29	10	S5617_247_0	4	2	Generic	1	4	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00		60.00				5.00		15.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	247	0		29	10	S5617_247_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00		45.00				1.00		3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	247	0		29	10	S5617_247_0	4	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31												27	27	27					27	27	27										27		27				27		27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	248	0		29	10	S5617_248_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00		45.00				1.00		3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	248	0		29	10	S5617_248_0	4	2	Generic	1	4	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00		60.00				5.00		15.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	248	0		29	10	S5617_248_0	4	3	Preferred Brand	1	4	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											36.15	25	25	25				27.43	20	20	20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	248	0		29	10	S5617_248_0	4	4	Non-Preferred Brand	1	4	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31											65.77	50	50	50				54.42	43	43	43										50		50				43		43			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	248	0		29	10	S5617_248_0	4	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31												27	27	27					27	27	27										27		27				27		27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	249	0		29	10	S5617_249_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00		45.00				1.00		3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	249	0		29	10	S5617_249_0	4	2	Generic	1	4	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00		60.00				5.00		15.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	249	0		29	10	S5617_249_0	4	3	Preferred Brand	1	4	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											29.19	25	25	25				21.89	20	20	20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	249	0		29	10	S5617_249_0	4	4	Non-Preferred Brand	1	4	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31											85.15	50	50	50				70.45	43	43	43										50		50				43		43			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	249	0		29	10	S5617_249_0	4	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31												27	27	27					27	27	27										27		27				27		27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	250	0		29	10	S5617_250_0	4	4	Non-Preferred Brand	1	4	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31											49.56	50	50	50				40.70	43	43	43										50		50				43		43			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	250	0		29	10	S5617_250_0	4	3	Preferred Brand	1	4	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											30.93	25	25	25				22.78	20	20	20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	250	0		29	10	S5617_250_0	4	2	Generic	1	4	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00		60.00				5.00		15.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	250	0		29	10	S5617_250_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00		45.00				1.00		3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	250	0		29	10	S5617_250_0	4	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31												27	27	27					27	27	27										27		27				27		27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	251	0		29	10	S5617_251_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00		45.00				1.00		3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	251	0		29	10	S5617_251_0	4	2	Generic	1	4	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00		60.00				5.00		15.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	251	0		29	10	S5617_251_0	4	3	Preferred Brand	1	4	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											16.04	25	25	25				11.73	20	20	20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	251	0		29	10	S5617_251_0	4	4	Non-Preferred Brand	1	4	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31											55.21	50	50	50				45.16	43	43	43										50		50				43		43			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	251	0		29	10	S5617_251_0	4	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31												27	27	27					27	27	27										27		27				27		27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	252	0		29	10	S5617_252_0	4	4	Non-Preferred Brand	1	4	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31											71.07	50	50	50				57.97	43	43	43										50		50				43		43			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	252	0		29	10	S5617_252_0	4	3	Preferred Brand	1	4	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											25.01	25	25	25				17.60	20	20	20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	252	0		29	10	S5617_252_0	4	2	Generic	1	4	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00		60.00				5.00		15.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	252	0		29	10	S5617_252_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00		45.00				1.00		3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	252	0		29	10	S5617_252_0	4	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31												27	27	27					27	27	27										27		27				27		27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	253	0		29	10	S5617_253_0	4	2	Generic	1	4	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00		60.00				5.00		15.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	253	0		29	10	S5617_253_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00		45.00				1.00		3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	253	0		29	10	S5617_253_0	4	3	Preferred Brand	1	4	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											17.87	25	25	25				12.47	20	20	20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	253	0		29	10	S5617_253_0	4	4	Non-Preferred Brand	1	4	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31											57.49	50	50	50				46.25	43	43	43										50		50				43		43			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	253	0		29	10	S5617_253_0	4	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31												27	27	27					27	27	27										27		27				27		27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	254	0		29	10	S5617_254_0	4	2	Generic	1	4	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00		60.00				5.00		15.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	254	0		29	10	S5617_254_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00		45.00				1.00		3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	254	0		29	10	S5617_254_0	4	3	Preferred Brand	1	4	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											15.18	25	25	25				11.54	20	20	20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	254	0		29	10	S5617_254_0	4	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31												27	27	27					27	27	27										27		27				27		27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	254	0		29	10	S5617_254_0	4	4	Non-Preferred Brand	1	4	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31											86.57	50	50	50				72.09	43	43	43										50		50				43		43			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	255	0		29	10	S5617_255_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00		45.00				1.00		3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	255	0		29	10	S5617_255_0	4	2	Generic	1	4	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00		60.00				5.00		15.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	255	0		29	10	S5617_255_0	4	4	Non-Preferred Brand	1	4	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31											97.72	30	30	30				91.77	29	29	29										30		30				29		29			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	255	0		29	10	S5617_255_0	4	3	Preferred Brand	1	4	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											27.19	25	25	25				19.71	20	20	20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	255	0		29	10	S5617_255_0	4	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31												27	27	27					27	27	27										27		27				27		27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	256	0		29	10	S5617_256_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00		45.00				1.00		3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	256	0		29	10	S5617_256_0	4	2	Generic	1	4	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00		60.00				5.00		15.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	256	0		29	10	S5617_256_0	4	3	Preferred Brand	1	4	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											22.44	25	25	25				16.79	20	20	20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	256	0		29	10	S5617_256_0	4	4	Non-Preferred Brand	1	4	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31											79.31	50	50	50				66.13	43	43	43										50		50				43		43			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	256	0		29	10	S5617_256_0	4	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31												27	27	27					27	27	27										27		27				27		27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	257	0		29	10	S5617_257_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00		45.00				1.00		3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	257	0		29	10	S5617_257_0	4	2	Generic	1	4	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00		60.00				5.00		15.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	257	0		29	10	S5617_257_0	4	3	Preferred Brand	1	4	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											24.17	25	25	25				18.04	20	20	20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	257	0		29	10	S5617_257_0	4	4	Non-Preferred Brand	1	4	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31											71.12	50	50	50				58.94	43	43	43										50		50				43		43			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	257	0		29	10	S5617_257_0	4	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31												27	27	27					27	27	27										27		27				27		27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	258	0		29	10	S5617_258_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00		45.00				1.00		3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	258	0		29	10	S5617_258_0	4	2	Generic	1	4	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00		60.00				5.00		15.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	258	0		29	10	S5617_258_0	4	3	Preferred Brand	1	4	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											22.24	25	25	25				16.73	20	20	20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	258	0		29	10	S5617_258_0	4	4	Non-Preferred Brand	1	4	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31											80.75	50	50	50				66.46	43	43	43										50		50				43		43			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	258	0		29	10	S5617_258_0	4	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31												27	27	27					27	27	27										27		27				27		27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	259	0		29	10	S5617_259_0	4	4	Non-Preferred Brand	1	4	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31											56.92	50	50	50				46.85	43	43	43										50		50				43		43			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	259	0		29	10	S5617_259_0	4	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31												27	27	27					27	27	27										27		27				27		27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	259	0		29	10	S5617_259_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00		45.00				1.00		3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	259	0		29	10	S5617_259_0	4	2	Generic	1	4	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00		60.00				5.00		15.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	259	0		29	10	S5617_259_0	4	3	Preferred Brand	1	4	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											28.71	25	25	25				21.14	20	20	20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	260	0		29	10	S5617_260_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00		45.00				1.00		3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	260	0		29	10	S5617_260_0	4	2	Generic	1	4	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00		60.00				5.00		15.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	260	0		29	10	S5617_260_0	4	3	Preferred Brand	1	4	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											20.14	25	25	25				14.37	20	20	20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	260	0		29	10	S5617_260_0	4	4	Non-Preferred Brand	1	4	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31											51.68	50	50	50				42.35	43	43	43										50		50				43		43			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	260	0		29	10	S5617_260_0	4	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31												27	27	27					27	27	27										27		27				27		27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	261	0		29	10	S5617_261_0	4	4	Non-Preferred Brand	1	4	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31											67.99	50	50	50				56.03	43	43	43										50		50				43		43			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	261	0		29	10	S5617_261_0	4	3	Preferred Brand	1	4	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											26.96	25	25	25				20.21	20	20	20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	261	0		29	10	S5617_261_0	4	2	Generic	1	4	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00		60.00				5.00		15.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	261	0		29	10	S5617_261_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00		45.00				1.00		3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	261	0		29	10	S5617_261_0	4	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31												27	27	27					27	27	27										27		27				27		27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	262	0		29	10	S5617_262_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00		45.00				1.00		3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	262	0		29	10	S5617_262_0	4	2	Generic	1	4	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00		60.00				5.00		15.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	262	0		29	10	S5617_262_0	4	3	Preferred Brand	1	4	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											26.84	25	25	25				18.95	20	20	20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	262	0		29	10	S5617_262_0	4	4	Non-Preferred Brand	1	4	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31											73.01	50	50	50				60.02	43	43	43										50		50				43		43			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	262	0		29	10	S5617_262_0	4	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31												27	27	27					27	27	27										27		27				27		27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	263	0		29	10	S5617_263_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00		45.00				1.00		3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	263	0		29	10	S5617_263_0	4	2	Generic	1	4	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00		60.00				5.00		15.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	263	0		29	10	S5617_263_0	4	3	Preferred Brand	1	4	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											22.66	25	25	25				16.50	20	20	20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	263	0		29	10	S5617_263_0	4	4	Non-Preferred Brand	1	4	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31											48.59	50	50	50				39.92	43	43	43										50		50				43		43			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	263	0		29	10	S5617_263_0	4	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31												27	27	27					27	27	27										27		27				27		27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	264	0		29	10	S5617_264_0	4	4	Non-Preferred Brand	1	4	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31											61.81	50	50	50				50.88	43	43	43										50		50				43		43			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	264	0		29	10	S5617_264_0	4	3	Preferred Brand	1	4	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											23.12	25	25	25				17.24	20	20	20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	264	0		29	10	S5617_264_0	4	2	Generic	1	4	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00		60.00				5.00		15.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	264	0		29	10	S5617_264_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00		45.00				1.00		3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	264	0		29	10	S5617_264_0	4	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31												27	27	27					27	27	27										27		27				27		27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	265	0		29	10	S5617_265_0	4	2	Generic	1	4	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00		60.00				5.00		15.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	265	0		29	10	S5617_265_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00		45.00				1.00		3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	265	0		29	10	S5617_265_0	4	3	Preferred Brand	1	4	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											19.26	25	25	25				14.16	20	20	20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	265	0		29	10	S5617_265_0	4	4	Non-Preferred Brand	1	4	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31											54.37	50	50	50				44.76	43	43	43										50		50				43		43			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	265	0		29	10	S5617_265_0	4	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31												27	27	27					27	27	27										27		27				27		27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	266	0		29	10	S5617_266_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00		45.00				1.00		3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	266	0		29	10	S5617_266_0	4	2	Generic	1	4	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00		60.00				5.00		15.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	266	0		29	10	S5617_266_0	4	3	Preferred Brand	1	4	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											19.49	25	25	25				14.54	20	20	20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	266	0		29	10	S5617_266_0	4	4	Non-Preferred Brand	1	4	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31											62.06	50	50	50				50.83	43	43	43										50		50				43		43			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	266	0		29	10	S5617_266_0	4	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31												27	27	27					27	27	27										27		27				27		27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	267	0		29	10	S5617_267_0	4	2	Generic	1	4	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00		60.00				5.00		15.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	267	0		29	10	S5617_267_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00		45.00				1.00		3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	267	0		29	10	S5617_267_0	4	3	Preferred Brand	1	4	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											18.50	25	25	25				13.18	20	20	20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	267	0		29	10	S5617_267_0	4	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31												27	27	27					27	27	27										27		27				27		27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	267	0		29	10	S5617_267_0	4	4	Non-Preferred Brand	1	4	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31											55.74	50	50	50				45.81	43	43	43										50		50				43		43			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	268	0		29	10	S5617_268_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00		45.00				1.00		3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	268	0		29	10	S5617_268_0	4	2	Generic	1	4	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00		60.00				5.00		15.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	268	0		29	10	S5617_268_0	4	3	Preferred Brand	1	4	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											12.69	25	25	25				9.23	20	20	20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	268	0		29	10	S5617_268_0	4	4	Non-Preferred Brand	1	4	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31											82.32	50	50	50				68.05	43	43	43										50		50				43		43			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	268	0		29	10	S5617_268_0	4	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31												27	27	27					27	27	27										27		27				27		27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	269	0		29	10	S5617_269_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00		45.00				1.00		3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	269	0		29	10	S5617_269_0	4	2	Generic	1	4	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00		60.00				5.00		15.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	269	0		29	10	S5617_269_0	4	4	Non-Preferred Brand	1	4	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31											66.94	50	50	50				55.60	43	43	43										50		50				43		43			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	269	0		29	10	S5617_269_0	4	3	Preferred Brand	1	4	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											26.33	25	25	25				19.56	20	20	20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	269	0		29	10	S5617_269_0	4	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31												27	27	27					27	27	27										27		27				27		27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	270	0		29	10	S5617_270_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00		45.00				1.00		3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	270	0		29	10	S5617_270_0	4	2	Generic	1	4	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00		60.00				5.00		15.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	270	0		29	10	S5617_270_0	4	3	Preferred Brand	1	4	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											18.89	25	25	25				16.84	20	20	20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	270	0		29	10	S5617_270_0	4	4	Non-Preferred Brand	1	4	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31											55.90	50	50	50				47.62	43	43	43										50		50				43		43			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	270	0		29	10	S5617_270_0	4	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31												27	27	27					27	27	27										27		27				27		27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	271	0		29	10	S5617_271_0	4	4	Non-Preferred Brand	1	4	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31											69.64	50	50	50				57.64	43	43	43										50		50				43		43			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	271	0		29	10	S5617_271_0	4	3	Preferred Brand	1	4	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											22.38	25	25	25				16.49	20	20	20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	271	0		29	10	S5617_271_0	4	2	Generic	1	4	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00		60.00				5.00		15.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	271	0		29	10	S5617_271_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00		45.00				1.00		3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	271	0		29	10	S5617_271_0	4	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31												27	27	27					27	27	27										27		27				27		27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	272	0		29	10	S5617_272_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00		45.00				1.00		3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	272	0		29	10	S5617_272_0	4	2	Generic	1	4	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00		60.00				5.00		15.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	272	0		29	10	S5617_272_0	4	3	Preferred Brand	1	4	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											28.43	25	25	25				21.34	20	20	20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	272	0		29	10	S5617_272_0	4	4	Non-Preferred Brand	1	4	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31											68.67	50	50	50				56.57	43	43	43										50		50				43		43			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	272	0		29	10	S5617_272_0	4	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31												27	27	27					27	27	27										27		27				27		27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	273	0		29	10	S5617_273_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00		45.00				1.00		3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	273	0		29	10	S5617_273_0	4	2	Generic	1	4	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00		60.00				5.00		15.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	273	0		29	10	S5617_273_0	4	3	Preferred Brand	1	4	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											22.07	25	25	25				16.17	20	20	20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	273	0		29	10	S5617_273_0	4	4	Non-Preferred Brand	1	4	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31											58.59	50	50	50				48.41	43	43	43										50		50				43		43			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	273	0		29	10	S5617_273_0	4	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31												27	27	27					27	27	27										27		27				27		27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	274	0		29	10	S5617_274_0	4	4	Non-Preferred Brand	1	4	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31											70.22	30	30	30				65.91	29	29	29										30		30				29		29			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	274	0		29	10	S5617_274_0	4	3	Preferred Brand	1	4	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											25.68	25	25	25				19.21	20	20	20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	274	0		29	10	S5617_274_0	4	2	Generic	1	4	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00		60.00				5.00		15.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	274	0		29	10	S5617_274_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00		45.00				1.00		3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	274	0		29	10	S5617_274_0	4	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31												27	27	27					27	27	27										27		27				27		27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	275	0		29	10	S5617_275_0	4	2	Generic	1	4	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00		60.00				5.00		15.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	275	0		29	10	S5617_275_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00		45.00				1.00		3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	275	0		29	10	S5617_275_0	4	3	Preferred Brand	1	4	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											22.40	25	25	25				16.71	20	20	20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	275	0		29	10	S5617_275_0	4	4	Non-Preferred Brand	1	4	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31											62.60	50	50	50				51.79	43	43	43										50		50				43		43			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	275	0		29	10	S5617_275_0	4	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31												27	27	27					27	27	27										27		27				27		27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	276	0		29	10	S5617_276_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00		45.00				1.00		3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	276	0		29	10	S5617_276_0	4	2	Generic	1	4	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00		60.00				5.00		15.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	276	0		29	10	S5617_276_0	4	3	Preferred Brand	1	4	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											21.71	25	25	25				16.02	20	20	20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	276	0		29	10	S5617_276_0	4	4	Non-Preferred Brand	1	4	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31											69.51	50	50	50				57.53	43	43	43										50		50				43		43			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	276	0		29	10	S5617_276_0	4	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31												27	27	27					27	27	27										27		27				27		27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	277	0		29	10	S5617_277_0	4	2	Generic	1	4	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00		60.00				5.00		15.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	277	0		29	10	S5617_277_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00		45.00				1.00		3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	277	0		29	10	S5617_277_0	4	3	Preferred Brand	1	4	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											18.19	25	25	25				12.42	20	20	20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	277	0		29	10	S5617_277_0	4	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31												27	27	27					27	27	27										27		27				27		27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	277	0		29	10	S5617_277_0	4	4	Non-Preferred Brand	1	4	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31											59.36	50	50	50				49.50	43	43	43										50		50				43		43			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	278	0		29	10	S5617_278_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00		45.00				1.00		3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	278	0		29	10	S5617_278_0	4	2	Generic	1	4	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00		60.00				5.00		15.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	278	0		29	10	S5617_278_0	4	3	Preferred Brand	1	4	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											22.99	25	25	25				16.96	20	20	20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	278	0		29	10	S5617_278_0	4	4	Non-Preferred Brand	1	4	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31											72.86	50	50	50				60.34	43	43	43										50		50				43		43			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	278	0		29	10	S5617_278_0	4	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31												27	27	27					27	27	27										27		27				27		27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	279	0		29	10	S5617_279_0	4	1	Preferred Generic	1	4	001000	1	2		111	01		110	1				30	60	90	2				30		90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00		45.00				1.00		3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	279	0		29	10	S5617_279_0	4	2	Generic	1	4	000100	1	2		111	01		110	1				30	60	90	2				30		90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00		60.00				5.00		15.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	279	0		29	10	S5617_279_0	4	4	Non-Preferred Brand	1	4	100100	1	1		111	01		110	1				30	60	90	2				30		90	30		31											70.10	50	50	50				58.03	43	43	43										50		50				43		43			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	279	0		29	10	S5617_279_0	4	3	Preferred Brand	1	4	000101	1	1		111	01		110	1				30	60	90	2				30		90	30		31											22.41	25	25	25				16.52	20	20	20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5617	279	0		29	10	S5617_279_0	4	5	Specialty Tier	1	4	010010	1	1		111	01		110	1				30	60	90	2				30		90	30		31												27	27	27					27	27	27										27		27				27		27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	104	0		29	10	S5660_104_0	1	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	1						90	31		31								5.00		15.00					0.00		0.00													8.00						3.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	104	0		29	10	S5660_104_0	1	2	Generic	1	2	000110	1	2		110	01		100	1				31		90	1						90	31		31								13.00		39.00					5.00		15.00													20.00						15.00				13.00				13.00			0.42	0.16				0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	104	0		29	10	S5660_104_0	1	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	1						90	31		31											34.63	25		25				32.21	23		23												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	104	0		29	10	S5660_104_0	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	1						90	31		31											82.89	50		50				76.78	48		48												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	104	0		29	10	S5660_104_0	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	105	0		29	10	S5660_105_0	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	1						90	31		31											99.11	47		47				94.30	45		45												50						50			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	105	0		29	10	S5660_105_0	1	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	1						90	31		31											45.28	25		25				41.80	23		23												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	105	0		29	10	S5660_105_0	1	2	Generic	1	2	000110	1	2		110	01		100	1				31		90	1						90	31		31								13.00		39.00					5.00		15.00													20.00						15.00				13.00				13.00			0.42	0.16				0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	105	0		29	10	S5660_105_0	1	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	1						90	31		31								5.00		15.00					0.00		0.00													8.00						3.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	105	0		29	10	S5660_105_0	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	106	0		29	10	S5660_106_0	1	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	1						90	31		31								5.00		15.00					0.00		0.00													8.00						3.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	106	0		29	10	S5660_106_0	1	2	Generic	1	2	000110	1	2		110	01		100	1				31		90	1						90	31		31								13.00		39.00					5.00		15.00													20.00						15.00				13.00				13.00			0.42	0.16				0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	106	0		29	10	S5660_106_0	1	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	1						90	31		31											46.67	24		24				42.75	22		22												25						25			24			24								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	106	0		29	10	S5660_106_0	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	1						90	31		31											79.69	50		50				76.45	48		48												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	106	0		29	10	S5660_106_0	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	107	0		29	10	S5660_107_0	1	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	1						90	31		31								5.00		15.00					0.00		0.00													8.00						3.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	107	0		29	10	S5660_107_0	1	2	Generic	1	2	000110	1	2		110	01		100	1				31		90	1						90	31		31								14.00		42.00					6.00		18.00													23.00						18.00				14.00				14.00			0.45	0.19				0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	107	0		29	10	S5660_107_0	1	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	1						90	31		31											45.96	23		23				41.22	21		21												25						25			23			23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	107	0		29	10	S5660_107_0	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	1						90	31		31											86.55	50		50				82.01	48		48												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	107	0		29	10	S5660_107_0	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	108	0		29	10	S5660_108_0	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	1						90	31		31											87.09	50		50				83.25	48		48												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	108	0		29	10	S5660_108_0	1	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	1						90	31		31											45.69	24		24				41.46	22		22												25						25			24			24								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	108	0		29	10	S5660_108_0	1	2	Generic	1	2	000110	1	2		110	01		100	1				31		90	1						90	31		31								12.00		36.00					4.00		12.00													17.00						12.00				12.00				12.00			0.39	0.13				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	108	0		29	10	S5660_108_0	1	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	1						90	31		31								5.00		15.00					0.00		0.00													8.00						3.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	108	0		29	10	S5660_108_0	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	109	0		29	10	S5660_109_0	1	2	Generic	1	2	000110	1	2		110	01		100	1				31		90	1						90	31		31								15.00		45.00					7.00		21.00													26.00						21.00				15.00				15.00			0.48	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	109	0		29	10	S5660_109_0	1	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	1						90	31		31								5.00		15.00					0.00		0.00													8.00						3.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	109	0		29	10	S5660_109_0	1	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	1						90	31		31											46.32	23		23				41.20	21		21												25						25			23			23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	109	0		29	10	S5660_109_0	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	1						90	31		31											88.53	50		50				81.94	48		48												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	109	0		29	10	S5660_109_0	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	110	0		29	10	S5660_110_0	1	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	1						90	31		31								5.00		15.00					0.00		0.00													8.00						3.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	110	0		29	10	S5660_110_0	1	2	Generic	1	2	000110	1	2		110	01		100	1				31		90	1						90	31		31								15.00		45.00					7.00		21.00													26.00						21.00				15.00				15.00			0.48	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	110	0		29	10	S5660_110_0	1	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	1						90	31		31											46.80	25		25				42.50	23		23												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	110	0		29	10	S5660_110_0	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	1						90	31		31											78.03	50		50				73.84	48		48												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	110	0		29	10	S5660_110_0	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	111	0		29	10	S5660_111_0	1	2	Generic	1	2	000110	1	2		110	01		100	1				31		90	1						90	31		31								17.00		51.00					9.00		27.00													32.00						27.00				17.00				17.00			0.55	0.29				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	111	0		29	10	S5660_111_0	1	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	1						90	31		31								5.00		15.00					0.00		0.00													8.00						3.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	111	0		29	10	S5660_111_0	1	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	1						90	31		31											46.36	22		22				40.93	20		20												25						25			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	111	0		29	10	S5660_111_0	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	111	0		29	10	S5660_111_0	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	1						90	31		31											78.16	50		50				72.33	48		48												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	112	0		29	10	S5660_112_0	1	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	1						90	31		31								5.00		15.00					0.00		0.00													8.00						3.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	112	0		29	10	S5660_112_0	1	2	Generic	1	2	000110	1	2		110	01		100	1				31		90	1						90	31		31								19.00		57.00					11.00		33.00													38.00						33.00				19.00				19.00			0.61	0.35				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	112	0		29	10	S5660_112_0	1	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	1						90	31		31											46.50	23		23				40.61	21		21												25						25			23			23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	112	0		29	10	S5660_112_0	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	1						90	31		31											63.03	50		50				56.73	48		48												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	112	0		29	10	S5660_112_0	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	113	0		29	10	S5660_113_0	1	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	1						90	31		31								6.00		18.00					1.00		3.00													8.00						3.00				6.00				6.00			0.19	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	113	0		29	10	S5660_113_0	1	2	Generic	1	2	000110	1	2		110	01		100	1				31		90	1						90	31		31								20.00		60.00					12.00		36.00													41.00						36.00				20.00				20.00			0.65	0.39				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	113	0		29	10	S5660_113_0	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	1						90	31		31											63.49	50		50				61.61	48		48												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	113	0		29	10	S5660_113_0	1	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	1						90	31		31											46.49	23		23				42.15	21		21												25						25			23			23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	113	0		29	10	S5660_113_0	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	114	0		29	10	S5660_114_0	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	114	0		29	10	S5660_114_0	1	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	1						90	31		31								5.00		15.00					0.00		0.00													8.00						3.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	114	0		29	10	S5660_114_0	1	2	Generic	1	2	000110	1	2		110	01		100	1				31		90	1						90	31		31								18.00		54.00					10.00		30.00													35.00						30.00				18.00				18.00			0.58	0.32				0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	114	0		29	10	S5660_114_0	1	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	1						90	31		31											44.99	21		21				39.17	19		19												25						25			21			21								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	114	0		29	10	S5660_114_0	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	1						90	31		31											76.62	50		50				73.52	48		48												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	115	0		29	10	S5660_115_0	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	1						90	31		31											97.79	50		50				94.01	48		48												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	115	0		29	10	S5660_115_0	1	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	1						90	31		31											45.99	23		23				42.00	21		21												25						25			23			23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	115	0		29	10	S5660_115_0	1	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	1						90	31		31								5.00		15.00					0.00		0.00													8.00						3.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	115	0		29	10	S5660_115_0	1	2	Generic	1	2	000110	1	2		110	01		100	1				31		90	1						90	31		31								17.00		51.00					9.00		27.00													32.00						27.00				17.00				17.00			0.55	0.29				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	115	0		29	10	S5660_115_0	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	116	0		29	10	S5660_116_0	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	1						90	31		31											81.12	50		50				75.60	48		48												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	116	0		29	10	S5660_116_0	1	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	1						90	31		31											41.23	25		25				37.88	23		23												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	116	0		29	10	S5660_116_0	1	2	Generic	1	2	000110	1	2		110	01		100	1				31		90	1						90	31		31								15.00		45.00					7.00		21.00													26.00						21.00				15.00				15.00			0.48	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	116	0		29	10	S5660_116_0	1	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	1						90	31		31								5.00		15.00					0.00		0.00													8.00						3.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	116	0		29	10	S5660_116_0	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	117	0		29	10	S5660_117_0	1	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	1						90	31		31								5.00		15.00					0.00		0.00													8.00						3.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	117	0		29	10	S5660_117_0	1	2	Generic	1	2	000110	1	2		110	01		100	1				31		90	1						90	31		31								17.00		51.00					9.00		27.00													32.00						27.00				17.00				17.00			0.55	0.29				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	117	0		29	10	S5660_117_0	1	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	1						90	31		31											45.09	22		22				40.63	20		20												25						25			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	117	0		29	10	S5660_117_0	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	1						90	31		31											76.87	50		50				72.90	48		48												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	117	0		29	10	S5660_117_0	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	118	0		29	10	S5660_118_0	1	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	1						90	31		31								5.00		15.00					0.00		0.00													8.00						3.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	118	0		29	10	S5660_118_0	1	2	Generic	1	2	000110	1	2		110	01		100	1				31		90	1						90	31		31								19.00		57.00					11.00		33.00													38.00						33.00				19.00				19.00			0.61	0.35				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	118	0		29	10	S5660_118_0	1	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	1						90	31		31											37.85	25		25				35.18	23		23												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	118	0		29	10	S5660_118_0	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	1						90	31		31											98.61	48		48				88.25	46		46												50						50			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	118	0		29	10	S5660_118_0	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	119	0		29	10	S5660_119_0	1	2	Generic	1	2	000110	1	2		110	01		100	1				31		90	1						90	31		31								18.00		54.00					10.00		30.00													35.00						30.00				18.00				18.00			0.58	0.32				0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	119	0		29	10	S5660_119_0	1	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	1						90	31		31								5.00		15.00					0.00		0.00													8.00						3.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	119	0		29	10	S5660_119_0	1	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	1						90	31		31											39.46	25		25				36.46	23		23												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	119	0		29	10	S5660_119_0	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	119	0		29	10	S5660_119_0	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	1						90	31		31											74.20	50		50				69.20	48		48												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	120	0		29	10	S5660_120_0	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	1						90	31		31											73.78	50		50				70.41	48		48												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	120	0		29	10	S5660_120_0	1	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	1						90	31		31											42.17	25		25				38.64	23		23												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	120	0		29	10	S5660_120_0	1	2	Generic	1	2	000110	1	2		110	01		100	1				31		90	1						90	31		31								19.00		57.00					11.00		33.00													38.00						33.00				19.00				19.00			0.61	0.35				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	120	0		29	10	S5660_120_0	1	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	1						90	31		31								5.00		15.00					0.00		0.00													8.00						3.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	120	0		29	10	S5660_120_0	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	121	0		29	10	S5660_121_0	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	1						90	31		31											87.80	50		50				82.51	48		48												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	121	0		29	10	S5660_121_0	1	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	1						90	31		31											46.76	22		22				41.23	20		20												25						25			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	121	0		29	10	S5660_121_0	1	2	Generic	1	2	000110	1	2		110	01		100	1				31		90	1						90	31		31								18.00		54.00					10.00		30.00													35.00						30.00				18.00				18.00			0.58	0.32				0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	121	0		29	10	S5660_121_0	1	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	1						90	31		31								5.00		15.00					0.00		0.00													8.00						3.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	121	0		29	10	S5660_121_0	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	122	0		29	10	S5660_122_0	1	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	1						90	31		31								5.00		15.00					0.00		0.00													8.00						3.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	122	0		29	10	S5660_122_0	1	2	Generic	1	2	000110	1	2		110	01		100	1				31		90	1						90	31		31								19.00		57.00					11.00		33.00													38.00						33.00				19.00				19.00			0.61	0.35				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	122	0		29	10	S5660_122_0	1	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	1						90	31		31											44.90	25		25				40.48	23		23												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	122	0		29	10	S5660_122_0	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	1						90	31		31											84.20	50		50				77.52	48		48												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	122	0		29	10	S5660_122_0	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	123	0		29	10	S5660_123_0	1	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	1						90	31		31								5.00		15.00					0.00		0.00													8.00						3.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	123	0		29	10	S5660_123_0	1	2	Generic	1	2	000110	1	2		110	01		100	1				31		90	1						90	31		31								17.00		51.00					9.00		27.00													32.00						27.00				17.00				17.00			0.55	0.29				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	123	0		29	10	S5660_123_0	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	1						90	31		31											74.70	50		50				70.91	48		48												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	123	0		29	10	S5660_123_0	1	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	1						90	31		31											46.94	22		22				42.34	20		20												25						25			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	123	0		29	10	S5660_123_0	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	124	0		29	10	S5660_124_0	1	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	1						90	31		31								5.00		15.00					0.00		0.00													8.00						3.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	124	0		29	10	S5660_124_0	1	2	Generic	1	2	000110	1	2		110	01		100	1				31		90	1						90	31		31								17.00		51.00					9.00		27.00													32.00						27.00				17.00				17.00			0.55	0.29				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	124	0		29	10	S5660_124_0	1	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	1						90	31		31											47.00	25		25				42.60	23		23												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	124	0		29	10	S5660_124_0	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	1						90	31		31											69.56	50		50				66.46	48		48												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	124	0		29	10	S5660_124_0	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	125	0		29	10	S5660_125_0	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	1						90	31		31											94.00	50		50				88.41	48		48												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	125	0		29	10	S5660_125_0	1	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	1						90	31		31								5.00		15.00					0.00		0.00													8.00						3.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	125	0		29	10	S5660_125_0	1	2	Generic	1	2	000110	1	2		110	01		100	1				31		90	1						90	31		31								11.00		33.00					3.00		9.00													14.00						9.00				11.00				11.00			0.35	0.10				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	125	0		29	10	S5660_125_0	1	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	1						90	31		31											44.59	25		25				40.54	23		23												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	125	0		29	10	S5660_125_0	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	126	0		29	10	S5660_126_0	1	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	1						90	31		31								5.00		15.00					0.00		0.00													8.00						3.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	126	0		29	10	S5660_126_0	1	2	Generic	1	2	000110	1	2		110	01		100	1				31		90	1						90	31		31								16.00		48.00					8.00		24.00													29.00						24.00				16.00				16.00			0.52	0.26				0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	126	0		29	10	S5660_126_0	1	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	1						90	31		31											43.97	25		25				38.62	23		23												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	126	0		29	10	S5660_126_0	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	1						90	31		31											83.53	50		50				79.89	48		48												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	126	0		29	10	S5660_126_0	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	127	0		29	10	S5660_127_0	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	127	0		29	10	S5660_127_0	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	1						90	31		31											61.69	50		50				57.74	48		48												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	127	0		29	10	S5660_127_0	1	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	1						90	31		31											38.32	25		25				34.65	23		23												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	127	0		29	10	S5660_127_0	1	2	Generic	1	2	000110	1	2		110	01		100	1				31		90	1						90	31		31								19.00		57.00					11.00		33.00													38.00						33.00				19.00				19.00			0.61	0.35				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	127	0		29	10	S5660_127_0	1	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	1						90	31		31								5.00		15.00					0.00		0.00													8.00						3.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	128	0		29	10	S5660_128_0	1	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	1						90	31		31											46.48	25		25				41.81	23		23												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	128	0		29	10	S5660_128_0	1	2	Generic	1	2	000110	1	2		110	01		100	1				31		90	1						90	31		31								16.00		48.00					8.00		24.00													29.00						24.00				16.00				16.00			0.52	0.26				0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	128	0		29	10	S5660_128_0	1	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	1						90	31		31								5.00		15.00					0.00		0.00													8.00						3.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	128	0		29	10	S5660_128_0	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	128	0		29	10	S5660_128_0	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	1						90	31		31											89.64	50		50				80.53	48		48												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	129	0		29	10	S5660_129_0	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	1						90	31		31											98.57	50		50				98.66	48		48												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	129	0		29	10	S5660_129_0	1	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	1						90	31		31								5.00		15.00					0.00		0.00													8.00						3.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	129	0		29	10	S5660_129_0	1	2	Generic	1	2	000110	1	2		110	01		100	1				31		90	1						90	31		31								16.00		48.00					8.00		24.00													29.00						24.00				16.00				16.00			0.52	0.26				0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	129	0		29	10	S5660_129_0	1	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	1						90	31		31											40.19	25		25				36.64	23		23												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	129	0		29	10	S5660_129_0	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	130	0		29	10	S5660_130_0	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	130	0		29	10	S5660_130_0	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	1						90	31		31											90.89	50		50				95.51	48		48												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	130	0		29	10	S5660_130_0	1	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	1						90	31		31											43.72	25		25				38.59	23		23												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	130	0		29	10	S5660_130_0	1	2	Generic	1	2	000110	1	2		110	01		100	1				31		90	1						90	31		31								14.00		42.00					6.00		18.00													23.00						18.00				14.00				14.00			0.45	0.19				0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	130	0		29	10	S5660_130_0	1	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	1						90	31		31								5.00		15.00					0.00		0.00													8.00						3.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	131	0		29	10	S5660_131_0	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	131	0		29	10	S5660_131_0	1	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	1						90	31		31								5.00		15.00					0.00		0.00													8.00						3.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	131	0		29	10	S5660_131_0	1	2	Generic	1	2	000110	1	2		110	01		100	1				31		90	1						90	31		31								17.00		51.00					9.00		27.00													32.00						27.00				17.00				17.00			0.55	0.29				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	131	0		29	10	S5660_131_0	1	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	1						90	31		31											46.66	25		25				40.09	23		23												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	131	0		29	10	S5660_131_0	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	1						90	31		31											92.43	50		50				80.13	48		48												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	132	0		29	10	S5660_132_0	1	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	1						90	31		31											38.56	25		25				35.95	23		23												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	132	0		29	10	S5660_132_0	1	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	1						90	31		31								5.00		15.00					0.00		0.00													8.00						3.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	132	0		29	10	S5660_132_0	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	132	0		29	10	S5660_132_0	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	1						90	31		31											95.80	50		50				91.13	48		48												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	132	0		29	10	S5660_132_0	1	2	Generic	1	2	000110	1	2		110	01		100	1				31		90	1						90	31		31								14.00		42.00					6.00		18.00													23.00						18.00				14.00				14.00			0.45	0.19				0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	133	0		29	10	S5660_133_0	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	1						90	31		31											90.60	50		50				86.77	48		48												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	133	0		29	10	S5660_133_0	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	133	0		29	10	S5660_133_0	1	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	1						90	31		31											45.51	22		22				40.49	20		20												25						25			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	133	0		29	10	S5660_133_0	1	2	Generic	1	2	000110	1	2		110	01		100	1				31		90	1						90	31		31								17.00		51.00					9.00		27.00													32.00						27.00				17.00				17.00			0.55	0.29				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	133	0		29	10	S5660_133_0	1	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	1						90	31		31								5.00		15.00					0.00		0.00													8.00						3.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	134	0		29	10	S5660_134_0	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	134	0		29	10	S5660_134_0	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	1						90	31		31											75.18	50		50				72.23	48		48												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	134	0		29	10	S5660_134_0	1	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	1						90	31		31											45.38	24		24				41.75	22		22												25						25			24			24								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	134	0		29	10	S5660_134_0	1	2	Generic	1	2	000110	1	2		110	01		100	1				31		90	1						90	31		31								19.00		57.00					11.00		33.00													38.00						33.00				19.00				19.00			0.61	0.35				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	134	0		29	10	S5660_134_0	1	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	1						90	31		31								5.00		15.00					0.00		0.00													8.00						3.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	135	0		29	10	S5660_135_0	1	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	1						90	31		31								5.00		15.00					0.00		0.00													8.00						3.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	135	0		29	10	S5660_135_0	1	2	Generic	1	2	000110	1	2		110	01		100	1				31		90	1						90	31		31								14.00		42.00					6.00		18.00													23.00						18.00				14.00				14.00			0.45	0.19				0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	135	0		29	10	S5660_135_0	1	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	1						90	31		31											43.33	25		25				40.22	23		23												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	135	0		29	10	S5660_135_0	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	1						90	31		31											81.86	50		50				78.91	48		48												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	135	0		29	10	S5660_135_0	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	136	0		29	10	S5660_136_0	1	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	1						90	31		31								5.00		15.00					0.00		0.00													8.00						3.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	136	0		29	10	S5660_136_0	1	2	Generic	1	2	000110	1	2		110	01		100	1				31		90	1						90	31		31								10.00		30.00					2.00		6.00													11.00						6.00				10.00				10.00			0.32	0.06				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	136	0		29	10	S5660_136_0	1	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	1						90	31		31											37.23	25		25				34.49	23		23												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	136	0		29	10	S5660_136_0	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	1						90	31		31											63.81	50		50				59.90	48		48												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	136	0		29	10	S5660_136_0	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	137	0		29	10	S5660_137_0	1	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				31		90	1						90	31		31								5.00		15.00					0.00		0.00													8.00						3.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	137	0		29	10	S5660_137_0	1	2	Generic	1	2	000110	1	2		110	01		100	1				31		90	1						90	31		31								20.00		60.00					12.00		36.00													41.00						36.00				20.00				20.00			0.65	0.39				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	137	0		29	10	S5660_137_0	1	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				31							31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	137	0		29	10	S5660_137_0	1	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				31		90	1						90	31		31											76.68	50		50				68.24	48		48												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	137	0		29	10	S5660_137_0	1	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				31		90	1						90	31		31											44.72	25		25				38.60	23		23												25						25			25			25								Preferred Generic, 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	1						90	31		31								10.00		30.00					1.00		3.00													5.00						0.00				10.00				10.00			0.32	0.03				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	172	0		29	10	S5660_172_0	2	2	Generic	1	4	000110	1	2		110	01		100	1				31		90	1						90	31		31								20.00		60.00					5.00		15.00													10.00						5.00				20.00				20.00			0.65	0.16				0.65	Preferred Generic, 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	1						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, 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	1						90	31		31											97.73	29		29				91.27	27		27												29						29			29			29								Preferred Generic, 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												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	176	0		29	10	S5660_176_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	1						90	31		31								10.00		30.00					1.00		3.00													5.00						0.00				10.00				10.00			0.32	0.03				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	176	0		29	10	S5660_176_0	1	2	Generic	1	4	000110	1	2		110	01		100	1				31		90	1						90	31		31								20.00		60.00					5.00		15.00													10.00						5.00				20.00				20.00			0.65	0.16				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	176	0		29	10	S5660_176_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	1						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	176	0		29	10	S5660_176_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				31		90	1						90	31		31											85.61	50		50				83.56	48		48												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	176	0		29	10	S5660_176_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	180	0		29	10	S5660_180_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	1						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	180	0		29	10	S5660_180_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				31		90	1						90	31		31											86.12	50		50				82.08	48		48												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	180	0		29	10	S5660_180_0	1	2	Generic	1	4	000110	1	2		110	01		100	1				31		90	1						90	31		31								20.00		60.00					5.00		15.00													10.00						5.00				20.00				20.00			0.65	0.16				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	180	0		29	10	S5660_180_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	1						90	31		31								10.00		30.00					1.00		3.00													5.00						0.00				10.00				10.00			0.32	0.03				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	180	0		29	10	S5660_180_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	181	0		29	10	S5660_181_0	1	2	Generic	1	4	000110	1	2		110	01		100	1				31		90	1						90	31		31								20.00		60.00					5.00		15.00													10.00						5.00				20.00				20.00			0.65	0.16				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	181	0		29	10	S5660_181_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	1						90	31		31								10.00		30.00					1.00		3.00													5.00						0.00				10.00				10.00			0.32	0.03				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	181	0		29	10	S5660_181_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	1						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	181	0		29	10	S5660_181_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	181	0		29	10	S5660_181_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				31		90	1						90	31		31											93.40	50		50				88.46	48		48												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	182	0		29	10	S5660_182_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	1						90	31		31								10.00		30.00					1.00		3.00													5.00						0.00				10.00				10.00			0.32	0.03				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	182	0		29	10	S5660_182_0	1	2	Generic	1	4	000110	1	2		110	01		100	1				31		90	1						90	31		31								20.00		60.00					5.00		15.00													10.00						5.00				20.00				20.00			0.65	0.16				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	182	0		29	10	S5660_182_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				31		90	1						90	31		31											99.68	36		36				90.88	34		34												36						36			36			36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	182	0		29	10	S5660_182_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	1						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	182	0		29	10	S5660_182_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	183	0		29	10	S5660_183_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				31		90	1						90	31		31											99.33	27		27				91.74	25		25												27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	183	0		29	10	S5660_183_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	1						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	183	0		29	10	S5660_183_0	1	2	Generic	1	4	000110	1	2		110	01		100	1				31		90	1						90	31		31								20.00		60.00					5.00		15.00													10.00						5.00				20.00				20.00			0.65	0.16				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	183	0		29	10	S5660_183_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	1						90	31		31								10.00		30.00					1.00		3.00													5.00						0.00				10.00				10.00			0.32	0.03				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	183	0		29	10	S5660_183_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	184	0		29	10	S5660_184_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				31		90	1						90	31		31											97.67	50		50				90.62	48		48												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	184	0		29	10	S5660_184_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	1						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	184	0		29	10	S5660_184_0	1	2	Generic	1	4	000110	1	2		110	01		100	1				31		90	1						90	31		31								20.00		60.00					5.00		15.00													10.00						5.00				20.00				20.00			0.65	0.16				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	184	0		29	10	S5660_184_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	1						90	31		31								10.00		30.00					1.00		3.00													5.00						0.00				10.00				10.00			0.32	0.03				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	184	0		29	10	S5660_184_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	185	0		29	10	S5660_185_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				31		90	1						90	31		31											98.32	46		46				92.32	44		44												46						46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	185	0		29	10	S5660_185_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	1						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	185	0		29	10	S5660_185_0	1	2	Generic	1	4	000110	1	2		110	01		100	1				31		90	1						90	31		31								20.00		60.00					5.00		15.00													10.00						5.00				20.00				20.00			0.65	0.16				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	185	0		29	10	S5660_185_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	1						90	31		31								10.00		30.00					1.00		3.00													5.00						0.00				10.00				10.00			0.32	0.03				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	185	0		29	10	S5660_185_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	186	0		29	10	S5660_186_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	1						90	31		31								10.00		30.00					1.00		3.00													5.00						0.00				10.00				10.00			0.32	0.03				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	186	0		29	10	S5660_186_0	1	2	Generic	1	4	000110	1	2		110	01		100	1				31		90	1						90	31		31								20.00		60.00					5.00		15.00													10.00						5.00				20.00				20.00			0.65	0.16				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	186	0		29	10	S5660_186_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	1						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	186	0		29	10	S5660_186_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				31		90	1						90	31		31											99.90	33		33				96.30	31		31												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	186	0		29	10	S5660_186_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	187	0		29	10	S5660_187_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	1						90	31		31								10.00		30.00					1.00		3.00													5.00						0.00				10.00				10.00			0.32	0.03				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	187	0		29	10	S5660_187_0	1	2	Generic	1	4	000110	1	2		110	01		100	1				31		90	1						90	31		31								20.00		60.00					5.00		15.00													10.00						5.00				20.00				20.00			0.65	0.16				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	187	0		29	10	S5660_187_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	1						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	187	0		29	10	S5660_187_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				31		90	1						90	31		31											88.91	50		50				85.52	48		48												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	187	0		29	10	S5660_187_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	190	0		29	10	S5660_190_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	1						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	190	0		29	10	S5660_190_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				31		90	1						90	31		31											97.21	34		34				91.51	32		32												34						34			34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	190	0		29	10	S5660_190_0	1	2	Generic	1	4	000110	1	2		110	01		100	1				31		90	1						90	31		31								20.00		60.00					5.00		15.00													10.00						5.00				20.00				20.00			0.65	0.16				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	190	0		29	10	S5660_190_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	1						90	31		31								10.00		30.00					1.00		3.00													5.00						0.00				10.00				10.00			0.32	0.03				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	190	0		29	10	S5660_190_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	192	0		29	10	S5660_192_0	1	2	Generic	1	4	000110	1	2		110	01		100	1				31		90	1						90	31		31								20.00		60.00					5.00		15.00													10.00						5.00				20.00				20.00			0.65	0.16				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	192	0		29	10	S5660_192_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	1						90	31		31								10.00		30.00					1.00		3.00													5.00						0.00				10.00				10.00			0.32	0.03				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	192	0		29	10	S5660_192_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	1						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	192	0		29	10	S5660_192_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	192	0		29	10	S5660_192_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				31		90	1						90	31		31											99.17	43		43				94.58	41		41												43						43			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	194	0		29	10	S5660_194_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	1						90	31		31								10.00		30.00					1.00		3.00													5.00						0.00				10.00				10.00			0.32	0.03				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	194	0		29	10	S5660_194_0	1	2	Generic	1	4	000110	1	2		110	01		100	1				31		90	1						90	31		31								20.00		60.00					5.00		15.00													10.00						5.00				20.00				20.00			0.65	0.16				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	194	0		29	10	S5660_194_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				31		90	1						90	31		31											99.49	48		48				94.66	46		46												48						48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	194	0		29	10	S5660_194_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	1						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	194	0		29	10	S5660_194_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	195	0		29	10	S5660_195_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				31		90	1						90	31		31											97.99	46		46				93.72	44		44												46						46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	195	0		29	10	S5660_195_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	1						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	195	0		29	10	S5660_195_0	1	2	Generic	1	4	000110	1	2		110	01		100	1				31		90	1						90	31		31								20.00		60.00					5.00		15.00													10.00						5.00				20.00				20.00			0.65	0.16				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	195	0		29	10	S5660_195_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	1						90	31		31								10.00		30.00					1.00		3.00													5.00						0.00				10.00				10.00			0.32	0.03				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	195	0		29	10	S5660_195_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	196	0		29	10	S5660_196_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				31		90	1						90	31		31											97.02	29		29				90.78	27		27												29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	196	0		29	10	S5660_196_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	1						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	196	0		29	10	S5660_196_0	1	2	Generic	1	4	000110	1	2		110	01		100	1				31		90	1						90	31		31								20.00		60.00					5.00		15.00													10.00						5.00				20.00				20.00			0.65	0.16				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	196	0		29	10	S5660_196_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	1						90	31		31								10.00		30.00					1.00		3.00													5.00						0.00				10.00				10.00			0.32	0.03				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	196	0		29	10	S5660_196_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	197	0		29	10	S5660_197_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				31		90	1						90	31		31											98.37	47		47				93.47	45		45												47						47			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	197	0		29	10	S5660_197_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	1						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	197	0		29	10	S5660_197_0	1	2	Generic	1	4	000110	1	2		110	01		100	1				31		90	1						90	31		31								20.00		60.00					5.00		15.00													10.00						5.00				20.00				20.00			0.65	0.16				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	197	0		29	10	S5660_197_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	1						90	31		31								10.00		30.00					1.00		3.00													5.00						0.00				10.00				10.00			0.32	0.03				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	197	0		29	10	S5660_197_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	198	0		29	10	S5660_198_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	1						90	31		31								10.00		30.00					1.00		3.00													5.00						0.00				10.00				10.00			0.32	0.03				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	198	0		29	10	S5660_198_0	1	2	Generic	1	4	000110	1	2		110	01		100	1				31		90	1						90	31		31								20.00		60.00					5.00		15.00													10.00						5.00				20.00				20.00			0.65	0.16				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	198	0		29	10	S5660_198_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	1						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	198	0		29	10	S5660_198_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				31		90	1						90	31		31											96.50	50		50				89.79	48		48												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	198	0		29	10	S5660_198_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	199	0		29	10	S5660_199_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	1						90	31		31								10.00		30.00					1.00		3.00													5.00						0.00				10.00				10.00			0.32	0.03				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	199	0		29	10	S5660_199_0	1	2	Generic	1	4	000110	1	2		110	01		100	1				31		90	1						90	31		31								20.00		60.00					5.00		15.00													10.00						5.00				20.00				20.00			0.65	0.16				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	199	0		29	10	S5660_199_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	1						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	199	0		29	10	S5660_199_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				31		90	1						90	31		31											98.59	35		35				92.95	33		33												35						35			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	199	0		29	10	S5660_199_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	202	0		29	10	S5660_202_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	1						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	202	0		29	10	S5660_202_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				31		90	1						90	31		31											98.82	37		37				92.37	35		35												37						37			37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	202	0		29	10	S5660_202_0	1	2	Generic	1	4	000110	1	2		110	01		100	1				31		90	1						90	31		31								20.00		60.00					5.00		15.00													10.00						5.00				20.00				20.00			0.65	0.16				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	202	0		29	10	S5660_202_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	1						90	31		31								10.00		30.00					1.00		3.00													5.00						0.00				10.00				10.00			0.32	0.03				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	202	0		29	10	S5660_202_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	203	0		29	10	S5660_203_0	1	2	Generic	1	4	000110	1	2		110	01		100	1				31		90	1						90	31		31								20.00		60.00					5.00		15.00													10.00						5.00				20.00				20.00			0.65	0.16				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	203	0		29	10	S5660_203_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	1						90	31		31								10.00		30.00					1.00		3.00													5.00						0.00				10.00				10.00			0.32	0.03				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	203	0		29	10	S5660_203_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	1						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	203	0		29	10	S5660_203_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	203	0		29	10	S5660_203_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				31		90	1						90	31		31											98.25	42		42				90.59	40		40												42						42			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	204	0		29	10	S5660_204_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	1						90	31		31								10.00		30.00					1.00		3.00													5.00						0.00				10.00				10.00			0.32	0.03				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	204	0		29	10	S5660_204_0	1	2	Generic	1	4	000110	1	2		110	01		100	1				31		90	1						90	31		31								20.00		60.00					5.00		15.00													10.00						5.00				20.00				20.00			0.65	0.16				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	204	0		29	10	S5660_204_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				31		90	1						90	31		31											98.05	34		34				94.25	32		32												34						34			34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	204	0		29	10	S5660_204_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	1						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	204	0		29	10	S5660_204_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	205	0		29	10	S5660_205_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				31		90	1						90	31		31											98.07	45		45				93.71	43		43												45						45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	205	0		29	10	S5660_205_0	1	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				31		90	1						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	205	0		29	10	S5660_205_0	1	2	Generic	1	4	000110	1	2		110	01		100	1				31		90	1						90	31		31								20.00		60.00					5.00		15.00													10.00						5.00				20.00				20.00			0.65	0.16				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	205	0		29	10	S5660_205_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				31		90	1						90	31		31								10.00		30.00					1.00		3.00													5.00						0.00				10.00				10.00			0.32	0.03				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	205	0		29	10	S5660_205_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				31							31			31		31												25							25												25						25					25			25								Preferred Generic, 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	1						90	31		31											98.95	45		45				93.91	43		43												45						45			45			45								Preferred Generic, 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	1						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	206	0		29	10	S5660_206_0	1	2	Generic	1	4	000110	1	2		110	01		100	1				31		90	1						90	31		31								20.00		60.00					5.00		15.00													10.00						5.00				20.00				20.00			0.65	0.16				0.65	Preferred Generic, 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	1						90	31		31								10.00		30.00					1.00		3.00													5.00						0.00				10.00				10.00			0.32	0.03				0.32	Preferred Generic, 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												25							25												25						25					25			25								Preferred Generic, 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	1						90	31		31											99.92	44		44				95.00	42		42												44						44			44			44								Preferred Generic, 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	1						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	207	0		29	10	S5660_207_0	1	2	Generic	1	4	000110	1	2		110	01		100	1				31		90	1						90	31		31								20.00		60.00					5.00		15.00													10.00						5.00				20.00				20.00			0.65	0.16				0.65	Preferred Generic, 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	1						90	31		31								10.00		30.00					1.00		3.00													5.00						0.00				10.00				10.00			0.32	0.03				0.32	Preferred Generic, 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												25							25												25						25					25			25								Preferred Generic, 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	1						90	31		31								10.00		30.00					1.00		3.00													5.00						0.00				10.00				10.00			0.32	0.03				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	208	0		29	10	S5660_208_0	1	2	Generic	1	4	000110	1	2		110	01		100	1				31		90	1						90	31		31								20.00		60.00					5.00		15.00													10.00						5.00				20.00				20.00			0.65	0.16				0.65	Preferred Generic, 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	1						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, 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	1						90	31		31											73.83	50		50				69.09	48		48												50						50			50			50								Preferred Generic, 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												25							25												25						25					25			25								Preferred Generic, 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	1						90	31		31								10.00		30.00					1.00		3.00													5.00						0.00				10.00				10.00			0.32	0.03				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	209	0		29	10	S5660_209_0	1	2	Generic	1	4	000110	1	2		110	01		100	1				31		90	1						90	31		31								20.00		60.00					5.00		15.00													10.00						5.00				20.00				20.00			0.65	0.16				0.65	Preferred Generic, 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	1						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, 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	1						90	31		31											80.85	50		50				75.39	48		48												50						50			50			50								Preferred Generic, 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												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	210	0		29	10	S5660_210_0	1	2	Generic	1	4	000110	1	2		110	01		100	1				31		90	1						90	31		31								20.00		60.00					5.00		15.00													10.00						5.00				20.00				20.00			0.65	0.16				0.65	Preferred Generic, 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	1						90	31		31								10.00		30.00					1.00		3.00													5.00						0.00				10.00				10.00			0.32	0.03				0.32	Preferred Generic, 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	1						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, 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	1						90	31		31											76.96	50		50				70.97	48		48												50						50			50			50								Preferred Generic, 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												25							25												25						25					25			25								Preferred Generic, 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	1						90	31		31								10.00		30.00					1.00		3.00													5.00						0.00				10.00				10.00			0.32	0.03				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	211	0		29	10	S5660_211_0	1	2	Generic	1	4	000110	1	2		110	01		100	1				31		90	1						90	31		31								20.00		60.00					5.00		15.00													10.00						5.00				20.00				20.00			0.65	0.16				0.65	Preferred Generic, 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	1						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, 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	1						90	31		31											99.96	50		50				92.38	48		48												50						50			50			50								Preferred Generic, 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												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	212	0		29	10	S5660_212_0	1	2	Generic	1	4	000110	1	2		110	01		100	1				31		90	1						90	31		31								20.00		60.00					5.00		15.00													10.00						5.00				20.00				20.00			0.65	0.16				0.65	Preferred Generic, 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	1						90	31		31								10.00		30.00					1.00		3.00													5.00						0.00				10.00				10.00			0.32	0.03				0.32	Preferred Generic, 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	1						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, 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												25							25												25						25					25			25								Preferred Generic, 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	1						90	31		31											86.65	50		50				75.68	48		48												50						50			50			50								Preferred Generic, 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	1						90	31		31								10.00		30.00					1.00		3.00													5.00						0.00				10.00				10.00			0.32	0.03				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	213	0		29	10	S5660_213_0	1	2	Generic	1	4	000110	1	2		110	01		100	1				31		90	1						90	31		31								20.00		60.00					5.00		15.00													10.00						5.00				20.00				20.00			0.65	0.16				0.65	Preferred Generic, 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	1						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, 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	1						90	31		31											61.55	50		50				57.30	48		48												50						50			50			50								Preferred Generic, 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												25							25												25						25					25			25								Preferred Generic, 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	1						90	31		31								10.00		30.00					1.00		3.00													5.00						0.00				10.00				10.00			0.32	0.03				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	214	0		29	10	S5660_214_0	1	2	Generic	1	4	000110	1	2		110	01		100	1				31		90	1						90	31		31								20.00		60.00					5.00		15.00													10.00						5.00				20.00				20.00			0.65	0.16				0.65	Preferred Generic, 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	1						90	31		31											93.84	50		50				86.10	48		48												50						50			50			50								Preferred Generic, 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	1						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, 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												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	215	0		29	10	S5660_215_0	1	2	Generic	1	4	000110	1	2		110	01		100	1				31		90	1						90	31		31								20.00		60.00					5.00		15.00													10.00						5.00				20.00				20.00			0.65	0.16				0.65	Preferred Generic, 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	1						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, 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	1						90	31		31											64.09	50		50				60.05	48		48												50						50			50			50								Preferred Generic, 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												25							25												25						25					25			25								Preferred Generic, 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	1						90	31		31								10.00		30.00					1.00		3.00													5.00						0.00				10.00				10.00			0.32	0.03				0.32	Preferred Generic, 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	1						90	31		31								10.00		30.00					1.00		3.00													5.00						0.00				10.00				10.00			0.32	0.03				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	216	0		29	10	S5660_216_0	1	2	Generic	1	4	000110	1	2		110	01		100	1				31		90	1						90	31		31								20.00		60.00					5.00		15.00													10.00						5.00				20.00				20.00			0.65	0.16				0.65	Preferred Generic, 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	1						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, 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	1						90	31		31											84.72	50		50				78.76	48		48												50						50			50			50								Preferred Generic, 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												25							25												25						25					25			25								Preferred Generic, 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	1						90	31		31								10.00		30.00					1.00		3.00													5.00						0.00				10.00				10.00			0.32	0.03				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5660	217	0		29	10	S5660_217_0	1	2	Generic	1	4	000110	1	2		110	01		100	1				31		90	1						90	31		31								20.00		60.00					5.00		15.00													10.00						5.00				20.00				20.00			0.65	0.16				0.65	Preferred Generic, 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	1						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, 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	1						90	31		31											75.18	50		50				71.18	48		48												50						50			50			50								Preferred Generic, 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												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	001	0		29	10	S5715_001_0	2	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31								100.00		300.00					95.00		285.00							300.00																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	001	0		29	10	S5715_001_0	2	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31								47.00		141.00					42.00		126.00							141.00																47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	001	0		29	10	S5715_001_0	2	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	001	0		29	10	S5715_001_0	2	2	Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								15.00		45.00					10.00		30.00							45.00																15.00				15.00			0.50	0.33				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	001	0		29	10	S5715_001_0	2	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31											1010.00	25		25				1010.00	25		25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	002	0		29	10	S5715_002_0	2	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					75.00		225.00							285.00																95.00				95.00			3.17	2.50				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	002	0		29	10	S5715_002_0	2	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31								40.00		120.00					25.00		75.00							120.00																40.00				40.00			1.33	0.83				1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	002	0		29	10	S5715_002_0	2	2	Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								7.00		21.00					2.00		6.00							21.00																7.00				7.00			0.23	0.07				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	002	0		29	10	S5715_002_0	2	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	002	0		29	10	S5715_002_0	2	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31											1330.00	33		33				1330.00	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	002	0		29	10	S5715_002_0	2	5	Specialty Tier	3	4	010010	1	1		110	01	100		1				30		90	1			90				30		31											1330.00	33		33				1330.00	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
S5715	002	0		29	10	S5715_002_0	2	4	Non-Preferred Brand	3	4	110000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					75.00		225.00							285.00																95.00				95.00			3.17	2.50				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5715	002	0		29	10	S5715_002_0	2	3	Preferred Brand	3	4	010001	1	2		110	01	100		1				30		90	1			90				30		31								40.00		120.00					25.00		75.00							120.00																40.00				40.00			1.33	0.83				1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
S5715	002	0		29	10	S5715_002_0	2	2	Generic	3	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								7.00		21.00					2.00		6.00							21.00																7.00				7.00			0.23	0.07				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5715	002	0		29	10	S5715_002_0	2	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5715	003	0		29	10	S5715_003_0	2	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31								47.00		141.00					42.00		126.00							141.00																47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	003	0		29	10	S5715_003_0	2	2	Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								15.00		45.00					10.00		30.00							45.00																15.00				15.00			0.50	0.33				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	003	0		29	10	S5715_003_0	2	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	003	0		29	10	S5715_003_0	2	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31								100.00		300.00					95.00		285.00							300.00																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	003	0		29	10	S5715_003_0	2	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31											1010.00	25		25				1010.00	25		25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	004	0		29	10	S5715_004_0	2	2	Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								7.00		21.00					2.00		6.00							21.00																7.00				7.00			0.23	0.07				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	004	0		29	10	S5715_004_0	2	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	004	0		29	10	S5715_004_0	2	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31								40.00		120.00					25.00		75.00							120.00																40.00				40.00			1.33	0.83				1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	004	0		29	10	S5715_004_0	2	5	Specialty Tier	3	4	010010	1	1		110	01	100		1				30		90	1			90				30		31											1330.00	33		33				1330.00	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
S5715	004	0		29	10	S5715_004_0	2	4	Non-Preferred Brand	3	4	110000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					75.00		225.00							285.00																95.00				95.00			3.17	2.50				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5715	004	0		29	10	S5715_004_0	2	3	Preferred Brand	3	4	010001	1	2		110	01	100		1				30		90	1			90				30		31								40.00		120.00					25.00		75.00							120.00																40.00				40.00			1.33	0.83				1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
S5715	004	0		29	10	S5715_004_0	2	2	Generic	3	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								7.00		21.00					2.00		6.00							21.00																7.00				7.00			0.23	0.07				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5715	004	0		29	10	S5715_004_0	2	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5715	004	0		29	10	S5715_004_0	2	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31											1330.00	33		33				1330.00	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	004	0		29	10	S5715_004_0	2	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					75.00		225.00							285.00																95.00				95.00			3.17	2.50				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	005	0		29	10	S5715_005_0	2	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31								100.00		300.00					95.00		285.00							300.00																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	005	0		29	10	S5715_005_0	2	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31								47.00		141.00					42.00		126.00							141.00																47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	005	0		29	10	S5715_005_0	2	2	Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								15.00		45.00					10.00		30.00							45.00																15.00				15.00			0.50	0.33				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	005	0		29	10	S5715_005_0	2	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	005	0		29	10	S5715_005_0	2	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31											1010.00	25		25				1010.00	25		25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	006	0		29	10	S5715_006_0	2	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5715	006	0		29	10	S5715_006_0	2	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31											1330.00	33		33				1330.00	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	006	0		29	10	S5715_006_0	2	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					75.00		225.00							285.00																95.00				95.00			3.17	2.50				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	006	0		29	10	S5715_006_0	2	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31								40.00		120.00					25.00		75.00							120.00																40.00				40.00			1.33	0.83				1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	006	0		29	10	S5715_006_0	2	2	Generic	3	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								7.00		21.00					2.00		6.00							21.00																7.00				7.00			0.23	0.07				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5715	006	0		29	10	S5715_006_0	2	3	Preferred Brand	3	4	010001	1	2		110	01	100		1				30		90	1			90				30		31								40.00		120.00					25.00		75.00							120.00																40.00				40.00			1.33	0.83				1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
S5715	006	0		29	10	S5715_006_0	2	5	Specialty Tier	3	4	010010	1	1		110	01	100		1				30		90	1			90				30		31											1330.00	33		33				1330.00	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
S5715	006	0		29	10	S5715_006_0	2	2	Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								7.00		21.00					2.00		6.00							21.00																7.00				7.00			0.23	0.07				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	006	0		29	10	S5715_006_0	2	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	006	0		29	10	S5715_006_0	2	4	Non-Preferred Brand	3	4	110000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					75.00		225.00							285.00																95.00				95.00			3.17	2.50				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5715	010	0		29	10	S5715_010_0	2	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31								100.00		300.00					95.00		285.00							300.00																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	010	0		29	10	S5715_010_0	2	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31											1010.00	25		25				1010.00	25		25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	010	0		29	10	S5715_010_0	2	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	010	0		29	10	S5715_010_0	2	2	Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								15.00		45.00					10.00		30.00							45.00																15.00				15.00			0.50	0.33				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	010	0		29	10	S5715_010_0	2	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31								47.00		141.00					42.00		126.00							141.00																47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	011	0		29	10	S5715_011_0	2	4	Non-Preferred Brand	1	4	110000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					75.00		225.00							285.00																95.00				95.00			3.17	2.50				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	011	0		29	10	S5715_011_0	2	3	Preferred Brand	1	4	010001	1	2		110	01	100		1				30		90	1			90				30		31								40.00		120.00					25.00		75.00							120.00																40.00				40.00			1.33	0.83				1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	011	0		29	10	S5715_011_0	2	2	Generic	1	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								7.00		21.00					2.00		6.00							21.00																7.00				7.00			0.23	0.07				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	011	0		29	10	S5715_011_0	2	1	Preferred Generic	1	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	011	0		29	10	S5715_011_0	2	5	Specialty Tier	3	4	010010	1	1		110	01	100		1				30		90	1			90				30		31											1330.00	33		33				1330.00	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
S5715	011	0		29	10	S5715_011_0	2	1	Preferred Generic	3	4	001000	1	2		110	01	100		1				30		90	1			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5715	011	0		29	10	S5715_011_0	2	2	Generic	3	4	000110	1	2		110	01	100		1				30		90	1			90				30		31								7.00		21.00					2.00		6.00							21.00																7.00				7.00			0.23	0.07				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5715	011	0		29	10	S5715_011_0	2	3	Preferred Brand	3	4	010001	1	2		110	01	100		1				30		90	1			90				30		31								40.00		120.00					25.00		75.00							120.00																40.00				40.00			1.33	0.83				1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
S5715	011	0		29	10	S5715_011_0	2	4	Non-Preferred Brand	3	4	110000	1	2		110	01	100		1				30		90	1			90				30		31								95.00		285.00					75.00		225.00							285.00																95.00				95.00			3.17	2.50				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5715	011	0		29	10	S5715_011_0	2	5	Specialty Tier	1	4	010010	1	1		110	01	100		1				30		90	1			90				30		31											1330.00	33		33				1330.00	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	012	0		29	10	S5715_012_0	2	4	Non-Preferred Brand	1	2	110000	1	2		110	01	100		1				30		90	1			90				30		31								100.00		300.00					95.00		285.00							300.00																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	012	0		29	10	S5715_012_0	2	3	Preferred Brand	1	2	010001	1	2		110	01	100		1				30		90	1			90				30		31								47.00		141.00					42.00		126.00							141.00																47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	012	0		29	10	S5715_012_0	2	2	Generic	1	2	000100	1	2		110	01	100		1				30		90	1			90				30		31								20.00		60.00					14.00		42.00							60.00																20.00				20.00			0.67	0.47				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	012	0		29	10	S5715_012_0	2	1	Preferred Generic	1	2	001000	1	2		110	01	100		1				30		90	1			90				30		31								6.00		18.00					1.00		3.00							18.00																6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	012	0		29	10	S5715_012_0	2	5	Specialty Tier	1	2	010010	1	1		110	01	100		1				30		90	1			90				30		31											1010.00	25		25				1010.00	25		25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	013	0		29	10	S5715_013_0	2	2	Generic	1	2	000100	1	2		110	01	100		1				30		90	1			90				30		31								15.00		45.00					10.00		30.00							45.00																15.00				15.00			0.50	0.33				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	013	0		29	10	S5715_013_0	2	1	Preferred Generic	1	2	001000	1	2		110	01	100		1				30		90	1			90				30		31								6.00		18.00					1.00		3.00							18.00																6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	013	0		29	10	S5715_013_0	2	3	Preferred Brand	1	2	010001	1	2		110	01	100		1				30		90	1			90				30		31								47.00		141.00					42.00		126.00							141.00																47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	013	0		29	10	S5715_013_0	2	4	Non-Preferred Brand	1	2	110000	1	2		110	01	100		1				30		90	1			90				30		31								100.00		300.00					95.00		285.00							300.00																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	013	0		29	10	S5715_013_0	2	5	Specialty Tier	1	2	010010	1	1		110	01	100		1				30		90	1			90				30		31											1010.00	25		25				1010.00	25		25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	014	0		29	10	S5715_014_0	2	2	Generic	1	2	000100	1	2		110	01	100		1				30		90	1			90				30		31								19.00		57.00					13.00		39.00							57.00																19.00				19.00			0.63	0.43				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	014	0		29	10	S5715_014_0	2	1	Preferred Generic	1	2	001000	1	2		110	01	100		1				30		90	1			90				30		31								6.00		18.00					1.00		3.00							18.00																6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	014	0		29	10	S5715_014_0	2	3	Preferred Brand	1	2	010001	1	2		110	01	100		1				30		90	1			90				30		31								47.00		141.00					42.00		126.00							141.00																47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	014	0		29	10	S5715_014_0	2	5	Specialty Tier	1	2	010010	1	1		110	01	100		1				30		90	1			90				30		31											1010.00	25		25				1010.00	25		25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	014	0		29	10	S5715_014_0	2	4	Non-Preferred Brand	1	2	110000	1	2		110	01	100		1				30		90	1			90				30		31								100.00		300.00					95.00		285.00							300.00																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	015	0		29	10	S5715_015_0	5	1	Preferred Generic	1	2	001000	1	2		110	01	100		1				30		90	1			90				30		31								6.00		18.00					1.00		3.00							18.00																6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	015	0		29	10	S5715_015_0	5	2	Generic	1	2	000100	1	2		110	01	100		1				30		90	1			90				30		31								19.00		57.00					12.00		36.00							57.00																19.00				19.00			0.63	0.40				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	015	0		29	10	S5715_015_0	5	4	Non-Preferred Brand	1	2	110000	1	2		110	01	100		1				30		90	1			90				30		31								100.00		300.00					95.00		285.00							300.00																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	015	0		29	10	S5715_015_0	5	3	Preferred Brand	1	2	010001	1	2		110	01	100		1				30		90	1			90				30		31								47.00		141.00					42.00		126.00							141.00																47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	015	0		29	10	S5715_015_0	5	5	Specialty Tier	1	2	010010	1	1		110	01	100		1				30		90	1			90				30		31											1010.00	25		25				1010.00	25		25						25															25			25								Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
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											64.69	50	50	50				51.75	40	40	40				40	40	40															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
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								45.00	90.00	135.00					30.00	60.00	90.00					30.00	90.00	90.00																45.00				45.00			1.50	1.00	1.00			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5726	013	0		29	10	S5726_013_0	4	2	Generic	1	3	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								14.00	28.00	42.00					5.00	10.00	15.00					5.00	15.00	15.00																14.00				14.00			0.47	0.17	0.17			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
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								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5726	013	0		29	10	S5726_013_0	4	6	Select Care Drugs	1	3	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
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											74.34	50	50	50				56.50	38	38	38				38	38	38															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
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								45.00	90.00	135.00					40.00	80.00	120.00					40.00	120.00	120.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5726	014	0		29	10	S5726_014_0	4	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
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								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5726	014	0		29	10	S5726_014_0	4	6	Select Care Drugs	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5726	014	0		29	10	S5726_014_0	4	6	Select Care Drugs	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
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								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5726	015	0		29	10	S5726_015_0	4	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5726	015	0		29	10	S5726_015_0	4	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5726	015	0		29	10	S5726_015_0	4	3	Preferred Brand	1	4	000101	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								45.00	90.00	135.00					25.00	50.00	75.00					25.00	75.00	75.00																45.00				45.00			1.50	0.83	0.83			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5726	015	0		29	10	S5726_015_0	4	4	Non-Preferred Brand	1	4	100100	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34											70.41	40	40	40				61.61	35	35	35				35	35	35															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5726	015	0		29	10	S5726_015_0	4	6	Select Care Drugs	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5726	015	0		29	10	S5726_015_0	4	6	Select Care Drugs	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5726	015	0		29	10	S5726_015_0	4	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5726	015	0		29	10	S5726_015_0	4	3	Preferred Brand	3	4	000101	1	1		111	01	111		1				30	60	90	1	30	60	90				30		34											74.42	65	65	65				73.27	64	64	64				65	65	65															65			65								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										2	1	
S5726	015	0		29	10	S5726_015_0	4	2	Generic	3	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5726	015	0		29	10	S5726_015_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5743	001	0		29	10	S5743_001_0	2	1	Preferred Generic	1	2	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								5.00	10.00	10.00					0.00	0.00	0.00											5.00	10.00	10.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5743	001	0		29	10	S5743_001_0	2	5	Specialty Tier	1	2	010010	1	1		111	01		111	1				30	60	90	1				30	60	90	30		31											215.07	25	25	25				212.40	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5743	001	0		29	10	S5743_001_0	2	4	Non-Preferred Brand	1	2	100000	1	1		111	01		111	1				30	60	90	1				30	60	90	30		31											67.32	50	50	50				60.00	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5743	001	0		29	10	S5743_001_0	2	3	Preferred Brand	1	2	000001	1	1		111	01		111	1				30	60	90	1				30	60	90	30		31											30.89	25	25	25				24.41	20	20	20										25	25	25				20	20	20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5743	001	0		29	10	S5743_001_0	2	2	Generic	1	2	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								10.00	20.00	20.00					3.00	6.00	6.00											10.00	20.00	20.00				3.00	6.00	6.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5743	004	0		29	10	S5743_004_0	2	1	Preferred Generic	3	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								5.00	10.00	10.00					0.00	0.00	0.00											5.00	10.00	10.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5743	004	0		29	10	S5743_004_0	2	5	Specialty Tier	1	4	010010	1	1		111	01		111	1				30	60	90	1				30	60	90	30		31											264.22	33	33	33				261.17	33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5743	004	0		29	10	S5743_004_0	2	4	Non-Preferred Brand	1	4	100000	1	1		111	01		111	1				30	60	90	1				30	60	90	30		31											58.23	50	50	50				51.80	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5743	004	0		29	10	S5743_004_0	2	3	Preferred Brand	1	4	000001	1	1		111	01		111	1				30	60	90	1				30	60	90	30		31											62.98	25	25	25				49.76	20	20	20										25	25	25				20	20	20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5743	004	0		29	10	S5743_004_0	2	2	Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								7.00	14.00	14.00					2.00	4.00	4.00											7.00	14.00	14.00				2.00	4.00	4.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5743	004	0		29	10	S5743_004_0	2	2	Generic	3	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								7.00	14.00	14.00					2.00	4.00	4.00											7.00	14.00	14.00				2.00	4.00	4.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5743	004	0		29	10	S5743_004_0	2	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								5.00	10.00	10.00					0.00	0.00	0.00											5.00	10.00	10.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5753	006	0		29	10	S5753_006_0	1	1	Preferred Generic	1	2	001000	1	2	111		10	111		1	31	60	90				1	31	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5753	006	0		29	10	S5753_006_0	1	5	Specialty Tier	1	2	010010	1	1	111		10	111		1	31	60	90				2	31	60	90					29	31					25	25	25																		25	25	25																25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5753	006	0		29	10	S5753_006_0	1	4	Non-Preferred Brand	1	2	100000	1	1	111		10	111		1	31	60	90				1	31	60	90					29	31				83.30	46	46	46																		46	46	46																46		46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5753	006	0		29	10	S5753_006_0	1	3	Preferred Brand	1	2	000001	1	2	111		10	111		1	31	60	90				1	31	60	90					29	31	46.00	92.00	138.00																			46.00	92.00	115.00																	46.00			46.00		1.48			1.48			1.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5753	006	0		29	10	S5753_006_0	1	2	Generic	1	2	000100	1	2	111		10	111		1	31	60	90				1	31	60	90					29	31	15.00	30.00	45.00																			15.00	30.00	37.50																	15.00			15.00		0.48			0.48			0.48	Preferred Generic, 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	3.00	6.00	9.00																			3.00	6.00	7.50																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, 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, 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				99.04	49	49	49																		49	49	49																49		49								Preferred Generic, 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	47.00	94.00	141.00																			47.00	94.00	117.50																	47.00			47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5753	007	0		29	10	S5753_007_0	1	2	Generic	1	4	000100	1	2	111		10	111		1	31	60	90				1	31	60	90					29	31	18.00	36.00	54.00																			18.00	36.00	45.00																	18.00			18.00		0.58			0.58			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5753	007	0		29	10	S5753_007_0	1	2	Generic	3	4	000100	1	2	111		10	111		1	31	60	90				1	31	60	90					29	31	18.00	36.00	54.00																			18.00	36.00	45.00																	18.00			18.00		0.58			0.58			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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	3.00	6.00	9.00																			3.00	6.00	7.50																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	006	0		29	10	S5755_006_0	4	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											101.88	50		50				76.49	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	006	0		29	10	S5755_006_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31											406.35	27						272.72	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	006	0		29	10	S5755_006_0	4	3	Preferred Brand	3	4	010001	1	1		110	01		100	1				30		90	1						90	30		31											167.12	65		65				152.41	60		60												65						60			65			65								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	006	0		29	10	S5755_006_0	4	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								47.00		118.00					37.00		93.00													118.00						90.00				47.00				47.00			1.57	1.23				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	006	0		29	10	S5755_006_0	4	2	Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31								15.00		45.00					7.00		21.00													45.00						39.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	006	0		29	10	S5755_006_0	4	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31								9.00		27.00					0.00		0.00													27.00						0.00				9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	006	0		29	10	S5755_006_0	4	4	Non-Preferred Brand	3	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											183.50	65		65				167.38	60		60												65						60			65			65								Preferred Generic, 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								47.00		118.00					37.00		93.00													118.00						90.00				47.00				47.00			1.57	1.23				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	007	0		29	10	S5755_007_0	4	2	Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31								15.00		45.00					7.00		21.00													45.00						39.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, 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								9.00		27.00					0.00		0.00													27.00						0.00				9.00				9.00			0.30	0.00				0.29	Preferred Generic, 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		110	01		100	1				30		90	1						90	30		31											108.28	50		50				74.93	40		40												50						40			50			50								Preferred Generic, 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		110	01		100	1				30		90	1						90	30		31											183.50	65		65				167.38	60		60												65						60			65			65								Preferred Generic, 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											167.12	65		65				152.41	60		60												65						60			65			65								Preferred Generic, 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											281.55	27						252.80	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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								9.00		27.00					0.00		0.00													27.00						0.00				9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	008	0		29	10	S5755_008_0	4	2	Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31								15.00		45.00					7.00		21.00													45.00						39.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, 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								47.00		118.00					37.00		93.00													118.00						90.00				47.00				47.00			1.57	1.23				1.52	Preferred Generic, 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											167.12	65		65				152.41	60		60												65						60			65			65								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
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											456.63	30						360.72	30												30						30					30			30								Preferred Generic, 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		110	01		100	1				30		90	1						90	30		31											82.17	50		50				65.61	40		40												50						40			50			50								Preferred Generic, 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		110	01		100	1				30		90	1						90	30		31											183.50	65		65				167.38	60		60												65						60			65			65								Preferred Generic, 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											167.12	65		65				152.41	60		60												65						60			65			65								Preferred Generic, 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											441.59	29						367.07	29												29						29					29			29								Preferred Generic, 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		110	01		100	1				30		90	1						90	30		31											93.89	50		50				69.76	40		40												50						40			50			50								Preferred Generic, 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								47.00		118.00					37.00		93.00													118.00						90.00				47.00				47.00			1.57	1.23				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	009	0		29	10	S5755_009_0	4	2	Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31								15.00		45.00					7.00		21.00													45.00						39.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, 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								9.00		27.00					0.00		0.00													27.00						0.00				9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	009	0		29	10	S5755_009_0	4	4	Non-Preferred Brand	3	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											183.50	65		65				167.38	60		60												65						60			65			65								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
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											167.12	65		65				152.41	60		60												65						60			65			65								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
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											462.37	31						387.22	31												31						31					31			31								Preferred Generic, 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		110	01		100	1				30		90	1						90	30		31											86.63	50		50				63.50	40		40												50						40			50			50								Preferred Generic, 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								47.00		118.00					37.00		93.00													118.00						90.00				47.00				47.00			1.57	1.23				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	010	0		29	10	S5755_010_0	4	2	Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31								15.00		45.00					7.00		21.00													45.00						39.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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								9.00		27.00					0.00		0.00													27.00						0.00				9.00				9.00			0.30	0.00				0.29	Preferred Generic, 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		110	01		100	1				30		90	1						90	30		31											183.50	65		65				167.38	60		60												65						60			65			65								Preferred Generic, 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											167.12	65		65				152.41	60		60												65						60			65			65								Preferred Generic, 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											360.92	27						338.03	27												27						27					27			27								Preferred Generic, 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		110	01		100	1				30		90	1						90	30		31											97.84	50		50				72.02	40		40												50						40			50			50								Preferred Generic, 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								47.00		118.00					37.00		93.00													118.00						90.00				47.00				47.00			1.57	1.23				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	011	0		29	10	S5755_011_0	4	2	Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31								15.00		45.00					7.00		21.00													45.00						39.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, 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								9.00		27.00					0.00		0.00													27.00						0.00				9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	011	0		29	10	S5755_011_0	4	4	Non-Preferred Brand	3	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											183.50	65		65				167.38	60		60												65						60			65			65								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	012	0		29	10	S5755_012_0	4	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31								9.00		27.00					0.00		0.00													27.00						0.00				9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	012	0		29	10	S5755_012_0	4	2	Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31								15.00		45.00					7.00		21.00													45.00						39.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	012	0		29	10	S5755_012_0	4	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								47.00		118.00					37.00		93.00													118.00						90.00				47.00				47.00			1.57	1.23				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	012	0		29	10	S5755_012_0	4	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											101.16	50		50				71.43	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	012	0		29	10	S5755_012_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31											527.09	28						416.12	28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	012	0		29	10	S5755_012_0	4	3	Preferred Brand	3	4	010001	1	1		110	01		100	1				30		90	1						90	30		31											167.12	65		65				152.41	60		60												65						60			65			65								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	012	0		29	10	S5755_012_0	4	4	Non-Preferred Brand	3	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											183.50	65		65				167.38	60		60												65						60			65			65								Preferred Generic, 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								9.00		27.00					0.00		0.00													27.00						0.00				9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	013	0		29	10	S5755_013_0	4	2	Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31								15.00		45.00					7.00		21.00													45.00						39.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, 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								47.00		118.00					37.00		93.00													118.00						90.00				47.00				47.00			1.57	1.23				1.52	Preferred Generic, 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		110	01		100	1				30		90	1						90	30		31											80.66	50		50				60.58	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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											483.70	31						390.32	31												31						31					31			31								Preferred Generic, 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											167.12	65		65				152.41	60		60												65						60			65			65								Preferred Generic, 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		110	01		100	1				30		90	1						90	30		31											183.50	65		65				167.38	60		60												65						60			65			65								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
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								47.00		118.00					37.00		93.00													118.00						90.00				47.00				47.00			1.57	1.23				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	014	0		29	10	S5755_014_0	4	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											88.17	50		50				65.15	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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											420.72	28						332.54	28												28						28					28			28								Preferred Generic, 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											167.12	65		65				152.41	60		60												65						60			65			65								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	014	0		29	10	S5755_014_0	4	4	Non-Preferred Brand	3	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											183.50	65		65				167.38	60		60												65						60			65			65								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
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								9.00		27.00					0.00		0.00													27.00						0.00				9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	014	0		29	10	S5755_014_0	4	2	Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31								15.00		45.00					7.00		21.00													45.00						39.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	015	0		29	10	S5755_015_0	4	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31								9.00		27.00					0.00		0.00													27.00						0.00				9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	015	0		29	10	S5755_015_0	4	2	Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31								15.00		45.00					7.00		21.00													45.00						39.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	015	0		29	10	S5755_015_0	4	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								47.00		118.00					37.00		93.00													118.00						90.00				47.00				47.00			1.57	1.23				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	015	0		29	10	S5755_015_0	4	4	Non-Preferred Brand	3	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											183.50	65		65				167.38	60		60												65						60			65			65								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	015	0		29	10	S5755_015_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31											388.11	31						360.33	31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	015	0		29	10	S5755_015_0	4	3	Preferred Brand	3	4	010001	1	1		110	01		100	1				30		90	1						90	30		31											167.12	65		65				152.41	60		60												65						60			65			65								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	015	0		29	10	S5755_015_0	4	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											71.28	50		50				56.77	40		40												50						40			50			50								Preferred Generic, 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								9.00		27.00					0.00		0.00													27.00						0.00				9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	016	0		29	10	S5755_016_0	4	2	Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31								15.00		45.00					7.00		21.00													45.00						39.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, 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								47.00		118.00					37.00		93.00													118.00						90.00				47.00				47.00			1.57	1.23				1.52	Preferred Generic, 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		110	01		100	1				30		90	1						90	30		31											97.59	50		50				74.43	40		40												50						40			50			50								Preferred Generic, 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											385.46	30						338.85	30												30						30					30			30								Preferred Generic, 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											167.12	65		65				152.41	60		60												65						60			65			65								Preferred Generic, 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		110	01		100	1				30		90	1						90	30		31											183.50	65		65				167.38	60		60												65						60			65			65								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
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								9.00		27.00					0.00		0.00													27.00						0.00				9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	017	0		29	10	S5755_017_0	4	2	Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31								15.00		45.00					7.00		21.00													45.00						39.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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								47.00		118.00					37.00		93.00													118.00						90.00				47.00				47.00			1.57	1.23				1.52	Preferred Generic, 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		110	01		100	1				30		90	1						90	30		31											88.20	50		50				67.81	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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											336.88	30						343.91	30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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											167.12	65		65				152.41	60		60												65						60			65			65								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	017	0		29	10	S5755_017_0	4	4	Non-Preferred Brand	3	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											183.50	65		65				167.38	60		60												65						60			65			65								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
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								9.00		27.00					0.00		0.00													27.00						0.00				9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	018	0		29	10	S5755_018_0	4	2	Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31								15.00		45.00					7.00		21.00													45.00						39.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, 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								47.00		118.00					37.00		93.00													118.00						90.00				47.00				47.00			1.57	1.23				1.52	Preferred Generic, 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		110	01		100	1				30		90	1						90	30		31											97.61	50		50				69.23	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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											457.04	27						364.16	27												27						27					27			27								Preferred Generic, 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											167.12	65		65				152.41	60		60												65						60			65			65								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	018	0		29	10	S5755_018_0	4	4	Non-Preferred Brand	3	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											183.50	65		65				167.38	60		60												65						60			65			65								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	020	0		29	10	S5755_020_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31											326.93	27						331.55	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	020	0		29	10	S5755_020_0	4	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31								9.00		27.00					0.00		0.00													27.00						0.00				9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	020	0		29	10	S5755_020_0	4	2	Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31								15.00		45.00					7.00		21.00													45.00						39.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	020	0		29	10	S5755_020_0	4	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								47.00		118.00					37.00		93.00													118.00						90.00				47.00				47.00			1.57	1.23				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	020	0		29	10	S5755_020_0	4	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											74.19	50		50				52.13	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	020	0		29	10	S5755_020_0	4	3	Preferred Brand	3	4	010001	1	1		110	01		100	1				30		90	1						90	30		31											167.12	65		65				152.41	60		60												65						60			65			65								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	020	0		29	10	S5755_020_0	4	4	Non-Preferred Brand	3	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											183.50	65		65				167.38	60		60												65						60			65			65								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
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											279.12	30						224.62	30												30						30					30			30								Preferred Generic, 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		110	01		100	1				30		90	1						90	30		31											98.63	50		50				64.50	40		40												50						40			50			50								Preferred Generic, 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								47.00		118.00					37.00		93.00													118.00						90.00				47.00				47.00			1.57	1.23				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	021	0		29	10	S5755_021_0	4	2	Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31								15.00		45.00					7.00		21.00													45.00						39.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, 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								9.00		27.00					0.00		0.00													27.00						0.00				9.00				9.00			0.30	0.00				0.29	Preferred Generic, 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											167.12	65		65				152.41	60		60												65						60			65			65								Preferred Generic, 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		110	01		100	1				30		90	1						90	30		31											183.50	65		65				167.38	60		60												65						60			65			65								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	022	0		29	10	S5755_022_0	5	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31								9.00		27.00					0.00		0.00													27.00						0.00				9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	022	0		29	10	S5755_022_0	5	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31											436.43	25						411.38	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	022	0		29	10	S5755_022_0	5	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											38.23	29		29				30.72	24		24												29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	022	0		29	10	S5755_022_0	5	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31											20.37	19		19				13.10	14		14												19						19			19			19								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	022	0		29	10	S5755_022_0	5	2	Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31								11.00		33.00					3.00		9.00													33.00						33.00				11.00				11.00			0.37	0.10				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	023	0		29	10	S5755_023_0	4	3	Preferred Brand	3	4	010001	1	1		110	01		100	1				30		90	1						90	30		31											167.12	65		65				152.41	60		60												65						60			65			65								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	023	0		29	10	S5755_023_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31											521.86	33						470.60	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	023	0		29	10	S5755_023_0	4	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											71.21	50		50				52.72	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	023	0		29	10	S5755_023_0	4	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								47.00		118.00					37.00		93.00													118.00						90.00				47.00				47.00			1.57	1.23				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	023	0		29	10	S5755_023_0	4	2	Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31								15.00		45.00					7.00		21.00													45.00						39.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	023	0		29	10	S5755_023_0	4	4	Non-Preferred Brand	3	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											183.50	65		65				167.38	60		60												65						60			65			65								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	023	0		29	10	S5755_023_0	4	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31								9.00		27.00					0.00		0.00													27.00						0.00				9.00				9.00			0.30	0.00				0.29	Preferred Generic, 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		110	01		100	1				30		90	1						90	30		31											79.09	50		50				63.52	40		40												50						40			50			50								Preferred Generic, 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								47.00		118.00					37.00		93.00													118.00						90.00				47.00				47.00			1.57	1.23				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	024	0		29	10	S5755_024_0	4	2	Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31								15.00		45.00					7.00		21.00													45.00						39.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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								9.00		27.00					0.00		0.00													27.00						0.00				9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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											395.18	32						386.67	32												32						32					32			32								Preferred Generic, 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		110	01		100	1				30		90	1						90	30		31											183.50	65		65				167.38	60		60												65						60			65			65								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
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											167.12	65		65				152.41	60		60												65						60			65			65								Preferred Generic, 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											167.12	65		65				152.41	60		60												65						60			65			65								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
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											380.31	27						364.26	27												27						27					27			27								Preferred Generic, 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		110	01		100	1				30		90	1						90	30		31											89.30	50		50				66.22	40		40												50						40			50			50								Preferred Generic, 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								47.00		118.00					37.00		93.00													118.00						90.00				47.00				47.00			1.57	1.23				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	025	0		29	10	S5755_025_0	4	2	Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31								15.00		45.00					7.00		21.00													45.00						39.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, 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								9.00		27.00					0.00		0.00													27.00						0.00				9.00				9.00			0.30	0.00				0.29	Preferred Generic, 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		110	01		100	1				30		90	1						90	30		31											183.50	65		65				167.38	60		60												65						60			65			65								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
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											167.12	65		65				152.41	60		60												65						60			65			65								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
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											381.29	27						388.80	27												27						27					27			27								Preferred Generic, 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		110	01		100	1				30		90	1						90	30		31											88.43	50		50				65.12	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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								47.00		118.00					37.00		93.00													118.00						90.00				47.00				47.00			1.57	1.23				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	026	0		29	10	S5755_026_0	4	2	Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31								15.00		45.00					7.00		21.00													45.00						39.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, 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								9.00		27.00					0.00		0.00													27.00						0.00				9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	026	0		29	10	S5755_026_0	4	4	Non-Preferred Brand	3	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											183.50	65		65				167.38	60		60												65						60			65			65								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
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								9.00		27.00					0.00		0.00													27.00						0.00				9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	028	0		29	10	S5755_028_0	4	2	Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31								15.00		45.00					7.00		21.00													45.00						39.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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								47.00		118.00					37.00		93.00													118.00						90.00				47.00				47.00			1.57	1.23				1.52	Preferred Generic, 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		110	01		100	1				30		90	1						90	30		31											99.19	50		50				75.95	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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											361.90	27						344.29	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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											167.12	65		65				152.41	60		60												65						60			65			65								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	028	0		29	10	S5755_028_0	4	4	Non-Preferred Brand	3	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											183.50	65		65				167.38	60		60												65						60			65			65								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
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								9.00		27.00					0.00		0.00													27.00						0.00				9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	029	0		29	10	S5755_029_0	4	2	Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31								15.00		45.00					7.00		21.00													45.00						39.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, 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								47.00		118.00					37.00		93.00													118.00						90.00				47.00				47.00			1.57	1.23				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	029	0		29	10	S5755_029_0	4	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											82.19	50		50				67.59	40		40												50						40			50			50								Preferred Generic, 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											167.12	65		65				152.41	60		60												65						60			65			65								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
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											545.93	31						329.01	31												31						31					31			31								Preferred Generic, 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		110	01		100	1				30		90	1						90	30		31											183.50	65		65				167.38	60		60												65						60			65			65								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	030	0		29	10	S5755_030_0	4	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31								9.00		27.00					0.00		0.00													27.00						0.00				9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	030	0		29	10	S5755_030_0	4	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											90.25	50		50				68.67	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	030	0		29	10	S5755_030_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31											396.66	26						361.05	26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	030	0		29	10	S5755_030_0	4	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								47.00		118.00					37.00		93.00													118.00						90.00				47.00				47.00			1.57	1.23				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	030	0		29	10	S5755_030_0	4	2	Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31								15.00		45.00					7.00		21.00													45.00						39.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, 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		110	01		100	1				30		90	1						90	30		31											183.50	65		65				167.38	60		60												65						60			65			65								Preferred Generic, 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											373.08	28						313.43	28												28						28					28			28								Preferred Generic, 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											167.12	65		65				152.41	60		60												65						60			65			65								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	031	0		29	10	S5755_031_0	4	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											91.34	50		50				72.36	40		40												50						40			50			50								Preferred Generic, 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								47.00		118.00					37.00		93.00													118.00						90.00				47.00				47.00			1.57	1.23				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	031	0		29	10	S5755_031_0	4	2	Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31								15.00		45.00					7.00		21.00													45.00						39.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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								9.00		27.00					0.00		0.00													27.00						0.00				9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	032	0		29	10	S5755_032_0	4	2	Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31								15.00		45.00					7.00		21.00													45.00						39.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	032	0		29	10	S5755_032_0	4	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31								9.00		27.00					0.00		0.00													27.00						0.00				9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	032	0		29	10	S5755_032_0	4	4	Non-Preferred Brand	3	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											183.50	65		65				167.38	60		60												65						60			65			65								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	032	0		29	10	S5755_032_0	4	3	Preferred Brand	3	4	010001	1	1		110	01		100	1				30		90	1						90	30		31											167.12	65		65				152.41	60		60												65						60			65			65								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	032	0		29	10	S5755_032_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31											398.82	29						409.36	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	032	0		29	10	S5755_032_0	4	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								47.00		118.00					37.00		93.00													118.00						90.00				47.00				47.00			1.57	1.23				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	032	0		29	10	S5755_032_0	4	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											86.92	50		50				65.26	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	033	0		29	10	S5755_033_0	4	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								47.00		118.00					37.00		93.00													118.00						90.00				47.00				47.00			1.57	1.23				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	033	0		29	10	S5755_033_0	4	2	Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31								15.00		45.00					7.00		21.00													45.00						39.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	033	0		29	10	S5755_033_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31											326.90	30						362.37	30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	033	0		29	10	S5755_033_0	4	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											87.05	50		50				70.60	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	033	0		29	10	S5755_033_0	4	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31								9.00		27.00					0.00		0.00													27.00						0.00				9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	034	0		29	10	S5755_034_0	4	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								47.00		118.00					37.00		93.00													118.00						90.00				47.00				47.00			1.57	1.23				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	034	0		29	10	S5755_034_0	4	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											97.77	50		50				73.79	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	034	0		29	10	S5755_034_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31											267.75	27						241.63	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	034	0		29	10	S5755_034_0	4	2	Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31								15.00		45.00					7.00		21.00													45.00						39.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	034	0		29	10	S5755_034_0	4	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31								9.00		27.00					0.00		0.00													27.00						0.00				9.00				9.00			0.30	0.00				0.29	Preferred Generic, 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		110	01		100	1				30		90	1						90	30		31											183.50	65		65				167.38	60		60												65						60			65			65								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
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											167.12	65		65				152.41	60		60												65						60			65			65								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5755	035	0		29	10	S5755_035_0	4	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											87.12	50		50				64.95	40		40												50						40			50			50								Preferred Generic, 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											360.62	27						360.71	27												27						27					27			27								Preferred Generic, 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								47.00		118.00					37.00		93.00													118.00						90.00				47.00				47.00			1.57	1.23				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	035	0		29	10	S5755_035_0	4	2	Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31								15.00		45.00					7.00		21.00													45.00						39.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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								9.00		27.00					0.00		0.00													27.00						0.00				9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	038	0		29	10	S5755_038_0	6	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31											396.00	25						542.19	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	038	0		29	10	S5755_038_0	6	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31											27.05	23		23				22.24	18		18												23						23			23			23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	038	0		29	10	S5755_038_0	6	2	Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31								11.00		33.00					3.00		9.00													33.00						33.00				11.00				11.00			0.37	0.10				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	038	0		29	10	S5755_038_0	6	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31								9.00		27.00					0.00		0.00													27.00						0.00				9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	038	0		29	10	S5755_038_0	6	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											47.52	33		33				39.07	28		28												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	039	0		29	10	S5755_039_0	5	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31								9.00		27.00					0.00		0.00													27.00						0.00				9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	039	0		29	10	S5755_039_0	5	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											42.07	31		31				33.54	26		26												31						31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	039	0		29	10	S5755_039_0	5	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31											21.31	21		21				19.66	16		16												21						21			21			21								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	039	0		29	10	S5755_039_0	5	2	Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31								11.00		33.00					3.00		9.00													33.00						33.00				11.00				11.00			0.37	0.10				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	039	0		29	10	S5755_039_0	5	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31											536.94	25						296.20	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	073	0		29	10	S5755_073_0	5	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31								9.00		27.00					0.00		0.00													27.00						0.00				9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	073	0		29	10	S5755_073_0	5	2	Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31								11.00		33.00					3.00		9.00													33.00						33.00				11.00				11.00			0.37	0.10				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	073	0		29	10	S5755_073_0	5	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31											21.05	21		21				16.24	16		16												21						21			21			21								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	073	0		29	10	S5755_073_0	5	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											45.42	31		31				35.57	26		26												31						31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	073	0		29	10	S5755_073_0	5	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31											340.27	25						429.01	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	074	0		29	10	S5755_074_0	5	2	Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31								11.00		33.00					3.00		9.00													33.00						33.00				11.00				11.00			0.37	0.10				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	074	0		29	10	S5755_074_0	5	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31								9.00		27.00					0.00		0.00													27.00						0.00				9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	074	0		29	10	S5755_074_0	5	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31											23.71	24		24				23.77	19		19												24						24			24			24								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	074	0		29	10	S5755_074_0	5	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31											467.31	25						486.44	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	074	0		29	10	S5755_074_0	5	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											49.64	34		34				45.42	29		29												34						34			34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	075	0		29	10	S5755_075_0	5	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31								9.00		27.00					0.00		0.00													27.00						0.00				9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	075	0		29	10	S5755_075_0	5	2	Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31								11.00		33.00					3.00		9.00													33.00						33.00				11.00				11.00			0.37	0.10				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	075	0		29	10	S5755_075_0	5	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											48.50	30		30				37.15	25		25												30						30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	075	0		29	10	S5755_075_0	5	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31											21.13	20		20				20.85	15		15												20						20			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	075	0		29	10	S5755_075_0	5	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31											407.10	25						382.72	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	076	0		29	10	S5755_076_0	5	2	Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31								11.00		33.00					3.00		9.00													33.00						33.00				11.00				11.00			0.37	0.10				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	076	0		29	10	S5755_076_0	5	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31								9.00		27.00					0.00		0.00													27.00						0.00				9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	076	0		29	10	S5755_076_0	5	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31											23.55	22		22				23.54	17		17												22						22			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	076	0		29	10	S5755_076_0	5	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31											341.45	25						324.65	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	076	0		29	10	S5755_076_0	5	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											51.85	32		32				31.69	27		27												32						32			32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	077	0		29	10	S5755_077_0	5	2	Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31								11.00		33.00					3.00		9.00													33.00						33.00				11.00				11.00			0.37	0.10				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	077	0		29	10	S5755_077_0	5	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31								9.00		27.00					0.00		0.00													27.00						0.00				9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	077	0		29	10	S5755_077_0	5	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31											21.52	21		21				20.46	16		16												21						21			21			21								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	077	0		29	10	S5755_077_0	5	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											44.31	31		31				36.78	26		26												31						31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	077	0		29	10	S5755_077_0	5	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31											396.65	25						310.69	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	078	0		29	10	S5755_078_0	5	2	Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31								11.00		33.00					3.00		9.00													33.00						33.00				11.00				11.00			0.37	0.10				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	078	0		29	10	S5755_078_0	5	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31								9.00		27.00					0.00		0.00													27.00						0.00				9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	078	0		29	10	S5755_078_0	5	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31											23.97	24		24				21.76	19		19												24						24			24			24								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	078	0		29	10	S5755_078_0	5	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31											367.67	25						358.02	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	078	0		29	10	S5755_078_0	5	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											48.53	34		34				36.18	29		29												34						34			34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	079	0		29	10	S5755_079_0	5	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31								9.00		27.00					0.00		0.00													27.00						0.00				9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	079	0		29	10	S5755_079_0	5	2	Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31								11.00		33.00					3.00		9.00													33.00						33.00				11.00				11.00			0.37	0.10				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	079	0		29	10	S5755_079_0	5	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31											23.94	22		22				21.47	17		17												22						22			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	079	0		29	10	S5755_079_0	5	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											49.10	32		32				37.15	27		27												32						32			32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	079	0		29	10	S5755_079_0	5	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31											362.45	25						318.48	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	080	0		29	10	S5755_080_0	5	2	Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31								11.00		33.00					3.00		9.00													33.00						33.00				11.00				11.00			0.37	0.10				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	080	0		29	10	S5755_080_0	5	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31								9.00		27.00					0.00		0.00													27.00						0.00				9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	080	0		29	10	S5755_080_0	5	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31											27.56	25		25				27.04	20		20												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	080	0		29	10	S5755_080_0	5	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											49.26	35		35				48.31	30		30												35						35			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	080	0		29	10	S5755_080_0	5	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31											451.40	25						375.46	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	081	0		29	10	S5755_081_0	5	2	Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31								11.00		33.00					3.00		9.00													33.00						33.00				11.00				11.00			0.37	0.10				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	081	0		29	10	S5755_081_0	5	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31								9.00		27.00					0.00		0.00													27.00						0.00				9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	081	0		29	10	S5755_081_0	5	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31											26.69	25		25				24.77	20		20												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	081	0		29	10	S5755_081_0	5	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31											434.21	25						423.26	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	081	0		29	10	S5755_081_0	5	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											45.96	35		35				39.27	30		30												35						35			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	082	0		29	10	S5755_082_0	5	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31								9.00		27.00					0.00		0.00													27.00						0.00				9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	082	0		29	10	S5755_082_0	5	2	Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31								11.00		33.00					3.00		9.00													33.00						33.00				11.00				11.00			0.37	0.10				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	082	0		29	10	S5755_082_0	5	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											58.19	32		32				43.09	27		27												32						32			32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	082	0		29	10	S5755_082_0	5	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31											29.24	22		22				20.94	17		17												22						22			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	082	0		29	10	S5755_082_0	5	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31											320.66	25						367.13	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	083	0		29	10	S5755_083_0	5	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31								9.00		27.00					0.00		0.00													27.00						0.00				9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	083	0		29	10	S5755_083_0	5	2	Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31								11.00		33.00					3.00		9.00													33.00						33.00				11.00				11.00			0.37	0.10				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	083	0		29	10	S5755_083_0	5	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31											25.38	22		22				22.35	17		17												22						22			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	083	0		29	10	S5755_083_0	5	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											46.20	32		32				38.84	27		27												32						32			32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	083	0		29	10	S5755_083_0	5	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31											377.06	25						346.41	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	084	0		29	10	S5755_084_0	5	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											43.36	29		29				36.61	24		24												29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	084	0		29	10	S5755_084_0	5	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31											21.47	19		19				17.51	14		14												19						19			19			19								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	084	0		29	10	S5755_084_0	5	2	Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31								11.00		33.00					3.00		9.00													33.00						33.00				11.00				11.00			0.37	0.10				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	084	0		29	10	S5755_084_0	5	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31								9.00		27.00					0.00		0.00													27.00						0.00				9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	084	0		29	10	S5755_084_0	5	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31											395.91	25						376.10	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	085	0		29	10	S5755_085_0	5	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31								9.00		27.00					0.00		0.00													27.00						0.00				9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	085	0		29	10	S5755_085_0	5	2	Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31								11.00		33.00					3.00		9.00													33.00						33.00				11.00				11.00			0.37	0.10				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	085	0		29	10	S5755_085_0	5	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31											23.49	23		23				19.40	18		18												23						23			23			23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	085	0		29	10	S5755_085_0	5	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											47.16	33		33				40.55	28		28												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	085	0		29	10	S5755_085_0	5	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31											375.82	25						315.42	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	086	0		29	10	S5755_086_0	5	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											50.53	34		34				40.17	29		29												34						34			34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	086	0		29	10	S5755_086_0	5	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31											24.27	24		24				23.75	19		19												24						24			24			24								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	086	0		29	10	S5755_086_0	5	2	Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31								11.00		33.00					3.00		9.00													33.00						33.00				11.00				11.00			0.37	0.10				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	086	0		29	10	S5755_086_0	5	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31								9.00		27.00					0.00		0.00													27.00						0.00				9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	086	0		29	10	S5755_086_0	5	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31											350.79	25						357.77	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	087	0		29	10	S5755_087_0	5	2	Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31								11.00		33.00					3.00		9.00													33.00						33.00				11.00				11.00			0.37	0.10				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	087	0		29	10	S5755_087_0	5	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31								9.00		27.00					0.00		0.00													27.00						0.00				9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	087	0		29	10	S5755_087_0	5	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31											19.38	19		19				15.46	14		14												19						19			19			19								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	087	0		29	10	S5755_087_0	5	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											43.97	29		29				34.94	24		24												29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	087	0		29	10	S5755_087_0	5	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31											447.35	25						423.37	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	088	0		29	10	S5755_088_0	5	2	Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31								11.00		33.00					3.00		9.00													33.00						33.00				11.00				11.00			0.37	0.10				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	088	0		29	10	S5755_088_0	5	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31								9.00		27.00					0.00		0.00													27.00						0.00				9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	088	0		29	10	S5755_088_0	5	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31											24.05	22		22				20.94	17		17												22						22			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	088	0		29	10	S5755_088_0	5	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31											382.38	25						372.20	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	088	0		29	10	S5755_088_0	5	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											46.33	32		32				38.41	27		27												32						32			32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	089	0		29	10	S5755_089_0	5	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31								9.00		27.00					0.00		0.00													27.00						0.00				9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	089	0		29	10	S5755_089_0	5	2	Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31								11.00		33.00					3.00		9.00													33.00						33.00				11.00				11.00			0.37	0.10				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	089	0		29	10	S5755_089_0	5	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											50.64	32		32				41.26	27		27												32						32			32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	089	0		29	10	S5755_089_0	5	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31											26.32	22		22				19.65	17		17												22						22			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	089	0		29	10	S5755_089_0	5	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31											401.95	25						388.35	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	091	0		29	10	S5755_091_0	5	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31											423.64	25						394.86	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	091	0		29	10	S5755_091_0	5	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31								9.00		27.00					0.00		0.00													27.00						0.00				9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	091	0		29	10	S5755_091_0	5	2	Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31								11.00		33.00					3.00		9.00													33.00						33.00				11.00				11.00			0.37	0.10				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	091	0		29	10	S5755_091_0	5	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31											23.46	21		21				20.34	16		16												21						21			21			21								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	091	0		29	10	S5755_091_0	5	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											40.94	31		31				33.33	26		26												31						31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	092	0		29	10	S5755_092_0	5	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											45.11	32		32				35.58	27		27												32						32			32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	092	0		29	10	S5755_092_0	5	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31								9.00		27.00					0.00		0.00													27.00						0.00				9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	092	0		29	10	S5755_092_0	5	2	Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31								11.00		33.00					3.00		9.00													33.00						33.00				11.00				11.00			0.37	0.10				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	092	0		29	10	S5755_092_0	5	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31											25.15	22		22				17.90	17		17												22						22			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	092	0		29	10	S5755_092_0	5	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31											303.48	25						357.58	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	093	0		29	10	S5755_093_0	5	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											47.03	33		33				41.41	28		28												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	093	0		29	10	S5755_093_0	5	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31								9.00		27.00					0.00		0.00													27.00						0.00				9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	093	0		29	10	S5755_093_0	5	2	Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31								11.00		33.00					3.00		9.00													33.00						33.00				11.00				11.00			0.37	0.10				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	093	0		29	10	S5755_093_0	5	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31											27.71	23		23				23.03	18		18												23						23			23			23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	093	0		29	10	S5755_093_0	5	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31											304.98	25						367.38	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	094	0		29	10	S5755_094_0	5	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31											336.43	25						366.82	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	094	0		29	10	S5755_094_0	5	2	Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31								11.00		33.00					3.00		9.00													33.00						33.00				11.00				11.00			0.37	0.10				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	094	0		29	10	S5755_094_0	5	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											47.07	32		32				37.48	27		27												32						32			32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	094	0		29	10	S5755_094_0	5	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31											30.32	22		22				20.38	17		17												22						22			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	094	0		29	10	S5755_094_0	5	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31								9.00		27.00					0.00		0.00													27.00						0.00				9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	095	0		29	10	S5755_095_0	5	2	Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31								11.00		33.00					3.00		9.00													33.00						33.00				11.00				11.00			0.37	0.10				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	095	0		29	10	S5755_095_0	5	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31											24.95	22		22				15.59	17		17												22						22			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	095	0		29	10	S5755_095_0	5	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											45.70	32		32				37.42	27		27												32						32			32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	095	0		29	10	S5755_095_0	5	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31											432.57	25						410.27	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	095	0		29	10	S5755_095_0	5	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31								9.00		27.00					0.00		0.00													27.00						0.00				9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	096	0		29	10	S5755_096_0	5	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31											372.43	25						274.41	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	096	0		29	10	S5755_096_0	5	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31											29.86	22		22				20.63	17		17												22						22			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	096	0		29	10	S5755_096_0	5	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											52.77	32		32				40.27	27		27												32						32			32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	096	0		29	10	S5755_096_0	5	2	Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31								11.00		33.00					3.00		9.00													33.00						33.00				11.00				11.00			0.37	0.10				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	096	0		29	10	S5755_096_0	5	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31								9.00		27.00					0.00		0.00													27.00						0.00				9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	097	0		29	10	S5755_097_0	5	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31											24.57	22		22				19.74	17		17												22						22			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	097	0		29	10	S5755_097_0	5	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											47.67	32		32				40.16	27		27												32						32			32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	097	0		29	10	S5755_097_0	5	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31											436.99	25						311.73	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	097	0		29	10	S5755_097_0	5	2	Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31								11.00		33.00					3.00		9.00													33.00						33.00				11.00				11.00			0.37	0.10				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	097	0		29	10	S5755_097_0	5	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31								9.00		27.00					0.00		0.00													27.00						0.00				9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	098	0		29	10	S5755_098_0	5	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31								9.00		27.00					0.00		0.00													27.00						0.00				9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	098	0		29	10	S5755_098_0	5	2	Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31								11.00		33.00					3.00		9.00													33.00						33.00				11.00				11.00			0.37	0.10				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	098	0		29	10	S5755_098_0	5	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31											26.12	23		23				21.58	18		18												23						23			23			23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	098	0		29	10	S5755_098_0	5	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											51.69	33		33				39.81	28		28												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	098	0		29	10	S5755_098_0	5	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31											355.85	25						337.02	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	099	0		29	10	S5755_099_0	5	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31								9.00		27.00					0.00		0.00													27.00						0.00				9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	099	0		29	10	S5755_099_0	5	2	Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31								11.00		33.00					3.00		9.00													33.00						33.00				11.00				11.00			0.37	0.10				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	099	0		29	10	S5755_099_0	5	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31											25.67	24		24				22.83	19		19												24						24			24			24								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	099	0		29	10	S5755_099_0	5	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											48.48	34		34				41.45	29		29												34						34			34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	099	0		29	10	S5755_099_0	5	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31											311.52	25						321.30	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	100	0		29	10	S5755_100_0	5	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31								9.00		27.00					0.00		0.00													27.00						0.00				9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	100	0		29	10	S5755_100_0	5	2	Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31								11.00		33.00					3.00		9.00													33.00						33.00				11.00				11.00			0.37	0.10				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	100	0		29	10	S5755_100_0	5	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31											28.18	23		23				21.18	18		18												23						23			23			23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	100	0		29	10	S5755_100_0	5	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											49.21	33		33				40.45	28		28												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	100	0		29	10	S5755_100_0	5	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31											402.00	25						444.23	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	101	0		29	10	S5755_101_0	5	2	Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31								11.00		33.00					3.00		9.00													33.00						33.00				11.00				11.00			0.37	0.10				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	101	0		29	10	S5755_101_0	5	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31								9.00		27.00					0.00		0.00													27.00						0.00				9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	101	0		29	10	S5755_101_0	5	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31											22.55	20		20				14.50	15		15												20						20			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	101	0		29	10	S5755_101_0	5	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31											337.04	25						342.24	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	101	0		29	10	S5755_101_0	5	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											40.27	30		30				33.63	25		25												30						30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	102	0		29	10	S5755_102_0	5	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31								9.00		27.00					0.00		0.00													27.00						0.00				9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	102	0		29	10	S5755_102_0	5	2	Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31								11.00		33.00					3.00		9.00													33.00						33.00				11.00				11.00			0.37	0.10				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	102	0		29	10	S5755_102_0	5	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											51.58	31		31				40.87	26		26												31						31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	102	0		29	10	S5755_102_0	5	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31											24.85	21		21				19.45	16		16												21						21			21			21								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	102	0		29	10	S5755_102_0	5	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31											352.22	25						383.58	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	103	0		29	10	S5755_103_0	5	2	Generic	1	2	000110	1	2		110	01		100	1				30		90	1						90	30		31								11.00		33.00					3.00		9.00													33.00						33.00				11.00				11.00			0.37	0.10				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	103	0		29	10	S5755_103_0	5	1	Preferred Generic	1	2	001010	1	2		110	01		100	1				30		90	1						90	30		31								9.00		27.00					0.00		0.00													27.00						0.00				9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	103	0		29	10	S5755_103_0	5	3	Preferred Brand	1	2	010001	1	1		110	01		100	1				30		90	1						90	30		31											26.60	22		22				20.71	17		17												22						22			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	103	0		29	10	S5755_103_0	5	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31											335.29	25						386.74	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	103	0		29	10	S5755_103_0	5	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											46.95	32		32				35.93	27		27												32						32			32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	107	0		29	10	S5755_107_0	6	2	Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31								20.00		60.00					5.00		15.00													60.00						60.00				20.00				20.00			0.67	0.17				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	107	0		29	10	S5755_107_0	6	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31								19.00		57.00					0.00		0.00													57.00						0.00				19.00				19.00			0.63	0.00				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	107	0		29	10	S5755_107_0	6	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								47.00		141.00					39.00		117.00													141.00						141.00				47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	107	0		29	10	S5755_107_0	6	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											46.74	50		50				37.39	40		40												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	107	0		29	10	S5755_107_0	6	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31											169.30	27						187.67	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	108	0		29	10	S5755_108_0	6	2	Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31								20.00		60.00					5.00		15.00													60.00						60.00				20.00				20.00			0.67	0.17				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	108	0		29	10	S5755_108_0	6	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31								19.00		57.00					0.00		0.00													57.00						0.00				19.00				19.00			0.63	0.00				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	108	0		29	10	S5755_108_0	6	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								47.00		141.00					39.00		117.00													141.00						141.00				47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	108	0		29	10	S5755_108_0	6	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31											136.21	27						155.72	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	108	0		29	10	S5755_108_0	6	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											42.74	50		50				34.19	40		40												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	109	0		29	10	S5755_109_0	6	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31								19.00		57.00					0.00		0.00													57.00						0.00				19.00				19.00			0.63	0.00				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	109	0		29	10	S5755_109_0	6	2	Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31								20.00		60.00					5.00		15.00													60.00						60.00				20.00				20.00			0.67	0.17				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	109	0		29	10	S5755_109_0	6	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								47.00		141.00					39.00		117.00													141.00						141.00				47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	109	0		29	10	S5755_109_0	6	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											61.72	50		50				49.38	40		40												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	109	0		29	10	S5755_109_0	6	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31											200.17	28						212.20	28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	110	0		29	10	S5755_110_0	6	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31								19.00		57.00					0.00		0.00													57.00						0.00				19.00				19.00			0.63	0.00				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	110	0		29	10	S5755_110_0	6	2	Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31								20.00		60.00					5.00		15.00													60.00						60.00				20.00				20.00			0.67	0.17				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	110	0		29	10	S5755_110_0	6	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								47.00		141.00					39.00		117.00													141.00						141.00				47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	110	0		29	10	S5755_110_0	6	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											50.21	50		50				40.17	40		40												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	110	0		29	10	S5755_110_0	6	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31											178.77	27						197.16	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	111	0		29	10	S5755_111_0	6	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											42.30	50		50				33.84	40		40												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	111	0		29	10	S5755_111_0	6	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								47.00		141.00					39.00		117.00													141.00						141.00				47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	111	0		29	10	S5755_111_0	6	2	Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31								20.00		60.00					5.00		15.00													60.00						60.00				20.00				20.00			0.67	0.17				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	111	0		29	10	S5755_111_0	6	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31								19.00		57.00					0.00		0.00													57.00						0.00				19.00				19.00			0.63	0.00				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	111	0		29	10	S5755_111_0	6	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31											200.56	27						215.57	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	112	0		29	10	S5755_112_0	6	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31								19.00		57.00					0.00		0.00													57.00						0.00				19.00				19.00			0.63	0.00				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	112	0		29	10	S5755_112_0	6	2	Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31								20.00		60.00					5.00		15.00													60.00						60.00				20.00				20.00			0.67	0.17				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	112	0		29	10	S5755_112_0	6	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								47.00		141.00					39.00		117.00													141.00						141.00				47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	112	0		29	10	S5755_112_0	6	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											43.76	50		50				35.01	40		40												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	112	0		29	10	S5755_112_0	6	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31											177.88	27						198.29	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	113	0		29	10	S5755_113_0	6	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											52.19	50		50				41.75	40		40												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	113	0		29	10	S5755_113_0	6	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								47.00		141.00					39.00		117.00													141.00						141.00				47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	113	0		29	10	S5755_113_0	6	2	Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31								20.00		60.00					5.00		15.00													60.00						60.00				20.00				20.00			0.67	0.17				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	113	0		29	10	S5755_113_0	6	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31								19.00		57.00					0.00		0.00													57.00						0.00				19.00				19.00			0.63	0.00				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	113	0		29	10	S5755_113_0	6	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31											181.72	27						200.65	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	114	0		29	10	S5755_114_0	6	2	Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31								20.00		60.00					5.00		15.00													60.00						60.00				20.00				20.00			0.67	0.17				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	114	0		29	10	S5755_114_0	6	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31								19.00		57.00					0.00		0.00													57.00						0.00				19.00				19.00			0.63	0.00				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	114	0		29	10	S5755_114_0	6	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								47.00		141.00					39.00		117.00													141.00						141.00				47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	114	0		29	10	S5755_114_0	6	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											41.52	50		50				33.22	40		40												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	114	0		29	10	S5755_114_0	6	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31											177.25	27						198.59	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	115	0		29	10	S5755_115_0	6	2	Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31								20.00		60.00					5.00		15.00													60.00						60.00				20.00				20.00			0.67	0.17				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	115	0		29	10	S5755_115_0	6	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31								19.00		57.00					0.00		0.00													57.00						0.00				19.00				19.00			0.63	0.00				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	115	0		29	10	S5755_115_0	6	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								47.00		141.00					39.00		117.00													141.00						141.00				47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	115	0		29	10	S5755_115_0	6	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31											181.54	27						204.76	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	115	0		29	10	S5755_115_0	6	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											51.75	50		50				41.40	40		40												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	116	0		29	10	S5755_116_0	6	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31								19.00		57.00					0.00		0.00													57.00						0.00				19.00				19.00			0.63	0.00				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	116	0		29	10	S5755_116_0	6	2	Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31								20.00		60.00					5.00		15.00													60.00						60.00				20.00				20.00			0.67	0.17				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	116	0		29	10	S5755_116_0	6	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											68.80	50		50				55.04	40		40												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	116	0		29	10	S5755_116_0	6	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								47.00		141.00					39.00		117.00													141.00						141.00				47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	116	0		29	10	S5755_116_0	6	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31											182.20	27						207.29	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	117	0		29	10	S5755_117_0	6	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											40.28	50		50				32.22	40		40												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	117	0		29	10	S5755_117_0	6	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31											191.09	27						211.38	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	117	0		29	10	S5755_117_0	6	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31								19.00		57.00					0.00		0.00													57.00						0.00				19.00				19.00			0.63	0.00				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	117	0		29	10	S5755_117_0	6	2	Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31								20.00		60.00					5.00		15.00													60.00						60.00				20.00				20.00			0.67	0.17				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	117	0		29	10	S5755_117_0	6	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								47.00		141.00					39.00		117.00													141.00						141.00				47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	118	0		29	10	S5755_118_0	6	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31								19.00		57.00					0.00		0.00													57.00						0.00				19.00				19.00			0.63	0.00				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	118	0		29	10	S5755_118_0	6	2	Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31								20.00		60.00					5.00		15.00													60.00						60.00				20.00				20.00			0.67	0.17				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	118	0		29	10	S5755_118_0	6	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								47.00		141.00					39.00		117.00													141.00						141.00				47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	118	0		29	10	S5755_118_0	6	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											42.81	50		50				34.25	40		40												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	118	0		29	10	S5755_118_0	6	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31											181.31	28						198.96	28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	119	0		29	10	S5755_119_0	6	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31								19.00		57.00					0.00		0.00													57.00						0.00				19.00				19.00			0.63	0.00				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	119	0		29	10	S5755_119_0	6	2	Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31								20.00		60.00					5.00		15.00													60.00						60.00				20.00				20.00			0.67	0.17				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	119	0		29	10	S5755_119_0	6	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								47.00		141.00					39.00		117.00													141.00						141.00				47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	119	0		29	10	S5755_119_0	6	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											52.43	50		50				41.94	40		40												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	119	0		29	10	S5755_119_0	6	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31											172.30	27						197.26	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	120	0		29	10	S5755_120_0	6	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											50.63	50		50				40.51	40		40												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	120	0		29	10	S5755_120_0	6	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								47.00		141.00					39.00		117.00													141.00						141.00				47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	120	0		29	10	S5755_120_0	6	2	Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31								20.00		60.00					5.00		15.00													60.00						60.00				20.00				20.00			0.67	0.17				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	120	0		29	10	S5755_120_0	6	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31								19.00		57.00					0.00		0.00													57.00						0.00				19.00				19.00			0.63	0.00				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	120	0		29	10	S5755_120_0	6	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31											192.53	27						210.85	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	121	0		29	10	S5755_121_0	6	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											52.46	50		50				41.97	40		40												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	121	0		29	10	S5755_121_0	6	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								47.00		141.00					39.00		117.00													141.00						141.00				47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	121	0		29	10	S5755_121_0	6	2	Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31								20.00		60.00					5.00		15.00													60.00						60.00				20.00				20.00			0.67	0.17				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	121	0		29	10	S5755_121_0	6	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31								19.00		57.00					0.00		0.00													57.00						0.00				19.00				19.00			0.63	0.00				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	121	0		29	10	S5755_121_0	6	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31											184.79	28						206.68	28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	122	0		29	10	S5755_122_0	6	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31								19.00		57.00					0.00		0.00													57.00						0.00				19.00				19.00			0.63	0.00				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	122	0		29	10	S5755_122_0	6	2	Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31								20.00		60.00					5.00		15.00													60.00						60.00				20.00				20.00			0.67	0.17				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	122	0		29	10	S5755_122_0	6	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								47.00		141.00					39.00		117.00													141.00						141.00				47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	122	0		29	10	S5755_122_0	6	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											53.95	50		50				43.16	40		40												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	122	0		29	10	S5755_122_0	6	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31											173.15	27						197.66	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	123	0		29	10	S5755_123_0	6	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31											168.36	27						195.31	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	123	0		29	10	S5755_123_0	6	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											71.80	50		50				57.44	40		40												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	123	0		29	10	S5755_123_0	6	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								47.00		141.00					39.00		117.00													141.00						141.00				47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	123	0		29	10	S5755_123_0	6	2	Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31								20.00		60.00					5.00		15.00													60.00						60.00				20.00				20.00			0.67	0.17				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	123	0		29	10	S5755_123_0	6	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31								19.00		57.00					0.00		0.00													57.00						0.00				19.00				19.00			0.63	0.00				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	124	0		29	10	S5755_124_0	6	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31											173.11	27						198.34	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	124	0		29	10	S5755_124_0	6	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								47.00		141.00					39.00		117.00													141.00						141.00				47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	124	0		29	10	S5755_124_0	6	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											54.10	50		50				43.28	40		40												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	124	0		29	10	S5755_124_0	6	2	Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31								20.00		60.00					5.00		15.00													60.00						60.00				20.00				20.00			0.67	0.17				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	124	0		29	10	S5755_124_0	6	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31								19.00		57.00					0.00		0.00													57.00						0.00				19.00				19.00			0.63	0.00				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	125	0		29	10	S5755_125_0	6	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								47.00		141.00					39.00		117.00													141.00						141.00				47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	125	0		29	10	S5755_125_0	6	2	Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31								20.00		60.00					5.00		15.00													60.00						60.00				20.00				20.00			0.67	0.17				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	125	0		29	10	S5755_125_0	6	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31								19.00		57.00					0.00		0.00													57.00						0.00				19.00				19.00			0.63	0.00				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	125	0		29	10	S5755_125_0	6	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31											165.31	27						190.06	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	125	0		29	10	S5755_125_0	6	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											47.38	50		50				37.91	40		40												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	126	0		29	10	S5755_126_0	6	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31											183.34	27						209.64	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	126	0		29	10	S5755_126_0	6	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								47.00		141.00					39.00		117.00													141.00						141.00				47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	126	0		29	10	S5755_126_0	6	2	Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31								20.00		60.00					5.00		15.00													60.00						60.00				20.00				20.00			0.67	0.17				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	126	0		29	10	S5755_126_0	6	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31								19.00		57.00					0.00		0.00													57.00						0.00				19.00				19.00			0.63	0.00				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	126	0		29	10	S5755_126_0	6	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											57.76	50		50				46.21	40		40												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	127	0		29	10	S5755_127_0	6	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31											169.98	27						193.06	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	127	0		29	10	S5755_127_0	6	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								47.00		141.00					39.00		117.00													141.00						141.00				47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	127	0		29	10	S5755_127_0	6	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											55.96	50		50				44.77	40		40												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	127	0		29	10	S5755_127_0	6	2	Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31								20.00		60.00					5.00		15.00													60.00						60.00				20.00				20.00			0.67	0.17				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	127	0		29	10	S5755_127_0	6	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31								19.00		57.00					0.00		0.00													57.00						0.00				19.00				19.00			0.63	0.00				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	128	0		29	10	S5755_128_0	6	2	Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31								20.00		60.00					5.00		15.00													60.00						60.00				20.00				20.00			0.67	0.17				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	128	0		29	10	S5755_128_0	6	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31								19.00		57.00					0.00		0.00													57.00						0.00				19.00				19.00			0.63	0.00				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	128	0		29	10	S5755_128_0	6	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								47.00		141.00					39.00		117.00													141.00						141.00				47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	128	0		29	10	S5755_128_0	6	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											58.73	50		50				46.98	40		40												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	128	0		29	10	S5755_128_0	6	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31											193.82	27						214.85	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	129	0		29	10	S5755_129_0	6	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31											176.68	27						202.91	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	129	0		29	10	S5755_129_0	6	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								47.00		141.00					39.00		117.00													141.00						141.00				47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	129	0		29	10	S5755_129_0	6	2	Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31								20.00		60.00					5.00		15.00													60.00						60.00				20.00				20.00			0.67	0.17				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	129	0		29	10	S5755_129_0	6	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											58.66	50		50				46.93	40		40												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	129	0		29	10	S5755_129_0	6	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31								19.00		57.00					0.00		0.00													57.00						0.00				19.00				19.00			0.63	0.00				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	130	0		29	10	S5755_130_0	6	2	Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31								20.00		60.00					5.00		15.00													60.00						60.00				20.00				20.00			0.67	0.17				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	130	0		29	10	S5755_130_0	6	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31								19.00		57.00					0.00		0.00													57.00						0.00				19.00				19.00			0.63	0.00				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	130	0		29	10	S5755_130_0	6	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								47.00		141.00					39.00		117.00													141.00						141.00				47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	130	0		29	10	S5755_130_0	6	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											50.76	50		50				40.61	40		40												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	130	0		29	10	S5755_130_0	6	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31											156.02	27						180.40	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	131	0		29	10	S5755_131_0	6	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31								19.00		57.00					0.00		0.00													57.00						0.00				19.00				19.00			0.63	0.00				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	131	0		29	10	S5755_131_0	6	2	Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31								20.00		60.00					5.00		15.00													60.00						60.00				20.00				20.00			0.67	0.17				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	131	0		29	10	S5755_131_0	6	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								47.00		141.00					39.00		117.00													141.00						141.00				47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	131	0		29	10	S5755_131_0	6	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											46.64	50		50				37.31	40		40												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	131	0		29	10	S5755_131_0	6	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31											195.64	27						206.87	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	132	0		29	10	S5755_132_0	6	2	Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31								20.00		60.00					5.00		15.00													60.00						60.00				20.00				20.00			0.67	0.17				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	132	0		29	10	S5755_132_0	6	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31								19.00		57.00					0.00		0.00													57.00						0.00				19.00				19.00			0.63	0.00				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	132	0		29	10	S5755_132_0	6	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								47.00		141.00					39.00		117.00													141.00						141.00				47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	132	0		29	10	S5755_132_0	6	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31											157.40	27						180.67	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	132	0		29	10	S5755_132_0	6	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											47.89	50		50				38.31	40		40												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	133	0		29	10	S5755_133_0	6	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31								19.00		57.00					0.00		0.00													57.00						0.00				19.00				19.00			0.63	0.00				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	133	0		29	10	S5755_133_0	6	2	Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31								20.00		60.00					5.00		15.00													60.00						60.00				20.00				20.00			0.67	0.17				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	133	0		29	10	S5755_133_0	6	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								47.00		141.00					39.00		117.00													141.00						141.00				47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	133	0		29	10	S5755_133_0	6	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											46.15	50		50				36.92	40		40												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	133	0		29	10	S5755_133_0	6	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31											179.37	27						200.83	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	134	0		29	10	S5755_134_0	6	1	Preferred Generic	1	4	001010	1	2		110	01		100	1				30		90	1						90	30		31								19.00		57.00					0.00		0.00													57.00						0.00				19.00				19.00			0.63	0.00				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	134	0		29	10	S5755_134_0	6	2	Generic	1	4	000110	1	2		110	01		100	1				30		90	1						90	30		31								20.00		60.00					5.00		15.00													60.00						60.00				20.00				20.00			0.67	0.17				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	134	0		29	10	S5755_134_0	6	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											50.78	50		50				40.62	40		40												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	134	0		29	10	S5755_134_0	6	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								47.00		141.00					39.00		117.00													141.00						141.00				47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5755	134	0		29	10	S5755_134_0	6	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31											162.28	27						186.00	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	125	0		29	10	S5768_125_0	1	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	125	0		29	10	S5768_125_0	1	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	125	0		29	10	S5768_125_0	1	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	125	0		29	10	S5768_125_0	1	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	125	0		29	10	S5768_125_0	1	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	125	0		29	10	S5768_125_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	125	0		29	10	S5768_125_0	1	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											69.58	50	50	50				67.12	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	126	0		29	10	S5768_126_0	1	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	126	0		29	10	S5768_126_0	1	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	126	0		29	10	S5768_126_0	1	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	126	0		29	10	S5768_126_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	126	0		29	10	S5768_126_0	1	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											73.18	50	50	50				68.05	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	126	0		29	10	S5768_126_0	1	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	126	0		29	10	S5768_126_0	1	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	127	0		29	10	S5768_127_0	1	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	127	0		29	10	S5768_127_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	127	0		29	10	S5768_127_0	1	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	127	0		29	10	S5768_127_0	1	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								44.00	88.00	132.00					44.00	88.00	132.00					44.00	88.00	132.00																	44.00			44.00			1.47	1.47	1.47			1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	127	0		29	10	S5768_127_0	1	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	127	0		29	10	S5768_127_0	1	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	127	0		29	10	S5768_127_0	1	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											50.26	46	46	46				47.26	46	46	46				46	46	46																46		46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	128	0		29	10	S5768_128_0	1	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	128	0		29	10	S5768_128_0	1	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	128	0		29	10	S5768_128_0	1	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	128	0		29	10	S5768_128_0	1	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											68.60	50	50	50				66.25	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	128	0		29	10	S5768_128_0	1	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	128	0		29	10	S5768_128_0	1	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	128	0		29	10	S5768_128_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	129	0		29	10	S5768_129_0	1	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	129	0		29	10	S5768_129_0	1	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	129	0		29	10	S5768_129_0	1	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											70.60	50	50	50				65.66	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	129	0		29	10	S5768_129_0	1	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	129	0		29	10	S5768_129_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	129	0		29	10	S5768_129_0	1	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	129	0		29	10	S5768_129_0	1	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	130	0		29	10	S5768_130_0	1	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	130	0		29	10	S5768_130_0	1	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	130	0		29	10	S5768_130_0	1	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	130	0		29	10	S5768_130_0	1	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	130	0		29	10	S5768_130_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	130	0		29	10	S5768_130_0	1	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											75.72	50	50	50				71.10	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	130	0		29	10	S5768_130_0	1	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	131	0		29	10	S5768_131_0	1	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	131	0		29	10	S5768_131_0	1	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	131	0		29	10	S5768_131_0	1	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	131	0		29	10	S5768_131_0	1	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											71.04	50	50	50				66.98	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	131	0		29	10	S5768_131_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	131	0		29	10	S5768_131_0	1	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	131	0		29	10	S5768_131_0	1	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	132	0		29	10	S5768_132_0	1	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	132	0		29	10	S5768_132_0	1	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	132	0		29	10	S5768_132_0	1	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											72.25	50	50	50				70.45	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	132	0		29	10	S5768_132_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	132	0		29	10	S5768_132_0	1	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	132	0		29	10	S5768_132_0	1	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	132	0		29	10	S5768_132_0	1	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, 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	33						1.00	33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	133	0		29	10	S5768_133_0	1	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	133	0		29	10	S5768_133_0	1	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	133	0		29	10	S5768_133_0	1	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, 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											69.08	50	50	50				67.02	50	50	50				50	50	50																50		50								Preferred Generic, 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								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	134	0		29	10	S5768_134_0	1	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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	33						1.00	33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	134	0		29	10	S5768_134_0	1	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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											73.06	50	50	50				72.11	50	50	50				50	50	50																50		50								Preferred Generic, 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								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	134	0		29	10	S5768_134_0	1	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, 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								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	135	0		29	10	S5768_135_0	1	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	135	0		29	10	S5768_135_0	1	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	135	0		29	10	S5768_135_0	1	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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	33						1.00	33						33																		33		33								Preferred Generic, 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											67.88	50	50	50				63.95	50	50	50				50	50	50																50		50								Preferred Generic, 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								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	136	0		29	10	S5768_136_0	1	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, 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											66.45	50	50	50				62.77	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	136	0		29	10	S5768_136_0	1	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, 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								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	136	0		29	10	S5768_136_0	1	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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	33						1.00	33						33																		33		33								Preferred Generic, 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								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	137	0		29	10	S5768_137_0	1	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, 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								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, 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											68.62	50	50	50				63.99	50	50	50				50	50	50																50		50								Preferred Generic, 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	33						1.00	33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	137	0		29	10	S5768_137_0	1	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	137	0		29	10	S5768_137_0	1	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	138	0		29	10	S5768_138_0	1	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, 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								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, 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											66.95	50	50	50				63.61	50	50	50				50	50	50																50		50								Preferred Generic, 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	33						1.00	33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	138	0		29	10	S5768_138_0	1	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	138	0		29	10	S5768_138_0	1	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	139	0		29	10	S5768_139_0	1	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, 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								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, 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											67.53	50	50	50				63.43	50	50	50				50	50	50																50		50								Preferred Generic, 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	33						1.00	33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	139	0		29	10	S5768_139_0	1	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	139	0		29	10	S5768_139_0	1	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	140	0		29	10	S5768_140_0	1	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, 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								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	140	0		29	10	S5768_140_0	1	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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	33						1.00	33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	140	0		29	10	S5768_140_0	1	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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											68.36	50	50	50				66.79	50	50	50				50	50	50																50		50								Preferred Generic, 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								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, 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											66.36	50	50	50				62.44	50	50	50				50	50	50																50		50								Preferred Generic, 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	33						1.00	33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	141	0		29	10	S5768_141_0	1	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	141	0		29	10	S5768_141_0	1	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	141	0		29	10	S5768_141_0	1	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, 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								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	142	0		29	10	S5768_142_0	1	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, 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								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	142	0		29	10	S5768_142_0	1	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	142	0		29	10	S5768_142_0	1	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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	33						1.00	33						33																		33		33								Preferred Generic, 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											62.65	50	50	50				59.20	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	143	0		29	10	S5768_143_0	1	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	143	0		29	10	S5768_143_0	1	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	143	0		29	10	S5768_143_0	1	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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	33						1.00	33						33																		33		33								Preferred Generic, 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											61.85	50	50	50				59.65	50	50	50				50	50	50																50		50								Preferred Generic, 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								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, 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								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	144	0		29	10	S5768_144_0	1	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, 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								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, 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											61.27	50	50	50				59.02	50	50	50				50	50	50																50		50								Preferred Generic, 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	33						1.00	33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	144	0		29	10	S5768_144_0	1	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	144	0		29	10	S5768_144_0	1	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, 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											70.33	50	50	50				67.68	50	50	50				50	50	50																50		50								Preferred Generic, 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								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	145	0		29	10	S5768_145_0	1	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	145	0		29	10	S5768_145_0	1	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	145	0		29	10	S5768_145_0	1	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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	33						1.00	33						33																		33		33								Preferred Generic, 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								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, 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	33						1.00	33						33																		33		33								Preferred Generic, 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											65.95	50	50	50				62.09	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	146	0		29	10	S5768_146_0	1	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	146	0		29	10	S5768_146_0	1	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, 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								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	146	0		29	10	S5768_146_0	1	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, 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								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	147	0		29	10	S5768_147_0	1	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, 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								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, 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											60.44	50	50	50				55.03	50	50	50				50	50	50																50		50								Preferred Generic, 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	33						1.00	33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	147	0		29	10	S5768_147_0	1	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	147	0		29	10	S5768_147_0	1	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	148	0		29	10	S5768_148_0	1	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	148	0		29	10	S5768_148_0	1	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, 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								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, 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											65.62	50	50	50				60.57	50	50	50				50	50	50																50		50								Preferred Generic, 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	33						1.00	33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	148	0		29	10	S5768_148_0	1	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	149	0		29	10	S5768_149_0	1	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, 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								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, 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											40.02	50	50	50				36.89	50	50	50				50	50	50																50		50								Preferred Generic, 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	33						1.00	33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	149	0		29	10	S5768_149_0	1	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	149	0		29	10	S5768_149_0	1	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	150	0		29	10	S5768_150_0	1	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	150	0		29	10	S5768_150_0	1	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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	33						1.00	33						33																		33		33								Preferred Generic, 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											77.24	48	48	48				72.66	48	48	48				48	48	48																48		48								Preferred Generic, 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								45.00	90.00	135.00					45.00	90.00	135.00					45.00	90.00	135.00																	45.00			45.00			1.50	1.50	1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	150	0		29	10	S5768_150_0	1	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	151	0		29	10	S5768_151_0	1	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	151	0		29	10	S5768_151_0	1	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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											62.76	50	50	50				61.22	50	50	50				50	50	50																50		50								Preferred Generic, 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								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	151	0		29	10	S5768_151_0	1	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, 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								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, 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	33						1.00	33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	152	0		29	10	S5768_152_0	1	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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	33						1.00	33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	152	0		29	10	S5768_152_0	1	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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											65.63	50	50	50				62.43	50	50	50				50	50	50																50		50								Preferred Generic, 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								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	152	0		29	10	S5768_152_0	1	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, 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								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, 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								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	153	0		29	10	S5768_153_0	1	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, 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								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	153	0		29	10	S5768_153_0	1	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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											60.55	50	50	50				57.65	50	50	50				50	50	50																50		50								Preferred Generic, 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	33						1.00	33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	153	0		29	10	S5768_153_0	1	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	154	0		29	10	S5768_154_0	1	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	154	0		29	10	S5768_154_0	1	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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	33						1.00	33						33																		33		33								Preferred Generic, 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								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, 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											70.70	50	50	50				64.85	50	50	50				50	50	50																50		50								Preferred Generic, 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								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	154	0		29	10	S5768_154_0	1	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, 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											71.29	50	50	50				69.70	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	155	0		29	10	S5768_155_0	1	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, 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								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, 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								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, 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	33						1.00	33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	155	0		29	10	S5768_155_0	1	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	155	0		29	10	S5768_155_0	1	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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											73.23	45	45	45				67.38	45	45	45				45	45	45																45		45								Preferred Generic, 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								40.00	80.00	120.00					40.00	80.00	120.00					40.00	80.00	120.00																	40.00			40.00			1.33	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	164	0		29	10	S5768_164_0	2	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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											69.37	45	45	45				69.97	45	45	45				45	45	45																45		45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	164	0		29	10	S5768_164_0	2	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, 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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, 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											73.30	45	45	45				67.34	45	45	45				45	45	45																45		45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	165	0		29	10	S5768_165_0	2	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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											66.62	45	45	45				66.97	45	45	45				45	45	45																45		45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
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								40.00	80.00	120.00					40.00	80.00	120.00					40.00	80.00	120.00																	40.00			40.00			1.33	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	165	0		29	10	S5768_165_0	2	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, 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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	166	0		29	10	S5768_166_0	2	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, 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								40.00	80.00	120.00					40.00	80.00	120.00					40.00	80.00	120.00																	40.00			40.00			1.33	1.33	1.33			1.29	Preferred Generic, 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											67.64	45	45	45				63.96	45	45	45				45	45	45																45		45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	166	0		29	10	S5768_166_0	2	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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											67.91	45	45	45				68.48	45	45	45				45	45	45																45		45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
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								40.00	80.00	120.00					40.00	80.00	120.00					40.00	80.00	120.00																	40.00			40.00			1.33	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	167	0		29	10	S5768_167_0	2	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, 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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, 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											70.63	45	45	45				64.30	45	45	45				45	45	45																45		45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	167	0		29	10	S5768_167_0	2	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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											67.59	45	45	45				68.18	45	45	45				45	45	45																45		45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
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								40.00	80.00	120.00					40.00	80.00	120.00					40.00	80.00	120.00																	40.00			40.00			1.33	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	168	0		29	10	S5768_168_0	2	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, 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											60.15	45	45	45				50.52	45	45	45				45	45	45																45		45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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											68.03	45	45	45				68.53	45	45	45				45	45	45																45		45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5768	168	0		29	10	S5768_168_0	2	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	169	0		29	10	S5768_169_0	2	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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											60.24	45	45	45				55.44	45	45	45				45	45	45																45		45								Preferred Generic, 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											67.26	45	45	45				67.74	45	45	45				45	45	45																45		45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5768	169	0		29	10	S5768_169_0	2	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										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, 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								40.00	80.00	120.00					40.00	80.00	120.00					40.00	80.00	120.00																	40.00			40.00			1.33	1.33	1.33			1.29	Preferred Generic, 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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, 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								40.00	80.00	120.00					40.00	80.00	120.00					40.00	80.00	120.00																	40.00			40.00			1.33	1.33	1.33			1.29	Preferred Generic, 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											66.36	45	45	45				66.26	45	45	45				45	45	45																45		45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5768	170	0		29	10	S5768_170_0	2	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, 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, 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											60.32	45	45	45				55.51	45	45	45				45	45	45																45		45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	170	0		29	10	S5768_170_0	2	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	171	0		29	10	S5768_171_0	2	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, 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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, 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								40.00	80.00	120.00					40.00	80.00	120.00					40.00	80.00	120.00																	40.00			40.00			1.33	1.33	1.33			1.29	Preferred Generic, 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											67.08	45	45	45				62.46	45	45	45				45	45	45																45		45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	171	0		29	10	S5768_171_0	2	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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											64.67	45	45	45				64.19	45	45	45				45	45	45																45		45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5768	172	0		29	10	S5768_172_0	2	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, 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											67.64	45	45	45				68.11	45	45	45				45	45	45																45		45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
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								40.00	80.00	120.00					40.00	80.00	120.00					40.00	80.00	120.00																	40.00			40.00			1.33	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	172	0		29	10	S5768_172_0	2	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, 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, 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											62.27	45	45	45				58.16	45	45	45				45	45	45																45		45								Preferred Generic, 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								40.00	80.00	120.00					40.00	80.00	120.00					40.00	80.00	120.00																	40.00			40.00			1.33	1.33	1.33			1.29	Preferred Generic, 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											68.34	45	45	45				65.26	45	45	45				45	45	45																45		45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	173	0		29	10	S5768_173_0	2	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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											67.34	45	45	45				67.41	45	45	45				45	45	45																45		45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	173	0		29	10	S5768_173_0	2	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	174	0		29	10	S5768_174_0	2	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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, 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											61.96	45	45	45				58.93	45	45	45				45	45	45																45		45								Preferred Generic, 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								40.00	80.00	120.00					40.00	80.00	120.00					40.00	80.00	120.00																	40.00			40.00			1.33	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	174	0		29	10	S5768_174_0	2	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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											68.29	45	45	45				68.44	45	45	45				45	45	45																45		45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
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											59.89	45	45	45				57.92	45	45	45				45	45	45																45		45								Preferred Generic, 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								40.00	80.00	120.00					40.00	80.00	120.00					40.00	80.00	120.00																	40.00			40.00			1.33	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	175	0		29	10	S5768_175_0	2	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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											68.53	45	45	45				68.70	45	45	45				45	45	45																45		45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5768	175	0		29	10	S5768_175_0	2	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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, 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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	176	0		29	10	S5768_176_0	2	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, 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								40.00	80.00	120.00					40.00	80.00	120.00					40.00	80.00	120.00																	40.00			40.00			1.33	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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											67.12	45	45	45				63.97	45	45	45				45	45	45																45		45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	176	0		29	10	S5768_176_0	2	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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											66.01	45	45	45				66.54	45	45	45				45	45	45																45		45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
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								40.00	80.00	120.00					40.00	80.00	120.00					40.00	80.00	120.00																	40.00			40.00			1.33	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	177	0		29	10	S5768_177_0	2	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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											66.57	45	45	45				67.34	45	45	45				45	45	45																45		45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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											58.60	45	45	45				55.73	45	45	45				45	45	45																45		45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	177	0		29	10	S5768_177_0	2	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, 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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, 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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	178	0		29	10	S5768_178_0	2	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										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											68.32	45	45	45				69.30	45	45	45				45	45	45																45		45								Preferred Generic, 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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	178	0		29	10	S5768_178_0	2	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, 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								40.00	80.00	120.00					40.00	80.00	120.00					40.00	80.00	120.00																	40.00			40.00			1.33	1.33	1.33			1.29	Preferred Generic, 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											67.29	45	45	45				64.02	45	45	45				45	45	45																45		45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	179	0		29	10	S5768_179_0	2	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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											66.30	45	45	45				66.57	45	45	45				45	45	45																45		45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
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											67.79	45	45	45				64.88	45	45	45				45	45	45																45		45								Preferred Generic, 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								40.00	80.00	120.00					40.00	80.00	120.00					40.00	80.00	120.00																	40.00			40.00			1.33	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	179	0		29	10	S5768_179_0	2	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, 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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, 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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	180	0		29	10	S5768_180_0	2	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, 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								40.00	80.00	120.00					40.00	80.00	120.00					40.00	80.00	120.00																	40.00			40.00			1.33	1.33	1.33			1.29	Preferred Generic, 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											69.33	45	45	45				66.04	45	45	45				45	45	45																45		45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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											67.51	45	45	45				67.45	45	45	45				45	45	45																45		45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5768	180	0		29	10	S5768_180_0	2	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	181	0		29	10	S5768_181_0	2	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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											69.23	45	45	45				69.18	45	45	45				45	45	45																45		45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5768	181	0		29	10	S5768_181_0	2	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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, 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											70.62	45	45	45				68.84	45	45	45				45	45	45																45		45								Preferred Generic, 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								40.00	80.00	120.00					40.00	80.00	120.00					40.00	80.00	120.00																	40.00			40.00			1.33	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, 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											54.35	35	35	35				54.18	35	35	35				35	35	35																35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5768	182	0		29	10	S5768_182_0	2	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, 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, 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											98.37	35	35	35				88.54	35	35	35				35	35	35																35		35								Preferred Generic, 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								40.00	80.00	120.00					40.00	80.00	120.00					40.00	80.00	120.00																	40.00			40.00			1.33	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	182	0		29	10	S5768_182_0	2	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, 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											97.74	45	45	45				95.45	45	45	45				45	45	45																45		45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	183	0		29	10	S5768_183_0	2	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										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											64.46	45	45	45				64.41	45	45	45				45	45	45																45		45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	183	0		29	10	S5768_183_0	2	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, 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								40.00	80.00	120.00					40.00	80.00	120.00					40.00	80.00	120.00																	40.00			40.00			1.33	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	184	0		29	10	S5768_184_0	2	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, 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								40.00	80.00	120.00					40.00	80.00	120.00					40.00	80.00	120.00																	40.00			40.00			1.33	1.33	1.33			1.29	Preferred Generic, 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											49.80	45	45	45				45.18	45	45	45				45	45	45																45		45								Preferred Generic, 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, 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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										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											62.38	45	45	45				62.02	45	45	45				45	45	45																45		45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5768	184	0		29	10	S5768_184_0	2	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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, 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											45.93	45	45	45				44.72	45	45	45				45	45	45																45		45								Preferred Generic, 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								40.00	80.00	120.00					40.00	80.00	120.00					40.00	80.00	120.00																	40.00			40.00			1.33	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	185	0		29	10	S5768_185_0	2	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, 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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	185	0		29	10	S5768_185_0	2	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, 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											70.32	45	45	45				70.78	45	45	45				45	45	45																45		45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	186	0		29	10	S5768_186_0	2	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, 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								40.00	80.00	120.00					40.00	80.00	120.00					40.00	80.00	120.00																	40.00			40.00			1.33	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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											66.70	45	45	45				63.10	45	45	45				45	45	45																45		45								Preferred Generic, 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, 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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	186	0		29	10	S5768_186_0	2	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										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											67.66	45	45	45				68.14	45	45	45				45	45	45																45		45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
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								40.00	80.00	120.00					40.00	80.00	120.00					40.00	80.00	120.00																	40.00			40.00			1.33	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	187	0		29	10	S5768_187_0	2	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, 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											86.15	45	45	45				83.37	45	45	45				45	45	45																45		45								Preferred Generic, 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, 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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	187	0		29	10	S5768_187_0	2	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										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											67.73	45	45	45				68.01	45	45	45				45	45	45																45		45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
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								40.00	80.00	120.00					40.00	80.00	120.00					40.00	80.00	120.00																	40.00			40.00			1.33	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	188	0		29	10	S5768_188_0	2	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, 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											65.85	45	45	45				64.18	45	45	45				45	45	45																45		45								Preferred Generic, 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											69.78	45	45	45				69.95	45	45	45				45	45	45																45		45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5768	188	0		29	10	S5768_188_0	2	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, 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, 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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	189	0		29	10	S5768_189_0	2	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, 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								40.00	80.00	120.00					40.00	80.00	120.00					40.00	80.00	120.00																	40.00			40.00			1.33	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	189	0		29	10	S5768_189_0	2	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, 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, 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											62.14	45	45	45				59.31	45	45	45				45	45	45																45		45								Preferred Generic, 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											67.96	45	45	45				68.30	45	45	45				45	45	45																45		45								Preferred Generic, 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											65.97	45	45	45				61.73	45	45	45				45	45	45																45		45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, 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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	190	0		29	10	S5768_190_0	2	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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											67.60	45	45	45				67.92	45	45	45				45	45	45																45		45								Preferred Generic, 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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	190	0		29	10	S5768_190_0	2	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, 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								40.00	80.00	120.00					40.00	80.00	120.00					40.00	80.00	120.00																	40.00			40.00			1.33	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	191	0		29	10	S5768_191_0	2	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, 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								40.00	80.00	120.00					40.00	80.00	120.00					40.00	80.00	120.00																	40.00			40.00			1.33	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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											64.08	45	45	45				63.65	45	45	45				45	45	45																45		45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
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, 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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	191	0		29	10	S5768_191_0	2	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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											51.41	45	45	45				46.30	45	45	45				45	45	45																45		45								Preferred Generic, 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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	192	0		29	10	S5768_192_0	2	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, 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								40.00	80.00	120.00					40.00	80.00	120.00					40.00	80.00	120.00																	40.00			40.00			1.33	1.33	1.33			1.29	Preferred Generic, 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											68.93	45	45	45				69.13	45	45	45				45	45	45																45		45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	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, 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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	192	0		29	10	S5768_192_0	2	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										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											62.75	45	45	45				59.11	45	45	45				45	45	45																45		45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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								40.00	80.00	120.00					40.00	80.00	120.00					40.00	80.00	120.00																	40.00			40.00			1.33	1.33	1.33			1.29	Preferred Generic, 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											61.55	45	45	45				55.52	45	45	45				45	45	45																45		45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	193	0		29	10	S5768_193_0	2	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	193	0		29	10	S5768_193_0	2	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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											69.33	45	45	45				70.37	45	45	45				45	45	45																45		45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	194	0		29	10	S5768_194_0	2	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, 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								40.00	80.00	120.00					40.00	80.00	120.00					40.00	80.00	120.00																	40.00			40.00			1.33	1.33	1.33			1.29	Preferred Generic, 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											66.60	45	45	45				66.88	45	45	45				45	45	45																45		45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	194	0		29	10	S5768_194_0	2	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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											78.90	45	45	45				71.00	45	45	45				45	45	45																45		45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	195	0		29	10	S5768_195_0	2	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	195	0		29	10	S5768_195_0	2	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	195	0		29	10	S5768_195_0	2	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								40.00	80.00	120.00					40.00	80.00	120.00					40.00	80.00	120.00																	40.00			40.00			1.33	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	195	0		29	10	S5768_195_0	2	4	Non-Preferred Brand	3	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											62.50	45	45	45				60.34	45	45	45				45	45	45																45		45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5768	195	0		29	10	S5768_195_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	195	0		29	10	S5768_195_0	2	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	195	0		29	10	S5768_195_0	2	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	195	0		29	10	S5768_195_0	2	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											41.16	45	45	45				36.43	45	45	45				45	45	45																45		45								Preferred Generic, 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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	196	0		29	10	S5768_196_0	2	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, 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								40.00	80.00	120.00					40.00	80.00	120.00					40.00	80.00	120.00																	40.00			40.00			1.33	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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											69.79	45	45	45				72.00	45	45	45				45	45	45																45		45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
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, 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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	196	0		29	10	S5768_196_0	2	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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											52.01	45	45	45				51.15	45	45	45				45	45	45																45		45								Preferred Generic, 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								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	197	0		29	10	S5768_197_0	1	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, 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								44.00	88.00	132.00					44.00	88.00	132.00					44.00	88.00	132.00																	44.00			44.00			1.47	1.47	1.47			1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	197	0		29	10	S5768_197_0	1	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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	33						1.00	33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	197	0		29	10	S5768_197_0	1	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
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											60.86	45	45	45				59.13	45	45	45				45	45	45																45		45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	198	0		29	10	S5768_198_0	2	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	198	0		29	10	S5768_198_0	2	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	198	0		29	10	S5768_198_0	2	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								40.00	80.00	120.00					40.00	80.00	120.00					40.00	80.00	120.00																	40.00			40.00			1.33	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	198	0		29	10	S5768_198_0	2	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	198	0		29	10	S5768_198_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	198	0		29	10	S5768_198_0	2	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	198	0		29	10	S5768_198_0	2	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											93.93	39	39	39				99.51	39	39	39				39	39	39																39		39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	199	0		29	10	S5768_199_0	2	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	199	0		29	10	S5768_199_0	2	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	199	0		29	10	S5768_199_0	2	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								40.00	80.00	120.00					40.00	80.00	120.00					40.00	80.00	120.00																	40.00			40.00			1.33	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	199	0		29	10	S5768_199_0	2	4	Non-Preferred Brand	3	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											67.57	45	45	45				67.83	45	45	45				45	45	45																45		45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5768	199	0		29	10	S5768_199_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	199	0		29	10	S5768_199_0	2	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	199	0		29	10	S5768_199_0	2	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	199	0		29	10	S5768_199_0	2	4	Non-Preferred Brand	1	4	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											92.78	45	45	45				96.03	45	45	45				45	45	45																45		45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	200	0		29	10	S5768_200_0	1	1	Preferred Generic	1	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	200	0		29	10	S5768_200_0	1	2	Generic	1	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	200	0		29	10	S5768_200_0	1	3	Preferred Brand	1	4	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	200	0		29	10	S5768_200_0	1	2	Generic	3	4	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								20.00	40.00	60.00					7.00	14.00	21.00					20.00	40.00	60.00																	20.00			20.00			0.67	0.23	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	200	0		29	10	S5768_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5768	200	0		29	10	S5768_200_0	1	1	Preferred Generic	3	4	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								10.00	20.00	30.00					1.00	2.00	3.00					10.00	20.00	30.00																	10.00			10.00			0.33	0.03	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5768	200	0		29	10	S5768_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											78.57	50	50	50				77.00	50	50	50				50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5795	002	0		29	10	S5795_002_0	3	4	Non-Preferred Brand	1	4	110000	1	2	110		01	110		1	30		90				1	30		90				30		31	90.00		225.00																			90.00		225.00																90.00				90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5795	002	0		29	10	S5795_002_0	3	2	Generic	3	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	12.00		30.00																			12.00		30.00																12.00				12.00		.40			.40			.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5795	002	0		29	10	S5795_002_0	3	1	Preferred Generic	3	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	2.00		4.00																			2.00		4.00																2.00				2.00		.06			.06			.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5795	002	0		29	10	S5795_002_0	3	5	Specialty Tier	1	4	010010	1	1	110		01	110		1	30		90				1	30		90				30		31					33		33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5795	002	0		29	10	S5795_002_0	3	3	Preferred Brand	1	4	000001	1	2	110		01	110		1	30		90				1	30		90				30		31	45.00		112.50																			45.00		112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5795	002	0		29	10	S5795_002_0	3	1	Preferred Generic	1	4	001000	1	2	110		01	110		1	30		90				1	30		90				30		31	2.00		4.00																			2.00		4.00																2.00				2.00		.06			.06			.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5795	002	0		29	10	S5795_002_0	3	2	Generic	1	4	000100	1	2	110		01	110		1	30		90				1	30		90				30		31	12.00		30.00																			12.00		30.00																12.00				12.00		.40			.40			.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5795	003	0		29	10	S5795_003_0	3	1	Preferred Generic	1	3	001000	1	2		110	01	110		1				30		90	1	30		90				30		31								10.00		25.00					4.00		10.00					4.00		10.00																10.00				4.00			.33	.13	.13			.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5795	003	0		29	10	S5795_003_0	3	2	Generic	1	3	000100	1	2		110	01	110		1				30		90	1	30		90				30		31								20.00		50.00					15.00		37.50					15.00		37.50																20.00				15.00			.66	.50	.50			.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5795	003	0		29	10	S5795_003_0	3	3	Preferred Brand	1	3	000001	1	2		110	01	110		1				30		90	1	30		90				30		31								47.00		117.50					42.00		105.00					42.00		105.00																47.00				42.00			1.56	1.40	1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5795	003	0		29	10	S5795_003_0	3	5	Specialty Tier	1	3	010010	1	1		110	01	110		1				30		90	1	30		90				30		31												25		25					25		25				25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5795	003	0		29	10	S5795_003_0	3	4	Non-Preferred Brand	1	3	110000	1	2		110	01	110		1				30		90	1	30		90				30		31								100.00		250.00					95.00		237.50					95.00		237.50																100.00				95.00			3.33	3.16	3.16			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5805	001	0		29	10	S5805_001_0	2	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31								6.00		18.00					3.00		9.00													18.00						0.00				6.00				6.00			0.20	0.10				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5805	001	0		29	10	S5805_001_0	2	2	Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31								12.00		36.00					8.00		24.00													36.00						0.00				12.00				12.00			0.40	0.26				0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5805	001	0		29	10	S5805_001_0	2	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31											509.00	33		33				509.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5805	001	0		29	10	S5805_001_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											98.00	47		47				73.00	40		40												47						40			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5805	001	0		29	10	S5805_001_0	2	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								45.00		135.00					35.00		105.00													135.00						90.00				45.00				45.00			1.50	1.16				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	035	0		29	10	S5810_035_0	2	1	Preferred Generic	1	2	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	035	0		29	10	S5810_035_0	2	2	Generic	1	2	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	035	0		29	10	S5810_035_0	2	3	Preferred Brand	1	2	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								35.00	70.00	105.00					35.00	70.00	105.00					35.00	70.00	105.00																	35.00			35.00			1.17	1.17	1.17			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	035	0		29	10	S5810_035_0	2	4	Non-Preferred Brand	1	2	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											70.35	36	36	36				68.18	36	36	36				36	36	36																36		36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	035	0		29	10	S5810_035_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	036	0		29	10	S5810_036_0	1	2	Generic	1	2	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	036	0		29	10	S5810_036_0	1	1	Preferred Generic	1	2	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	036	0		29	10	S5810_036_0	1	3	Preferred Brand	1	2	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								35.00	70.00	105.00					35.00	70.00	105.00					35.00	70.00	105.00																	35.00			35.00			1.17	1.17	1.17			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	036	0		29	10	S5810_036_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	036	0		29	10	S5810_036_0	1	4	Non-Preferred Brand	1	2	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											70.26	41	41	41				68.83	41	41	41				41	41	41																41		41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	037	0		29	10	S5810_037_0	1	1	Preferred Generic	1	2	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	037	0		29	10	S5810_037_0	1	2	Generic	1	2	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	037	0		29	10	S5810_037_0	1	4	Non-Preferred Brand	1	2	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											76.04	44	44	44				76.31	44	44	44				44	44	44																44		44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	037	0		29	10	S5810_037_0	1	3	Preferred Brand	1	2	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								35.00	70.00	105.00					35.00	70.00	105.00					35.00	70.00	105.00																	35.00			35.00			1.17	1.17	1.17			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	037	0		29	10	S5810_037_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	038	0		29	10	S5810_038_0	1	2	Generic	1	2	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	038	0		29	10	S5810_038_0	1	1	Preferred Generic	1	2	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	038	0		29	10	S5810_038_0	1	3	Preferred Brand	1	2	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								35.00	70.00	105.00					35.00	70.00	105.00					35.00	70.00	105.00																	35.00			35.00			1.17	1.17	1.17			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	038	0		29	10	S5810_038_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	038	0		29	10	S5810_038_0	1	4	Non-Preferred Brand	1	2	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											77.56	43	43	43				76.83	43	43	43				43	43	43																43		43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	039	0		29	10	S5810_039_0	1	2	Generic	1	2	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	039	0		29	10	S5810_039_0	1	1	Preferred Generic	1	2	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	039	0		29	10	S5810_039_0	1	3	Preferred Brand	1	2	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								40.00	80.00	120.00					40.00	80.00	120.00					40.00	80.00	120.00																	40.00			40.00			1.33	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	039	0		29	10	S5810_039_0	1	4	Non-Preferred Brand	1	2	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											69.63	42	42	42				68.19	42	42	42				42	42	42																42		42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	039	0		29	10	S5810_039_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	040	0		29	10	S5810_040_0	1	2	Generic	1	2	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	040	0		29	10	S5810_040_0	1	1	Preferred Generic	1	2	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	040	0		29	10	S5810_040_0	1	3	Preferred Brand	1	2	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								35.00	70.00	105.00					35.00	70.00	105.00					35.00	70.00	105.00																	35.00			35.00			1.17	1.17	1.17			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	040	0		29	10	S5810_040_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	040	0		29	10	S5810_040_0	1	4	Non-Preferred Brand	1	2	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											77.81	43	43	43				75.26	43	43	43				43	43	43																43		43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	041	0		29	10	S5810_041_0	1	1	Preferred Generic	1	2	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	041	0		29	10	S5810_041_0	1	2	Generic	1	2	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	041	0		29	10	S5810_041_0	1	3	Preferred Brand	1	2	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								40.00	80.00	120.00					40.00	80.00	120.00					40.00	80.00	120.00																	40.00			40.00			1.33	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	041	0		29	10	S5810_041_0	1	4	Non-Preferred Brand	1	2	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											70.27	41	41	41				68.14	41	41	41				41	41	41																41		41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	041	0		29	10	S5810_041_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	042	0		29	10	S5810_042_0	1	1	Preferred Generic	1	2	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	042	0		29	10	S5810_042_0	1	2	Generic	1	2	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	042	0		29	10	S5810_042_0	1	3	Preferred Brand	1	2	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								35.00	70.00	105.00					35.00	70.00	105.00					35.00	70.00	105.00																	35.00			35.00			1.17	1.17	1.17			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	042	0		29	10	S5810_042_0	1	4	Non-Preferred Brand	1	2	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											87.50	42	42	42				86.14	42	42	42				42	42	42																42		42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	042	0		29	10	S5810_042_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	043	0		29	10	S5810_043_0	1	1	Preferred Generic	1	2	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	043	0		29	10	S5810_043_0	1	2	Generic	1	2	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	043	0		29	10	S5810_043_0	1	3	Preferred Brand	1	2	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								35.00	70.00	105.00					35.00	70.00	105.00					35.00	70.00	105.00																	35.00			35.00			1.17	1.17	1.17			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	043	0		29	10	S5810_043_0	1	4	Non-Preferred Brand	1	2	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											61.50	36	36	36				59.86	36	36	36				36	36	36																36		36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	043	0		29	10	S5810_043_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	044	0		29	10	S5810_044_0	1	2	Generic	1	2	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, 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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, 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								35.00	70.00	105.00					35.00	70.00	105.00					35.00	70.00	105.00																	35.00			35.00			1.17	1.17	1.17			1.13	Preferred Generic, 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								Preferred Generic, 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											60.34	38	38	38				59.02	38	38	38				38	38	38																38		38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	045	0		29	10	S5810_045_0	1	1	Preferred Generic	1	2	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	045	0		29	10	S5810_045_0	1	2	Generic	1	2	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	045	0		29	10	S5810_045_0	1	4	Non-Preferred Brand	1	2	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											75.15	42	42	42				71.91	42	42	42				42	42	42																42		42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	045	0		29	10	S5810_045_0	1	3	Preferred Brand	1	2	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								35.00	70.00	105.00					35.00	70.00	105.00					35.00	70.00	105.00																	35.00			35.00			1.17	1.17	1.17			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	045	0		29	10	S5810_045_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	046	0		29	10	S5810_046_0	1	2	Generic	1	2	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	046	0		29	10	S5810_046_0	1	1	Preferred Generic	1	2	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	046	0		29	10	S5810_046_0	1	3	Preferred Brand	1	2	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								35.00	70.00	105.00					35.00	70.00	105.00					35.00	70.00	105.00																	35.00			35.00			1.17	1.17	1.17			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	046	0		29	10	S5810_046_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	046	0		29	10	S5810_046_0	1	4	Non-Preferred Brand	1	2	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											55.35	38	38	38				53.54	38	38	38				38	38	38																38		38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	047	0		29	10	S5810_047_0	1	2	Generic	1	2	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	047	0		29	10	S5810_047_0	1	1	Preferred Generic	1	2	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	047	0		29	10	S5810_047_0	1	3	Preferred Brand	1	2	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								30.00	60.00	90.00					30.00	60.00	90.00					30.00	60.00	90.00																	30.00			30.00			1.00	1.00	1.00			0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	047	0		29	10	S5810_047_0	1	4	Non-Preferred Brand	1	2	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											69.26	39	39	39				68.07	39	39	39				39	39	39																39		39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	047	0		29	10	S5810_047_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	048	0		29	10	S5810_048_0	1	2	Generic	1	2	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	048	0		29	10	S5810_048_0	1	1	Preferred Generic	1	2	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	048	0		29	10	S5810_048_0	1	3	Preferred Brand	1	2	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								35.00	70.00	105.00					35.00	70.00	105.00					35.00	70.00	105.00																	35.00			35.00			1.17	1.17	1.17			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	048	0		29	10	S5810_048_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	048	0		29	10	S5810_048_0	1	4	Non-Preferred Brand	1	2	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											70.82	38	38	38				68.72	38	38	38				38	38	38																38		38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	049	0		29	10	S5810_049_0	1	1	Preferred Generic	1	2	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	049	0		29	10	S5810_049_0	1	2	Generic	1	2	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	049	0		29	10	S5810_049_0	1	3	Preferred Brand	1	2	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								35.00	70.00	105.00					35.00	70.00	105.00					35.00	70.00	105.00																	35.00			35.00			1.17	1.17	1.17			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	049	0		29	10	S5810_049_0	1	4	Non-Preferred Brand	1	2	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											64.40	37	37	37				62.74	37	37	37				37	37	37																37		37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	049	0		29	10	S5810_049_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	050	0		29	10	S5810_050_0	1	1	Preferred Generic	1	2	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	050	0		29	10	S5810_050_0	1	2	Generic	1	2	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	050	0		29	10	S5810_050_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	050	0		29	10	S5810_050_0	1	4	Non-Preferred Brand	1	2	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											69.87	37	37	37				68.29	37	37	37				37	37	37																37		37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	050	0		29	10	S5810_050_0	1	3	Preferred Brand	1	2	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								30.00	60.00	90.00					30.00	60.00	90.00					30.00	60.00	90.00																	30.00			30.00			1.00	1.00	1.00			0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	051	0		29	10	S5810_051_0	1	3	Preferred Brand	1	2	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								35.00	70.00	105.00					35.00	70.00	105.00					35.00	70.00	105.00																	35.00			35.00			1.17	1.17	1.17			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	051	0		29	10	S5810_051_0	1	1	Preferred Generic	1	2	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	051	0		29	10	S5810_051_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	051	0		29	10	S5810_051_0	1	4	Non-Preferred Brand	1	2	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											67.63	40	40	40				65.79	40	40	40				40	40	40																40		40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	051	0		29	10	S5810_051_0	1	2	Generic	1	2	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	052	0		29	10	S5810_052_0	1	3	Preferred Brand	1	2	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								35.00	70.00	105.00					35.00	70.00	105.00					35.00	70.00	105.00																	35.00			35.00			1.17	1.17	1.17			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	052	0		29	10	S5810_052_0	1	1	Preferred Generic	1	2	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	052	0		29	10	S5810_052_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	052	0		29	10	S5810_052_0	1	4	Non-Preferred Brand	1	2	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											65.17	35	35	35				63.85	35	35	35				35	35	35																35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	052	0		29	10	S5810_052_0	1	2	Generic	1	2	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	053	0		29	10	S5810_053_0	1	2	Generic	1	2	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	053	0		29	10	S5810_053_0	1	3	Preferred Brand	1	2	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								35.00	70.00	105.00					35.00	70.00	105.00					35.00	70.00	105.00																	35.00			35.00			1.17	1.17	1.17			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	053	0		29	10	S5810_053_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	053	0		29	10	S5810_053_0	1	4	Non-Preferred Brand	1	2	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											46.85	36	36	36				46.07	36	36	36				36	36	36																36		36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	053	0		29	10	S5810_053_0	1	1	Preferred Generic	1	2	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	054	0		29	10	S5810_054_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	054	0		29	10	S5810_054_0	1	4	Non-Preferred Brand	1	2	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											78.21	43	43	43				75.79	43	43	43				43	43	43																43		43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	054	0		29	10	S5810_054_0	1	3	Preferred Brand	1	2	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								35.00	70.00	105.00					35.00	70.00	105.00					35.00	70.00	105.00																	35.00			35.00			1.17	1.17	1.17			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	054	0		29	10	S5810_054_0	1	1	Preferred Generic	1	2	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	054	0		29	10	S5810_054_0	1	2	Generic	1	2	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, 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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	055	0		29	10	S5810_055_0	2	2	Generic	1	2	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, 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								Preferred Generic, 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											63.91	38	38	38				62.55	38	38	38				38	38	38																38		38								Preferred Generic, 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								35.00	70.00	105.00					35.00	70.00	105.00					35.00	70.00	105.00																	35.00			35.00			1.17	1.17	1.17			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	056	0		29	10	S5810_056_0	1	4	Non-Preferred Brand	1	2	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											77.01	45	45	45				76.04	45	45	45				45	45	45																45		45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	056	0		29	10	S5810_056_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	056	0		29	10	S5810_056_0	1	2	Generic	1	2	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	056	0		29	10	S5810_056_0	1	3	Preferred Brand	1	2	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								35.00	70.00	105.00					35.00	70.00	105.00					35.00	70.00	105.00																	35.00			35.00			1.17	1.17	1.17			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	056	0		29	10	S5810_056_0	1	1	Preferred Generic	1	2	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	057	0		29	10	S5810_057_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	057	0		29	10	S5810_057_0	1	4	Non-Preferred Brand	1	2	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											63.87	35	35	35				60.05	35	35	35				35	35	35																35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	057	0		29	10	S5810_057_0	1	3	Preferred Brand	1	2	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								30.00	60.00	90.00					30.00	60.00	90.00					30.00	60.00	90.00																	30.00			30.00			1.00	1.00	1.00			0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	057	0		29	10	S5810_057_0	1	1	Preferred Generic	1	2	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	057	0		29	10	S5810_057_0	1	2	Generic	1	2	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	058	0		29	10	S5810_058_0	1	1	Preferred Generic	1	2	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	058	0		29	10	S5810_058_0	1	2	Generic	1	2	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	058	0		29	10	S5810_058_0	1	4	Non-Preferred Brand	1	2	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											65.98	38	38	38				64.48	38	38	38				38	38	38																38		38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	058	0		29	10	S5810_058_0	1	3	Preferred Brand	1	2	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								30.00	60.00	90.00					30.00	60.00	90.00					30.00	60.00	90.00																	30.00			30.00			1.00	1.00	1.00			0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	058	0		29	10	S5810_058_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	059	0		29	10	S5810_059_0	1	2	Generic	1	2	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	059	0		29	10	S5810_059_0	1	1	Preferred Generic	1	2	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	059	0		29	10	S5810_059_0	1	3	Preferred Brand	1	2	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								35.00	70.00	105.00					35.00	70.00	105.00					35.00	70.00	105.00																	35.00			35.00			1.17	1.17	1.17			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	059	0		29	10	S5810_059_0	1	4	Non-Preferred Brand	1	2	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											70.05	35	35	35				68.37	35	35	35				35	35	35																35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	059	0		29	10	S5810_059_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	060	0		29	10	S5810_060_0	1	1	Preferred Generic	1	2	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	060	0		29	10	S5810_060_0	1	2	Generic	1	2	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	060	0		29	10	S5810_060_0	1	3	Preferred Brand	1	2	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								35.00	70.00	105.00					35.00	70.00	105.00					35.00	70.00	105.00																	35.00			35.00			1.17	1.17	1.17			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	060	0		29	10	S5810_060_0	1	4	Non-Preferred Brand	1	2	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											51.13	35	35	35				49.93	35	35	35				35	35	35																35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	060	0		29	10	S5810_060_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	061	0		29	10	S5810_061_0	1	1	Preferred Generic	1	2	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	061	0		29	10	S5810_061_0	1	2	Generic	1	2	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	061	0		29	10	S5810_061_0	1	3	Preferred Brand	1	2	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								30.00	60.00	90.00					30.00	60.00	90.00					30.00	60.00	90.00																	30.00			30.00			1.00	1.00	1.00			0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	061	0		29	10	S5810_061_0	1	4	Non-Preferred Brand	1	2	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											72.97	33	33	33				70.46	33	33	33				33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	061	0		29	10	S5810_061_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	062	0		29	10	S5810_062_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	062	0		29	10	S5810_062_0	1	1	Preferred Generic	1	2	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	062	0		29	10	S5810_062_0	1	2	Generic	1	2	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	062	0		29	10	S5810_062_0	1	3	Preferred Brand	1	2	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								35.00	70.00	105.00					35.00	70.00	105.00					35.00	70.00	105.00																	35.00			35.00			1.17	1.17	1.17			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	062	0		29	10	S5810_062_0	1	4	Non-Preferred Brand	1	2	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											82.36	39	39	39				76.07	39	39	39				39	39	39																39		39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	063	0		29	10	S5810_063_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	063	0		29	10	S5810_063_0	1	4	Non-Preferred Brand	1	2	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											61.86	43	43	43				56.61	43	43	43				43	43	43																43		43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	063	0		29	10	S5810_063_0	1	1	Preferred Generic	1	2	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	063	0		29	10	S5810_063_0	1	2	Generic	1	2	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	063	0		29	10	S5810_063_0	1	3	Preferred Brand	1	2	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								35.00	70.00	105.00					35.00	70.00	105.00					35.00	70.00	105.00																	35.00			35.00			1.17	1.17	1.17			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	064	0		29	10	S5810_064_0	1	4	Non-Preferred Brand	1	2	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											62.05	36	36	36				60.94	36	36	36				36	36	36																36		36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	064	0		29	10	S5810_064_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	064	0		29	10	S5810_064_0	1	1	Preferred Generic	1	2	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	064	0		29	10	S5810_064_0	1	2	Generic	1	2	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	064	0		29	10	S5810_064_0	1	3	Preferred Brand	1	2	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								30.00	60.00	90.00					30.00	60.00	90.00					30.00	60.00	90.00																	30.00			30.00			1.00	1.00	1.00			0.97	Preferred Generic, 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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, 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											55.87	35	35	35				54.17	35	35	35				35	35	35																35		35								Preferred Generic, 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								35.00	70.00	105.00					35.00	70.00	105.00					35.00	70.00	105.00																	35.00			35.00			1.17	1.17	1.17			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	065	0		29	10	S5810_065_0	1	2	Generic	1	2	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, 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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	066	0		29	10	S5810_066_0	1	1	Preferred Generic	1	2	001000	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	066	0		29	10	S5810_066_0	1	3	Preferred Brand	1	2	010001	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								35.00	70.00	105.00					35.00	70.00	105.00					35.00	70.00	105.00																	35.00			35.00			1.17	1.17	1.17			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	066	0		29	10	S5810_066_0	1	4	Non-Preferred Brand	1	2	110000	1	1		111	10	111		1				30	60	90	1	30	60	90					10	31											65.42	40	40	40				64.96	40	40	40				40	40	40																40		40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	066	0		29	10	S5810_066_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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	066	0		29	10	S5810_066_0	1	2	Generic	1	2	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	067	0		29	10	S5810_067_0	1	2	Generic	1	2	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, 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								35.00	70.00	105.00					35.00	70.00	105.00					35.00	70.00	105.00																	35.00			35.00			1.17	1.17	1.17			1.13	Preferred Generic, 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											57.42	43	43	43				56.30	43	43	43				43	43	43																43		43								Preferred Generic, 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								Preferred Generic, 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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5810	068	0		29	10	S5810_068_0	1	2	Generic	1	2	000100	1	2		111	10	111		1				30	60	90	1	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	21.00																	7.00			7.00			0.23	0.07	0.23			0.23	Preferred Generic, 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								40.00	80.00	120.00					40.00	80.00	120.00					40.00	80.00	120.00																	40.00			40.00			1.33	1.33	1.33			1.29	Preferred Generic, 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											74.70	46	46	46				71.05	46	46	46				46	46	46																46		46								Preferred Generic, 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								Preferred Generic, 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								6.00	12.00	18.00					1.00	2.00	3.00					6.00	12.00	18.00																	6.00			6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	001	0		29	10	S5820_001_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											89.00	50		50				61.00	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	001	0		29	10	S5820_001_0	2	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31											385.00	33		33				385.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	001	0		29	10	S5820_001_0	2	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31								8.00		24.00					3.00		9.00													24.00						0.00				8.00				8.00			0.26	0.10				0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	001	0		29	10	S5820_001_0	2	2	Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31								12.00		36.00					8.00		24.00													36.00						0.00				12.00				12.00			0.40	0.26				0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	001	0		29	10	S5820_001_0	2	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								45.00		135.00					35.00		105.00													135.00						90.00				45.00				45.00			1.50	1.16				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	002	0		29	10	S5820_002_0	2	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31								4.00		12.00					2.00		6.00													12.00						0.00				4.00				4.00			0.13	0.06				0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	002	0		29	10	S5820_002_0	2	2	Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	002	0		29	10	S5820_002_0	2	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								46.00		138.00					36.00		108.00													138.00						93.00				46.00				46.00			1.53	1.20				1.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	002	0		29	10	S5820_002_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											96.00	50		50				70.00	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	002	0		29	10	S5820_002_0	2	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31											436.00	33		33				436.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	003	0		29	10	S5820_003_0	2	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31											521.00	33		33				521.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	003	0		29	10	S5820_003_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											92.00	50		50				67.00	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	003	0		29	10	S5820_003_0	2	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								45.00		135.00					35.00		105.00													135.00						90.00				45.00				45.00			1.50	1.16				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	003	0		29	10	S5820_003_0	2	2	Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31								11.00		33.00					8.00		24.00													33.00						0.00				11.00				11.00			0.36	0.26				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	003	0		29	10	S5820_003_0	2	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31								7.00		21.00					4.00		12.00													21.00						0.00				7.00				7.00			0.23	0.13				0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	004	0		29	10	S5820_004_0	2	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31								8.00		24.00					5.00		15.00													24.00						0.00				8.00				8.00			0.26	0.16				0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	004	0		29	10	S5820_004_0	2	2	Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31								15.00		45.00					10.00		30.00													45.00						0.00				15.00				15.00			0.50	0.33				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	004	0		29	10	S5820_004_0	2	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31											451.00	33		33				451.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	004	0		29	10	S5820_004_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											90.00	50		50				63.00	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	004	0		29	10	S5820_004_0	2	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								45.00		135.00					35.00		105.00													135.00						90.00				45.00				45.00			1.50	1.16				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	005	0		29	10	S5820_005_0	2	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31								10.00		30.00					5.00		15.00													30.00						0.00				10.00				10.00			0.33	0.16				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	005	0		29	10	S5820_005_0	2	2	Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31								14.00		42.00					8.00		24.00													42.00						0.00				14.00				14.00			0.46	0.26				0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	005	0		29	10	S5820_005_0	2	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31											436.00	33		33				436.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	005	0		29	10	S5820_005_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											85.00	50		50				59.00	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	005	0		29	10	S5820_005_0	2	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								45.00		135.00					35.00		105.00													135.00						90.00				45.00				45.00			1.50	1.16				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	006	0		29	10	S5820_006_0	2	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31								4.00		12.00					2.00		6.00													12.00						0.00				4.00				4.00			0.13	0.06				0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	006	0		29	10	S5820_006_0	2	2	Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31								20.00		60.00					15.00		45.00													60.00						0.00				20.00				20.00			0.66	0.50				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	006	0		29	10	S5820_006_0	2	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								47.00		141.00					36.00		108.00													141.00						93.00				47.00				47.00			1.56	1.20				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	006	0		29	10	S5820_006_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											83.00	50		50				57.00	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	006	0		29	10	S5820_006_0	2	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31											434.00	33		33				434.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	007	0		29	10	S5820_007_0	2	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31								7.00		21.00					3.00		9.00													21.00						0.00				7.00				7.00			0.23	0.10				0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	007	0		29	10	S5820_007_0	2	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31											455.00	33		33				455.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	007	0		29	10	S5820_007_0	2	2	Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31								13.00		39.00					7.00		21.00													39.00						0.00				13.00				13.00			0.43	0.23				0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	007	0		29	10	S5820_007_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											81.00	50		50				55.00	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	007	0		29	10	S5820_007_0	2	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								45.00		135.00					35.00		105.00													135.00						90.00				45.00				45.00			1.50	1.16				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	008	0		29	10	S5820_008_0	2	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31								10.00		30.00					5.00		15.00													30.00						0.00				10.00				10.00			0.33	0.16				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	008	0		29	10	S5820_008_0	2	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								45.00		135.00					35.00		105.00													135.00						90.00				45.00				45.00			1.50	1.16				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	008	0		29	10	S5820_008_0	2	2	Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31								14.00		42.00					8.00		24.00													42.00						0.00				14.00				14.00			0.46	0.26				0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	008	0		29	10	S5820_008_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											77.00	50		50				54.00	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	008	0		29	10	S5820_008_0	2	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31											449.00	33		33				449.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	009	0		29	10	S5820_009_0	2	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31											518.00	33		33				518.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	009	0		29	10	S5820_009_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											77.00	50		50				54.00	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	009	0		29	10	S5820_009_0	2	2	Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31								13.00		39.00					8.00		24.00													39.00						0.00				13.00				13.00			0.43	0.26				0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	009	0		29	10	S5820_009_0	2	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								45.00		135.00					35.00		105.00													135.00						90.00				45.00				45.00			1.50	1.16				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	009	0		29	10	S5820_009_0	2	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31								8.00		24.00					3.00		9.00													24.00						0.00				8.00				8.00			0.26	0.10				0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	010	0		29	10	S5820_010_0	2	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31								4.00		12.00					2.00		6.00													12.00						0.00				4.00				4.00			0.13	0.06				0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	010	0		29	10	S5820_010_0	2	2	Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31								20.00		60.00					15.00		45.00													60.00						0.00				20.00				20.00			0.66	0.50				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	010	0		29	10	S5820_010_0	2	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								47.00		141.00					36.00		108.00													141.00						93.00				47.00				47.00			1.56	1.20				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	010	0		29	10	S5820_010_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											80.00	50		50				57.00	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	010	0		29	10	S5820_010_0	2	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31											465.00	33		33				465.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	011	0		29	10	S5820_011_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											74.00	50		50				53.00	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	011	0		29	10	S5820_011_0	2	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								43.00		129.00					33.00		99.00													129.00						84.00				43.00				43.00			1.43	1.10				1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	011	0		29	10	S5820_011_0	2	2	Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31								12.00		36.00					7.00		21.00													36.00						0.00				12.00				12.00			0.40	0.23				0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	011	0		29	10	S5820_011_0	2	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31								6.00		18.00					3.00		9.00													18.00						0.00				6.00				6.00			0.20	0.10				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	011	0		29	10	S5820_011_0	2	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31											463.00	33		33				463.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	012	0		29	10	S5820_012_0	2	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31								9.00		27.00					4.00		12.00													27.00						0.00				9.00				9.00			0.30	0.13				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	012	0		29	10	S5820_012_0	2	2	Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31								14.00		42.00					9.00		27.00													42.00						0.00				14.00				14.00			0.46	0.30				0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	012	0		29	10	S5820_012_0	2	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								45.00		135.00					35.00		105.00													135.00						90.00				45.00				45.00			1.50	1.16				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	012	0		29	10	S5820_012_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											82.00	50		50				58.00	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	012	0		29	10	S5820_012_0	2	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31											433.00	33		33				433.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	013	0		29	10	S5820_013_0	2	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31								8.00		24.00					4.00		12.00													24.00						0.00				8.00				8.00			0.26	0.13				0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	013	0		29	10	S5820_013_0	2	2	Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31								16.00		48.00					10.00		30.00													48.00						0.00				16.00				16.00			0.53	0.33				0.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	013	0		29	10	S5820_013_0	2	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								46.00		138.00					35.00		105.00													138.00						90.00				46.00				46.00			1.53	1.16				1.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	013	0		29	10	S5820_013_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											84.00	50		50				61.00	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	013	0		29	10	S5820_013_0	2	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31											426.00	33		33				426.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	014	0		29	10	S5820_014_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											80.00	50		50				58.00	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	014	0		29	10	S5820_014_0	2	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								45.00		135.00					35.00		105.00													135.00						90.00				45.00				45.00			1.50	1.16				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	014	0		29	10	S5820_014_0	2	2	Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31								14.00		42.00					8.00		24.00													42.00						0.00				14.00				14.00			0.46	0.26				0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	014	0		29	10	S5820_014_0	2	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31								7.00		21.00					3.00		9.00													21.00						0.00				7.00				7.00			0.23	0.10				0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	014	0		29	10	S5820_014_0	2	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31											429.00	33		33				429.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	015	0		29	10	S5820_015_0	2	2	Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31								15.00		45.00					10.00		30.00													45.00						0.00				15.00				15.00			0.50	0.33				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	015	0		29	10	S5820_015_0	2	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31								8.00		24.00					5.00		15.00													24.00						0.00				8.00				8.00			0.26	0.16				0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	015	0		29	10	S5820_015_0	2	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								45.00		135.00					35.00		105.00													135.00						90.00				45.00				45.00			1.50	1.16				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	015	0		29	10	S5820_015_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											89.00	50		50				62.00	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	015	0		29	10	S5820_015_0	2	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31											356.00	33		33				356.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	016	0		29	10	S5820_016_0	2	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31								4.00		12.00					2.00		6.00													12.00						0.00				4.00				4.00			0.13	0.06				0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	016	0		29	10	S5820_016_0	2	2	Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31								20.00		60.00					12.00		36.00													60.00						0.00				20.00				20.00			0.66	0.40				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	016	0		29	10	S5820_016_0	2	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								47.00		141.00					36.00		108.00													141.00						93.00				47.00				47.00			1.56	1.20				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	016	0		29	10	S5820_016_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											82.00	50		50				63.00	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	016	0		29	10	S5820_016_0	2	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31											414.00	33		33				414.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	017	0		29	10	S5820_017_0	2	2	Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31								16.00		48.00					8.00		24.00													48.00						0.00				16.00				16.00			0.53	0.26				0.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	017	0		29	10	S5820_017_0	2	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31								8.00		24.00					4.00		12.00													24.00						0.00				8.00				8.00			0.26	0.13				0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	017	0		29	10	S5820_017_0	2	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								45.00		135.00					35.00		105.00													135.00						90.00				45.00				45.00			1.50	1.16				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	017	0		29	10	S5820_017_0	2	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31											404.00	33		33				404.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	017	0		29	10	S5820_017_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											83.00	50		50				57.00	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	018	0		29	10	S5820_018_0	2	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31								8.00		24.00					3.00		9.00													24.00						0.00				8.00				8.00			0.26	0.10				0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	018	0		29	10	S5820_018_0	2	2	Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31								12.00		36.00					8.00		24.00													36.00						0.00				12.00				12.00			0.40	0.26				0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	018	0		29	10	S5820_018_0	2	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								45.00		135.00					35.00		105.00													135.00						90.00				45.00				45.00			1.50	1.16				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	018	0		29	10	S5820_018_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											69.00	50		50				45.00	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	018	0		29	10	S5820_018_0	2	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31											472.00	33		33				472.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	019	0		29	10	S5820_019_0	2	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31								8.00		24.00					3.00		9.00													24.00						0.00				8.00				8.00			0.26	0.10				0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	019	0		29	10	S5820_019_0	2	2	Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31								13.00		39.00					7.00		21.00													39.00						0.00				13.00				13.00			0.43	0.23				0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	019	0		29	10	S5820_019_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											73.00	50		50				48.00	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	019	0		29	10	S5820_019_0	2	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								45.00		135.00					35.00		105.00													135.00						90.00				45.00				45.00			1.50	1.16				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	019	0		29	10	S5820_019_0	2	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31											520.00	33		33				520.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	020	0		29	10	S5820_020_0	2	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31								7.00		21.00					2.00		6.00													21.00						0.00				7.00				7.00			0.23	0.06				0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	020	0		29	10	S5820_020_0	2	2	Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31								11.00		33.00					6.00		18.00													33.00						0.00				11.00				11.00			0.36	0.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	020	0		29	10	S5820_020_0	2	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								46.00		138.00					35.00		105.00													138.00						90.00				46.00				46.00			1.53	1.16				1.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	020	0		29	10	S5820_020_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											75.00	50		50				52.00	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	020	0		29	10	S5820_020_0	2	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31											482.00	33		33				482.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	021	0		29	10	S5820_021_0	2	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31											487.00	33		33				487.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	021	0		29	10	S5820_021_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											83.00	50		50				59.00	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	021	0		29	10	S5820_021_0	2	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								45.00		135.00					35.00		105.00													135.00						90.00				45.00				45.00			1.50	1.16				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	021	0		29	10	S5820_021_0	2	2	Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31								17.00		51.00					12.00		36.00													51.00						0.00				17.00				17.00			0.56	0.40				0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	021	0		29	10	S5820_021_0	2	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31								6.00		18.00					3.00		9.00													18.00						0.00				6.00				6.00			0.20	0.10				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	022	0		29	10	S5820_022_0	2	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31											460.00	33		33				460.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	022	0		29	10	S5820_022_0	2	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								47.00		141.00					35.00		105.00													141.00						90.00				47.00				47.00			1.56	1.16				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	022	0		29	10	S5820_022_0	2	2	Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31								15.00		45.00					7.00		21.00													45.00						0.00				15.00				15.00			0.50	0.23				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	022	0		29	10	S5820_022_0	2	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31								9.00		27.00					3.00		9.00													27.00						0.00				9.00				9.00			0.30	0.10				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	022	0		29	10	S5820_022_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											71.00	50		50				49.00	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	023	0		29	10	S5820_023_0	2	2	Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31								15.00		45.00					10.00		30.00													45.00						0.00				15.00				15.00			0.50	0.33				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	023	0		29	10	S5820_023_0	2	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								45.00		135.00					35.00		105.00													135.00						90.00				45.00				45.00			1.50	1.16				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	023	0		29	10	S5820_023_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											82.00	50		50				55.00	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	023	0		29	10	S5820_023_0	2	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31											429.00	33		33				429.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	023	0		29	10	S5820_023_0	2	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31								5.00		15.00					3.00		9.00													15.00						0.00				5.00				5.00			0.16	0.10				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	024	0		29	10	S5820_024_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											83.00	50		50				61.00	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	024	0		29	10	S5820_024_0	2	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								45.00		135.00					35.00		105.00													135.00						90.00				45.00				45.00			1.50	1.16				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	024	0		29	10	S5820_024_0	2	2	Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31								15.00		45.00					10.00		30.00													45.00						0.00				15.00				15.00			0.50	0.33				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	024	0		29	10	S5820_024_0	2	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31								6.00		18.00					3.00		9.00													18.00						0.00				6.00				6.00			0.20	0.10				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	024	0		29	10	S5820_024_0	2	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31											365.00	33		33				365.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	025	0		29	10	S5820_025_0	2	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31								8.00		24.00					5.00		15.00													24.00						0.00				8.00				8.00			0.26	0.16				0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	025	0		29	10	S5820_025_0	2	2	Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31								15.00		45.00					10.00		30.00													45.00						0.00				15.00				15.00			0.50	0.33				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	025	0		29	10	S5820_025_0	2	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								45.00		135.00					35.00		105.00													135.00						90.00				45.00				45.00			1.50	1.16				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	025	0		29	10	S5820_025_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											78.00	50		50				57.00	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	025	0		29	10	S5820_025_0	2	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31											342.00	33		33				342.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	026	0		29	10	S5820_026_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											99.00	50		50				63.00	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	026	0		29	10	S5820_026_0	2	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								47.00		141.00					35.00		105.00													141.00						90.00				47.00				47.00			1.56	1.16				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	026	0		29	10	S5820_026_0	2	2	Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31								18.00		54.00					13.00		39.00													54.00						0.00				18.00				18.00			0.60	0.43				0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	026	0		29	10	S5820_026_0	2	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31								10.00		30.00					5.00		15.00													30.00						0.00				10.00				10.00			0.33	0.16				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	026	0		29	10	S5820_026_0	2	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31											421.00	33		33				421.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	027	0		29	10	S5820_027_0	2	2	Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31								18.00		54.00					13.00		39.00													54.00						0.00				18.00				18.00			0.60	0.43				0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	027	0		29	10	S5820_027_0	2	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								47.00		141.00					35.00		105.00													141.00						90.00				47.00				47.00			1.56	1.16				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	027	0		29	10	S5820_027_0	2	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31								10.00		30.00					5.00		15.00													30.00						0.00				10.00				10.00			0.33	0.16				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	027	0		29	10	S5820_027_0	2	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31											419.00	33		33				419.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	027	0		29	10	S5820_027_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											81.00	50		50				59.00	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	028	0		29	10	S5820_028_0	2	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31											545.00	33		33				545.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	028	0		29	10	S5820_028_0	2	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								45.00		135.00					35.00		105.00													135.00						90.00				45.00				45.00			1.50	1.16				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	028	0		29	10	S5820_028_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											78.00	50		50				57.00	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	028	0		29	10	S5820_028_0	2	2	Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31								15.00		45.00					10.00		30.00													45.00						0.00				15.00				15.00			0.50	0.33				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	028	0		29	10	S5820_028_0	2	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31								8.00		24.00					5.00		15.00													24.00						0.00				8.00				8.00			0.26	0.16				0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	029	0		29	10	S5820_029_0	2	2	Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31								15.00		45.00					10.00		30.00													45.00						0.00				15.00				15.00			0.50	0.33				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	029	0		29	10	S5820_029_0	2	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31								7.00		21.00					4.00		12.00													21.00						0.00				7.00				7.00			0.23	0.13				0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	029	0		29	10	S5820_029_0	2	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								45.00		135.00					35.00		105.00													135.00						90.00				45.00				45.00			1.50	1.16				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	029	0		29	10	S5820_029_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											77.00	50		50				54.00	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	029	0		29	10	S5820_029_0	2	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31											371.00	33		33				371.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	030	0		29	10	S5820_030_0	2	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31								6.00		18.00					3.00		9.00													18.00						0.00				6.00				6.00			0.20	0.10				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	030	0		29	10	S5820_030_0	2	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								45.00		135.00					35.00		105.00													135.00						90.00				45.00				45.00			1.50	1.16				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	030	0		29	10	S5820_030_0	2	2	Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31								13.00		39.00					8.00		24.00													39.00						0.00				13.00				13.00			0.43	0.26				0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	030	0		29	10	S5820_030_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											77.00	50		50				59.00	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	030	0		29	10	S5820_030_0	2	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31											402.00	33		33				402.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	031	0		29	10	S5820_031_0	2	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								45.00		135.00					35.00		105.00													135.00						90.00				45.00				45.00			1.50	1.16				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	031	0		29	10	S5820_031_0	2	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31								8.00		24.00					4.00		12.00													24.00						0.00				8.00				8.00			0.26	0.13				0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	031	0		29	10	S5820_031_0	2	2	Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31								15.00		45.00					10.00		30.00													45.00						0.00				15.00				15.00			0.50	0.33				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	031	0		29	10	S5820_031_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											93.00	50		50				64.00	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	031	0		29	10	S5820_031_0	2	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31											511.00	33		33				511.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	032	0		29	10	S5820_032_0	2	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31											590.00	33		33				590.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	032	0		29	10	S5820_032_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											93.00	50		50				66.00	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	032	0		29	10	S5820_032_0	2	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								45.00		135.00					35.00		105.00													135.00						90.00				45.00				45.00			1.50	1.16				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	032	0		29	10	S5820_032_0	2	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31								8.00		24.00					5.00		15.00													24.00						0.00				8.00				8.00			0.26	0.16				0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	032	0		29	10	S5820_032_0	2	2	Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31								15.00		45.00					10.00		30.00													45.00						0.00				15.00				15.00			0.50	0.33				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	033	0		29	10	S5820_033_0	2	3	Preferred Brand	1	4	010001	1	2		110	01		100	1				30		90	1						90	30		31								45.00		135.00					35.00		105.00													135.00						90.00				45.00				45.00			1.50	1.16				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	033	0		29	10	S5820_033_0	2	4	Non-Preferred Brand	1	4	110000	1	1		110	01		100	1				30		90	1						90	30		31											72.00	50		50				64.00	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	033	0		29	10	S5820_033_0	2	5	Specialty Tier	1	4	010010	1	1		110	01		100	1				30		90	1						90	30		31											411.00	33		33				411.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	033	0		29	10	S5820_033_0	2	2	Generic	1	4	000100	1	2		110	01		100	1				30		90	1						90	30		31								15.00		45.00					10.00		30.00													45.00						0.00				15.00				15.00			0.50	0.33				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	033	0		29	10	S5820_033_0	2	1	Preferred Generic	1	4	001000	1	2		110	01		100	1				30		90	1						90	30		31								8.00		24.00					5.00		15.00													24.00						0.00				8.00				8.00			0.26	0.16				0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	034	0		29	10	S5820_034_0	2	5	Specialty Tier	1	2	010010	1	1	110		01	100		1	30		90				1			90				30		31				387.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	034	0		29	10	S5820_034_0	2	4	Non-Preferred Brand	1	2	110000	1	1	110		01	100		1	30		90				1			90				30		31				99.00	50		50																				50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	034	0		29	10	S5820_034_0	2	1	Preferred Generic	1	2	001000	1	2	110		01	100		1	30		90				1			90				30		31	2.00		6.00																					6.00																2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	034	0		29	10	S5820_034_0	2	2	Generic	1	2	000100	1	2	110		01	100		1	30		90				1			90				30		31	4.00		12.00																					12.00																4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	034	0		29	10	S5820_034_0	2	3	Preferred Brand	1	2	010001	1	2	110		01	100		1	30		90				1			90				30		31	35.00		105.00																					105.00																35.00				35.00		1.16						1.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	035	0		29	10	S5820_035_0	2	3	Preferred Brand	1	2	010001	1	2	110		01	100		1	30		90				1			90				30		31	36.00		108.00																					108.00																36.00				36.00		1.20						1.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	035	0		29	10	S5820_035_0	2	1	Preferred Generic	1	2	001000	1	2	110		01	100		1	30		90				1			90				30		31	2.00		6.00																					6.00																2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	035	0		29	10	S5820_035_0	2	2	Generic	1	2	000100	1	2	110		01	100		1	30		90				1			90				30		31	6.00		18.00																					18.00																6.00				6.00		0.20						0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	035	0		29	10	S5820_035_0	2	4	Non-Preferred Brand	1	2	110000	1	1	110		01	100		1	30		90				1			90				30		31				94.00	40		40																				40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	035	0		29	10	S5820_035_0	2	5	Specialty Tier	1	2	010010	1	1	110		01	100		1	30		90				1			90				30		31				562.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	036	0		29	10	S5820_036_0	2	2	Generic	1	2	000100	1	2	110		01	100		1	30		90				1			90				30		31	6.00		18.00																					18.00																6.00				6.00		0.20						0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	036	0		29	10	S5820_036_0	2	1	Preferred Generic	1	2	001000	1	2	110		01	100		1	30		90				1			90				30		31	2.00		6.00																					6.00																2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	036	0		29	10	S5820_036_0	2	3	Preferred Brand	1	2	010001	1	2	110		01	100		1	30		90				1			90				30		31	25.00		75.00																					75.00																25.00				25.00		0.83						0.80	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	036	0		29	10	S5820_036_0	2	4	Non-Preferred Brand	1	2	110000	1	1	110		01	100		1	30		90				1			90				30		31				90.00	50		50																				50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	036	0		29	10	S5820_036_0	2	5	Specialty Tier	1	2	010010	1	1	110		01	100		1	30		90				1			90				30		31				454.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	037	0		29	10	S5820_037_0	2	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31								2.00		6.00					1.00		3.00													6.00						3.00				2.00				2.00			0.06	0.03				0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	037	0		29	10	S5820_037_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											68.00	50		50				59.00	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	037	0		29	10	S5820_037_0	2	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31											645.00	25		25				645.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	037	0		29	10	S5820_037_0	2	2	Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31								8.00		24.00					3.00		9.00													24.00						9.00				8.00				8.00			0.26	0.10				0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	037	0		29	10	S5820_037_0	2	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31								30.00		90.00					20.00		60.00													90.00						60.00				30.00				30.00			1.00	0.66				0.96	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	038	0		29	10	S5820_038_0	2	2	Generic	1	2	000100	1	2	110		01	100		1	30		90				1			90				30		31	5.00		15.00																					15.00																5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	038	0		29	10	S5820_038_0	2	1	Preferred Generic	1	2	001000	1	2	110		01	100		1	30		90				1			90				30		31	2.00		6.00																					6.00																2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	038	0		29	10	S5820_038_0	2	3	Preferred Brand	1	2	010001	1	2	110		01	100		1	30		90				1			90				30		31	28.00		84.00																					84.00																28.00				28.00		0.93						0.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	038	0		29	10	S5820_038_0	2	4	Non-Preferred Brand	1	2	110000	1	1	110		01	100		1	30		90				1			90				30		31				89.00	50		50																				50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5820	038	0		29	10	S5820_038_0	2	5	Specialty Tier	1	2	010010	1	1	110		01	100		1	30		90				1			90				30		31				320.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5877	004	0		29	10	S5877_004_0	5	1	Generic	1	2	001000	1	2	110		10	100		1	34		90				2			90					29	34	8.00		24.00																					24.00																	8.00			8.00		0.24						0.24	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5877	004	0		29	10	S5877_004_0	5	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								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5877	004	0		29	10	S5877_004_0	5	3	Non-Preferred Brand	1	2	100000	1	2	110		10	100		1	34		90				2			90					29	34	100.00		300.00																					300.00																	100.00			100.00		2.94						2.94	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5877	004	0		29	10	S5877_004_0	5	2	Preferred Brand	1	2	000001	1	2	110		10	100		1	34		90				2			90					29	34	47.00		141.00																					141.00																	47.00			47.00		1.38						1.38	Generic, Preferred Brand, Non-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	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												
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				45.00	40		40																				40																40		40								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				42.00	20		20																				20																20		20								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	001	0		29	10	S5884_001_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	001	0		29	10	S5884_001_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	001	0		29	10	S5884_001_0	1	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	001	0		29	10	S5884_001_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31											66.00	50		50				57.00	44		44										50		50				44		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	001	0		29	10	S5884_001_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	001	0		29	10	S5884_001_0	1	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	001	0		29	10	S5884_001_0	1	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.16	3.13		3.16	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	002	0		29	10	S5884_002_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	002	0		29	10	S5884_002_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	002	0		29	10	S5884_002_0	1	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	002	0		29	10	S5884_002_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31											68.00	50		50				59.00	44		44										50		50				44		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	002	0		29	10	S5884_002_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	002	0		29	10	S5884_002_0	1	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	002	0		29	10	S5884_002_0	1	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.16	3.13		3.16	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	004	0		29	10	S5884_004_0	1	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	004	0		29	10	S5884_004_0	1	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.16	3.13		3.16	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	004	0		29	10	S5884_004_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	004	0		29	10	S5884_004_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	004	0		29	10	S5884_004_0	1	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	004	0		29	10	S5884_004_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31											70.00	50		50				61.00	44		44										50		50				44		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	004	0		29	10	S5884_004_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	005	0		29	10	S5884_005_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	005	0		29	10	S5884_005_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	005	0		29	10	S5884_005_0	1	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.16	3.13		3.16	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	005	0		29	10	S5884_005_0	1	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	005	0		29	10	S5884_005_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	005	0		29	10	S5884_005_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31											66.00	50		50				57.00	44		44										50		50				44		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	005	0		29	10	S5884_005_0	1	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	008	0		29	10	S5884_008_0	1	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.16	3.13		3.16	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	008	0		29	10	S5884_008_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	008	0		29	10	S5884_008_0	1	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	008	0		29	10	S5884_008_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31											66.00	50		50				58.00	44		44										50		50				44		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	008	0		29	10	S5884_008_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	008	0		29	10	S5884_008_0	1	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	008	0		29	10	S5884_008_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	009	0		29	10	S5884_009_0	1	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.16	3.13		3.16	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	009	0		29	10	S5884_009_0	1	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	009	0		29	10	S5884_009_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31											69.00	50		50				60.00	44		44										50		50				44		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	009	0		29	10	S5884_009_0	1	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	009	0		29	10	S5884_009_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	009	0		29	10	S5884_009_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	009	0		29	10	S5884_009_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	010	0		29	10	S5884_010_0	1	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	010	0		29	10	S5884_010_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		7.00				12.00				12.00			0.40	0.23		0.40	0.23	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	010	0		29	10	S5884_010_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	010	0		29	10	S5884_010_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31											67.00	50		50				58.00	44		44										50		50				44		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	010	0		29	10	S5884_010_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	010	0		29	10	S5884_010_0	1	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	010	0		29	10	S5884_010_0	1	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.16	3.13		3.16	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	015	0		29	10	S5884_015_0	1	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	015	0		29	10	S5884_015_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	015	0		29	10	S5884_015_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	015	0		29	10	S5884_015_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31											66.00	50		50				57.00	44		44										50		50				44		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	015	0		29	10	S5884_015_0	1	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.16	3.13		3.16	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	015	0		29	10	S5884_015_0	1	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	015	0		29	10	S5884_015_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	019	0		29	10	S5884_019_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	019	0		29	10	S5884_019_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	019	0		29	10	S5884_019_0	1	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	019	0		29	10	S5884_019_0	1	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	019	0		29	10	S5884_019_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	019	0		29	10	S5884_019_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31											67.00	50		50				58.00	44		44										50		50				44		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	019	0		29	10	S5884_019_0	1	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.16	3.13		3.16	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	020	0		29	10	S5884_020_0	1	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	020	0		29	10	S5884_020_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	020	0		29	10	S5884_020_0	1	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.16	3.13		3.16	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	020	0		29	10	S5884_020_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	020	0		29	10	S5884_020_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31											70.00	50		50				61.00	44		44										50		50				44		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	020	0		29	10	S5884_020_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	020	0		29	10	S5884_020_0	1	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	021	0		29	10	S5884_021_0	1	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.16	3.13		3.16	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	021	0		29	10	S5884_021_0	1	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	021	0		29	10	S5884_021_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	021	0		29	10	S5884_021_0	1	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	021	0		29	10	S5884_021_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31											63.00	50		50				54.00	44		44										50		50				44		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	021	0		29	10	S5884_021_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	021	0		29	10	S5884_021_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	022	0		29	10	S5884_022_0	1	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	022	0		29	10	S5884_022_0	1	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.16	3.13		3.16	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	022	0		29	10	S5884_022_0	1	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	022	0		29	10	S5884_022_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	022	0		29	10	S5884_022_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	022	0		29	10	S5884_022_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	022	0		29	10	S5884_022_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31											67.00	50		50				58.00	44		44										50		50				44		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	024	0		29	10	S5884_024_0	1	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.16	3.13		3.16	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	024	0		29	10	S5884_024_0	1	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	024	0		29	10	S5884_024_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	024	0		29	10	S5884_024_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31											65.00	50		50				57.00	44		44										50		50				44		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	024	0		29	10	S5884_024_0	1	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	024	0		29	10	S5884_024_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	024	0		29	10	S5884_024_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	028	0		29	10	S5884_028_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	028	0		29	10	S5884_028_0	1	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.16	3.13		3.16	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	028	0		29	10	S5884_028_0	1	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	028	0		29	10	S5884_028_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31											65.00	50		50				57.00	44		44										50		50				44		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	028	0		29	10	S5884_028_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	028	0		29	10	S5884_028_0	1	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	028	0		29	10	S5884_028_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.38	Preferred Generic, 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								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	030	0		29	10	S5884_030_0	2	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.38	Preferred Generic, 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								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, 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								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.16	3.13		3.16	3.13	3.06	Preferred Generic, 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, 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								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, 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											70.00	50		50				61.00	44		44										50		50				44		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	062	0		29	10	S5884_062_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	062	0		29	10	S5884_062_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	062	0		29	10	S5884_062_0	1	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	062	0		29	10	S5884_062_0	1	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	062	0		29	10	S5884_062_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	062	0		29	10	S5884_062_0	1	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	062	0		29	10	S5884_062_0	1	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.16	3.13		3.16	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	065	0		29	10	S5884_065_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	065	0		29	10	S5884_065_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	065	0		29	10	S5884_065_0	1	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	065	0		29	10	S5884_065_0	1	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.16	3.13		3.16	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	065	0		29	10	S5884_065_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	065	0		29	10	S5884_065_0	1	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	065	0		29	10	S5884_065_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31											63.00	50		50				55.00	44		44										50		50				44		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	066	0		29	10	S5884_066_0	1	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	066	0		29	10	S5884_066_0	1	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	066	0		29	10	S5884_066_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	066	0		29	10	S5884_066_0	1	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	066	0		29	10	S5884_066_0	1	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.16	3.13		3.16	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	066	0		29	10	S5884_066_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	066	0		29	10	S5884_066_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	071	0		29	10	S5884_071_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	071	0		29	10	S5884_071_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	071	0		29	10	S5884_071_0	1	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.16	3.13		3.16	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	071	0		29	10	S5884_071_0	1	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	071	0		29	10	S5884_071_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	071	0		29	10	S5884_071_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31											68.00	50		50				58.00	44		44										50		50				44		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	071	0		29	10	S5884_071_0	1	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	072	0		29	10	S5884_072_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	072	0		29	10	S5884_072_0	1	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	072	0		29	10	S5884_072_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31											65.00	50		50				56.00	44		44										50		50				44		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	072	0		29	10	S5884_072_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	072	0		29	10	S5884_072_0	1	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	072	0		29	10	S5884_072_0	1	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.16	3.13		3.16	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	072	0		29	10	S5884_072_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	073	0		29	10	S5884_073_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	073	0		29	10	S5884_073_0	1	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	073	0		29	10	S5884_073_0	1	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	073	0		29	10	S5884_073_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	073	0		29	10	S5884_073_0	1	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	073	0		29	10	S5884_073_0	1	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.16	3.13		3.16	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	073	0		29	10	S5884_073_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	074	0		29	10	S5884_074_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	074	0		29	10	S5884_074_0	1	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	074	0		29	10	S5884_074_0	1	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.16	3.13		3.16	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	074	0		29	10	S5884_074_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31											67.00	50		50				58.00	44		44										50		50				44		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	074	0		29	10	S5884_074_0	1	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	074	0		29	10	S5884_074_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	074	0		29	10	S5884_074_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	076	0		29	10	S5884_076_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31											65.00	50		50				56.00	44		44										50		50				44		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	076	0		29	10	S5884_076_0	1	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	076	0		29	10	S5884_076_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	076	0		29	10	S5884_076_0	1	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	076	0		29	10	S5884_076_0	1	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.16	3.13		3.16	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	076	0		29	10	S5884_076_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	076	0		29	10	S5884_076_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	077	0		29	10	S5884_077_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	077	0		29	10	S5884_077_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	077	0		29	10	S5884_077_0	1	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	077	0		29	10	S5884_077_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31											64.00	50		50				56.00	44		44										50		50				44		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	077	0		29	10	S5884_077_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	077	0		29	10	S5884_077_0	1	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	077	0		29	10	S5884_077_0	1	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.16	3.13		3.16	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	078	0		29	10	S5884_078_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	078	0		29	10	S5884_078_0	1	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	078	0		29	10	S5884_078_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31											69.00	50		50				60.00	44		44										50		50				44		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	078	0		29	10	S5884_078_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	078	0		29	10	S5884_078_0	1	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.16	3.13		3.16	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	078	0		29	10	S5884_078_0	1	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	078	0		29	10	S5884_078_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	083	0		29	10	S5884_083_0	1	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	083	0		29	10	S5884_083_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	083	0		29	10	S5884_083_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	083	0		29	10	S5884_083_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31											65.00	50		50				57.00	44		44										50		50				44		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	083	0		29	10	S5884_083_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	083	0		29	10	S5884_083_0	1	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	083	0		29	10	S5884_083_0	1	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.16	3.13		3.16	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	085	0		29	10	S5884_085_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	085	0		29	10	S5884_085_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	085	0		29	10	S5884_085_0	1	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	085	0		29	10	S5884_085_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31											64.00	50		50				56.00	44		44										50		50				44		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	085	0		29	10	S5884_085_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	085	0		29	10	S5884_085_0	1	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	085	0		29	10	S5884_085_0	1	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.16	3.13		3.16	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	086	0		29	10	S5884_086_0	1	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	086	0		29	10	S5884_086_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		7.00				12.00				12.00			0.40	0.23		0.40	0.23	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	086	0		29	10	S5884_086_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	086	0		29	10	S5884_086_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31											68.00	50		50				58.00	44		44										50		50				44		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	086	0		29	10	S5884_086_0	1	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.16	3.13		3.16	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	086	0		29	10	S5884_086_0	1	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	086	0		29	10	S5884_086_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	087	0		29	10	S5884_087_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	087	0		29	10	S5884_087_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	087	0		29	10	S5884_087_0	1	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	087	0		29	10	S5884_087_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31											86.00	50		50				71.00	44		44										50		50				44		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	087	0		29	10	S5884_087_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	087	0		29	10	S5884_087_0	1	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	087	0		29	10	S5884_087_0	1	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.16	3.13		3.16	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	089	0		29	10	S5884_089_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	089	0		29	10	S5884_089_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	089	0		29	10	S5884_089_0	1	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	089	0		29	10	S5884_089_0	1	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	089	0		29	10	S5884_089_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	089	0		29	10	S5884_089_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31											62.00	50		50				54.00	44		44										50		50				44		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	089	0		29	10	S5884_089_0	1	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.16	3.13		3.16	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	092	0		29	10	S5884_092_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31											73.00	50		50				64.00	44		44										50		50				44		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	092	0		29	10	S5884_092_0	1	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	092	0		29	10	S5884_092_0	1	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.16	3.13		3.16	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	092	0		29	10	S5884_092_0	1	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	092	0		29	10	S5884_092_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	092	0		29	10	S5884_092_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	092	0		29	10	S5884_092_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	093	0		29	10	S5884_093_0	1	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.16	3.13		3.16	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	093	0		29	10	S5884_093_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	093	0		29	10	S5884_093_0	1	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	093	0		29	10	S5884_093_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31											70.00	50		50				62.00	44		44										50		50				44		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	093	0		29	10	S5884_093_0	1	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	093	0		29	10	S5884_093_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	093	0		29	10	S5884_093_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	094	0		29	10	S5884_094_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	094	0		29	10	S5884_094_0	1	3	Preferred Brand	3	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	094	0		29	10	S5884_094_0	1	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	094	0		29	10	S5884_094_0	1	3	Preferred Brand	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	094	0		29	10	S5884_094_0	1	4	Non-Preferred Brand	3	4	110000	1	2		110	01		110	1				30		90	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.16	3.13		3.16	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	1	
S5884	094	0		29	10	S5884_094_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	094	0		29	10	S5884_094_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
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											49.00	38		38				45.00	35		35										38		38				35		30			38			38								Preferred Generic, 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, 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								3.00		9.00					1.00		3.00											3.00		9.00				1.00		0.00				3.00				3.00			0.10	0.03		0.10	0.03	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	101	0		29	10	S5884_101_0	1	2	Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								4.00		12.00					2.00		6.00											4.00		12.00				2.00		0.00				4.00				4.00			0.13	0.06		0.13	0.06	0.12	Preferred Generic, 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											26.00	25		25				20.00	20		20										25		25				20		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	102	0		29	10	S5884_102_0	2	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		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	102	0		29	10	S5884_102_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		110	1				30		90	2				30		90	30		31											48.00	36		36				45.00	35		35										36		36				35		30			36			36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	102	0		29	10	S5884_102_0	2	2	Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								4.00		12.00					2.00		6.00											4.00		12.00				2.00		0.00				4.00				4.00			0.13	0.06		0.13	0.06	0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	102	0		29	10	S5884_102_0	2	1	Preferred Generic	1	2	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								2.00		6.00					1.00		3.00											2.00		6.00				1.00		0.00				2.00				2.00			0.06	0.03		0.06	0.03	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	102	0		29	10	S5884_102_0	2	5	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	103	0		29	10	S5884_103_0	1	2	Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								4.00		12.00					2.00		6.00											4.00		12.00				2.00		0.00				4.00				4.00			0.13	0.06		0.13	0.06	0.12	Preferred Generic, 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								3.00		9.00					1.00		3.00											3.00		9.00				1.00		0.00				3.00				3.00			0.10	0.03		0.10	0.03	0.09	Preferred Generic, 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											27.00	25		25				20.00	20		20										25		25				20		15			25			25								Preferred Generic, 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, 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											59.00	40		40				49.00	35		35										40		40				35		30			40			40								Preferred Generic, 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								3.00		9.00					1.00		3.00											3.00		9.00				1.00		0.00				3.00				3.00			0.10	0.03		0.10	0.03	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	104	0		29	10	S5884_104_0	1	2	Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								4.00		12.00					2.00		6.00											4.00		12.00				2.00		0.00				4.00				4.00			0.13	0.06		0.13	0.06	0.12	Preferred Generic, 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											54.00	42		42				44.00	35		35										42		42				35		30			42			42								Preferred Generic, 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											26.00	25		25				19.00	20		20										25		25				20		15			25			25								Preferred Generic, 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, 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											54.00	42		42				44.00	35		35										42		42				35		30			42			42								Preferred Generic, 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											26.00	25		25				18.00	20		20										25		25				20		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	105	0		29	10	S5884_105_0	1	2	Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								5.00		15.00					2.00		6.00											5.00		15.00				2.00		0.00				5.00				5.00			0.16	0.06		0.16	0.06	0.16	Preferred Generic, 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								3.00		9.00					1.00		3.00											3.00		9.00				1.00		0.00				3.00				3.00			0.10	0.03		0.10	0.03	0.09	Preferred Generic, 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, 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											60.00	42		42				46.00	35		35										42		42				35		30			42			42								Preferred Generic, 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											24.00	25		25				18.00	20		20										25		25				20		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	106	0		29	10	S5884_106_0	1	2	Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								4.00		12.00					2.00		6.00											4.00		12.00				2.00		0.00				4.00				4.00			0.13	0.06		0.13	0.06	0.12	Preferred Generic, 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								3.00		9.00					1.00		3.00											3.00		9.00				1.00		0.00				3.00				3.00			0.10	0.03		0.10	0.03	0.09	Preferred Generic, 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, 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											58.00	44		44				46.00	35		35										44		44				35		30			44			44								Preferred Generic, 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											27.00	25		25				20.00	20		20										25		25				20		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	107	0		29	10	S5884_107_0	1	2	Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								5.00		15.00					2.00		6.00											5.00		15.00				2.00		0.00				5.00				5.00			0.16	0.06		0.16	0.06	0.16	Preferred Generic, 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								3.00		9.00					1.00		3.00											3.00		9.00				1.00		0.00				3.00				3.00			0.10	0.03		0.10	0.03	0.09	Preferred Generic, 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, 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								3.00		9.00					1.00		3.00											3.00		9.00				1.00		0.00				3.00				3.00			0.10	0.03		0.10	0.03	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	108	0		29	10	S5884_108_0	1	2	Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								4.00		12.00					2.00		6.00											4.00		12.00				2.00		0.00				4.00				4.00			0.13	0.06		0.13	0.06	0.12	Preferred Generic, 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											24.00	25		25				18.00	20		20										25		25				20		15			25			25								Preferred Generic, 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											65.00	44		44				47.00	35		35										44		44				35		30			44			44								Preferred Generic, 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, 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								3.00		9.00					1.00		3.00											3.00		9.00				1.00		0.00				3.00				3.00			0.10	0.03		0.10	0.03	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	109	0		29	10	S5884_109_0	1	2	Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								6.00		18.00					2.00		6.00											6.00		18.00				2.00		0.00				6.00				6.00			0.20	0.06		0.20	0.06	0.19	Preferred Generic, 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											25.00	25		25				19.00	20		20										25		25				20		15			25			25								Preferred Generic, 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											58.00	41		41				44.00	35		35										41		41				35		30			41			41								Preferred Generic, 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, 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, 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											55.00	41		41				45.00	35		35										41		41				35		30			41			41								Preferred Generic, 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											27.00	25		25				20.00	20		20										25		25				20		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	110	0		29	10	S5884_110_0	1	2	Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								5.00		15.00					2.00		6.00											5.00		15.00				2.00		0.00				5.00				5.00			0.16	0.06		0.16	0.06	0.16	Preferred Generic, 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								2.00		6.00					1.00		3.00											2.00		6.00				1.00		0.00				2.00				2.00			0.06	0.03		0.06	0.03	0.06	Preferred Generic, 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, 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											56.00	40		40				48.00	35		35										40		40				35		30			40			40								Preferred Generic, 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											26.00	25		25				19.00	20		20										25		25				20		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	111	0		29	10	S5884_111_0	1	2	Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								4.00		12.00					2.00		6.00											4.00		12.00				2.00		0.00				4.00				4.00			0.13	0.06		0.13	0.06	0.12	Preferred Generic, 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								2.00		6.00					1.00		3.00											2.00		6.00				1.00		0.00				2.00				2.00			0.06	0.03		0.06	0.03	0.06	Preferred Generic, 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								2.00		6.00					1.00		3.00											2.00		6.00				1.00		0.00				2.00				2.00			0.06	0.03		0.06	0.03	0.06	Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	112	0		29	10	S5884_112_0	1	2	Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								4.00		12.00					2.00		6.00											4.00		12.00				2.00		0.00				4.00				4.00			0.13	0.06		0.13	0.06	0.12	Preferred Generic, 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											25.00	25		25				19.00	20		20										25		25				20		15			25			25								Preferred Generic, 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											49.00	39		39				42.00	35		35										39		39				35		30			39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	113	0		29	10	S5884_113_0	1	2	Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								6.00		18.00					2.00		6.00											6.00		18.00				2.00		0.00				6.00				6.00			0.20	0.06		0.20	0.06	0.19	Preferred Generic, 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								3.00		9.00					1.00		3.00											3.00		9.00				1.00		0.00				3.00				3.00			0.10	0.03		0.10	0.03	0.09	Preferred Generic, 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											24.00	25		25				17.00	20		20										25		25				20		15			25			25								Preferred Generic, 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, 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											54.00	41		41				44.00	35		35										41		41				35		30			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	114	0		29	10	S5884_114_0	1	2	Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								3.00		9.00					2.00		6.00											3.00		9.00				2.00		0.00				3.00				3.00			0.10	0.06		0.10	0.06	0.09	Preferred Generic, 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								2.00		6.00					1.00		3.00											2.00		6.00				1.00		0.00				2.00				2.00			0.06	0.03		0.06	0.03	0.06	Preferred Generic, 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											28.00	25		25				20.00	20		20										25		25				20		15			25			25								Preferred Generic, 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											52.00	38		38				46.00	35		35										38		38				35		30			38			38								Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	115	0		29	10	S5884_115_0	1	2	Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								3.00		9.00					2.00		6.00											3.00		9.00				2.00		0.00				3.00				3.00			0.10	0.06		0.10	0.06	0.09	Preferred Generic, 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								2.00		6.00					1.00		3.00											2.00		6.00				1.00		0.00				2.00				2.00			0.06	0.03		0.06	0.03	0.06	Preferred Generic, 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											30.00	25		25				23.00	20		20										25		25				20		15			25			25								Preferred Generic, 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, 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											59.00	36		36				53.00	35		35										36		36				35		30			36			36								Preferred Generic, 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								2.00		6.00					1.00		3.00											2.00		6.00				1.00		0.00				2.00				2.00			0.06	0.03		0.06	0.03	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	116	0		29	10	S5884_116_0	1	2	Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								3.00		9.00					2.00		6.00											3.00		9.00				2.00		0.00				3.00				3.00			0.10	0.06		0.10	0.06	0.09	Preferred Generic, 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											23.00	25		25				19.00	20		20										25		25				20		15			25			25								Preferred Generic, 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											55.00	42		42				46.00	35		35										42		42				35		30			42			42								Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	131	0		29	10	S5884_131_0	1	2	Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								4.00		12.00					2.00		6.00											4.00		12.00				2.00		0.00				4.00				4.00			0.13	0.06		0.13	0.06	0.12	Preferred Generic, 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								2.00		6.00					1.00		3.00											2.00		6.00				1.00		0.00				2.00				2.00			0.06	0.03		0.06	0.03	0.06	Preferred Generic, 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											27.00	25		25				18.00	20		20										25		25				20		15			25			25								Preferred Generic, 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, 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											55.00	38		38				49.00	35		35										38		38				35		30			38			38								Preferred Generic, 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								3.00		9.00					1.00		3.00											3.00		9.00				1.00		0.00				3.00				3.00			0.10	0.03		0.10	0.03	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	132	0		29	10	S5884_132_0	1	2	Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								6.00		18.00					2.00		6.00											6.00		18.00				2.00		0.00				6.00				6.00			0.20	0.06		0.20	0.06	0.19	Preferred Generic, 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											26.00	25		25				20.00	20		20										25		25				20		15			25			25								Preferred Generic, 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											57.00	40		40				47.00	35		35										40		40				35		30			40			40								Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	133	0		29	10	S5884_133_0	1	2	Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								4.00		12.00					2.00		6.00											4.00		12.00				2.00		0.00				4.00				4.00			0.13	0.06		0.13	0.06	0.12	Preferred Generic, 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								3.00		9.00					1.00		3.00											3.00		9.00				1.00		0.00				3.00				3.00			0.10	0.03		0.10	0.03	0.09	Preferred Generic, 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											28.00	25		25				20.00	20		20										25		25				20		15			25			25								Preferred Generic, 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											55.00	40		40				44.00	35		35										40		40				35		30			40			40								Preferred Generic, 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, 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								2.00		6.00					1.00		3.00											2.00		6.00				1.00		0.00				2.00				2.00			0.06	0.03		0.06	0.03	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	134	0		29	10	S5884_134_0	1	2	Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								5.00		15.00					2.00		6.00											5.00		15.00				2.00		0.00				5.00				5.00			0.16	0.06		0.16	0.06	0.16	Preferred Generic, 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											27.00	25		25				20.00	20		20										25		25				20		15			25			25								Preferred Generic, 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											62.00	45		45				47.00	35		35										45		45				35		30			45			45								Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	135	0		29	10	S5884_135_0	1	2	Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								4.00		12.00					2.00		6.00											4.00		12.00				2.00		0.00				4.00				4.00			0.13	0.06		0.13	0.06	0.12	Preferred Generic, 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								2.00		6.00					1.00		3.00											2.00		6.00				1.00		0.00				2.00				2.00			0.06	0.03		0.06	0.03	0.06	Preferred Generic, 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											26.00	25		25				19.00	20		20										25		25				20		15			25			25								Preferred Generic, 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											55.00	39		39				47.00	35		35										39		39				35		30			39			39								Preferred Generic, 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, 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								2.00		6.00					1.00		3.00											2.00		6.00				1.00		0.00				2.00				2.00			0.06	0.03		0.06	0.03	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	136	0		29	10	S5884_136_0	1	2	Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								5.00		15.00					2.00		6.00											5.00		15.00				2.00		0.00				5.00				5.00			0.16	0.06		0.16	0.06	0.16	Preferred Generic, 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											25.00	25		25				18.00	20		20										25		25				20		15			25			25								Preferred Generic, 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											56.00	41		41				45.00	35		35										41		41				35		30			41			41								Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	137	0		29	10	S5884_137_0	1	2	Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								4.00		12.00					2.00		6.00											4.00		12.00				2.00		0.00				4.00				4.00			0.13	0.06		0.13	0.06	0.12	Preferred Generic, 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								2.00		6.00					1.00		3.00											2.00		6.00				1.00		0.00				2.00				2.00			0.06	0.03		0.06	0.03	0.06	Preferred Generic, 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											26.00	25		25				19.00	20		20										25		25				20		15			25			25								Preferred Generic, 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, 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											57.00	39		39				48.00	35		35										39		39				35		30			39			39								Preferred Generic, 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								3.00		9.00					1.00		3.00											3.00		9.00				1.00		0.00				3.00				3.00			0.10	0.03		0.10	0.03	0.09	Preferred Generic, 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											27.00	25		25				19.00	20		20										25		25				20		15			25			25								Preferred Generic, 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, 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											56.00	40		40				45.00	35		35										40		40				35		30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	138	0		29	10	S5884_138_0	1	2	Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								6.00		18.00					2.00		6.00											6.00		18.00				2.00		0.00				6.00				6.00			0.20	0.06		0.20	0.06	0.19	Preferred Generic, 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								3.00		9.00					1.00		3.00											3.00		9.00				1.00		0.00				3.00				3.00			0.10	0.03		0.10	0.03	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	139	0		29	10	S5884_139_0	1	2	Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								6.00		18.00					2.00		6.00											6.00		18.00				2.00		0.00				6.00				6.00			0.20	0.06		0.20	0.06	0.19	Preferred Generic, 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											27.00	25		25				19.00	20		20										25		25				20		15			25			25								Preferred Generic, 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											56.00	40		40				46.00	35		35										40		40				35		30			40			40								Preferred Generic, 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, 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, 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								3.00		9.00					1.00		3.00											3.00		9.00				1.00		0.00				3.00				3.00			0.10	0.03		0.10	0.03	0.09	Preferred Generic, 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											26.00	25		25				19.00	20		20										25		25				20		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	140	0		29	10	S5884_140_0	1	2	Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								4.00		12.00					2.00		6.00											4.00		12.00				2.00		0.00				4.00				4.00			0.13	0.06		0.13	0.06	0.12	Preferred Generic, 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											58.00	42		42				46.00	35		35										42		42				35		30			42			42								Preferred Generic, 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								3.00		9.00					1.00		3.00											3.00		9.00				1.00		0.00				3.00				3.00			0.10	0.03		0.10	0.03	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	141	0		29	10	S5884_141_0	1	2	Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								6.00		18.00					2.00		6.00											6.00		18.00				2.00		0.00				6.00				6.00			0.20	0.06		0.20	0.06	0.19	Preferred Generic, 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		15			25			25								Preferred Generic, 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, 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											58.00	43		43				45.00	35		35										43		43				35		30			43			43								Preferred Generic, 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											26.00	25		25				19.00	20		20										25		25				20		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	142	0		29	10	S5884_142_0	1	2	Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								5.00		15.00					2.00		6.00											5.00		15.00				2.00		0.00				5.00				5.00			0.16	0.06		0.16	0.06	0.16	Preferred Generic, 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, 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											63.00	43		43				45.00	35		35										43		43				35		30			43			43								Preferred Generic, 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								3.00		9.00					1.00		3.00											3.00		9.00				1.00		0.00				3.00				3.00			0.10	0.03		0.10	0.03	0.09	Preferred Generic, 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											30.00	25		25				21.00	20		20										25		25				20		15			25			25								Preferred Generic, 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, 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								3.00		9.00					1.00		3.00											3.00		9.00				1.00		0.00				3.00				3.00			0.10	0.03		0.10	0.03	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	143	0		29	10	S5884_143_0	1	2	Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								4.00		12.00					2.00		6.00											4.00		12.00				2.00		0.00				4.00				4.00			0.13	0.06		0.13	0.06	0.12	Preferred Generic, 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											69.00	44		44				49.00	35		35										44		44				35		30			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	144	0		29	10	S5884_144_0	1	2	Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								5.00		15.00					2.00		6.00											5.00		15.00				2.00		0.00				5.00				5.00			0.16	0.06		0.16	0.06	0.16	Preferred Generic, 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											26.00	25		25				19.00	20		20										25		25				20		15			25			25								Preferred Generic, 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, 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											52.00	42		42				43.00	35		35										42		42				35		30			42			42								Preferred Generic, 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								3.00		9.00					1.00		3.00											3.00		9.00				1.00		0.00				3.00				3.00			0.10	0.03		0.10	0.03	0.09	Preferred Generic, 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, 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											55.00	39		39				45.00	35		35										39		39				35		30			39			39								Preferred Generic, 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											25.00	25		25				18.00	20		20										25		25				20		15			25			25								Preferred Generic, 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								3.00		9.00					1.00		3.00											3.00		9.00				1.00		0.00				3.00				3.00			0.10	0.03		0.10	0.03	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	145	0		29	10	S5884_145_0	1	2	Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								4.00		12.00					2.00		6.00											4.00		12.00				2.00		0.00				4.00				4.00			0.13	0.06		0.13	0.06	0.12	Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	146	0		29	10	S5884_146_0	1	2	Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								5.00		15.00					2.00		6.00											5.00		15.00				2.00		0.00				5.00				5.00			0.16	0.06		0.16	0.06	0.16	Preferred Generic, 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											28.00	25		25				19.00	20		20										25		25				20		15			25			25								Preferred Generic, 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											54.00	48		48				42.00	35		35										48		48				35		30			48			48								Preferred Generic, 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								3.00		9.00					1.00		3.00											3.00		9.00				1.00		0.00				3.00				3.00			0.10	0.03		0.10	0.03	0.09	Preferred Generic, 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, 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											25.00	25		25				18.00	20		20										25		25				20		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	147	0		29	10	S5884_147_0	1	2	Generic	1	2	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								6.00		18.00					2.00		6.00											6.00		18.00				2.00		0.00				6.00				6.00			0.20	0.06		0.20	0.06	0.19	Preferred Generic, 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								3.00		9.00					1.00		3.00											3.00		9.00				1.00		0.00				3.00				3.00			0.10	0.03		0.10	0.03	0.09	Preferred Generic, 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											60.00	42		42				46.00	35		35										42		42				35		30			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	148	0		29	10	S5884_148_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	148	0		29	10	S5884_148_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		0.00				20.00				20.00			0.66	0.13		0.66	0.13	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	148	0		29	10	S5884_148_0	1	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31											35.00	25		25				26.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	148	0		29	10	S5884_148_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	148	0		29	10	S5884_148_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31											99.00	47		47				57.00	35		35										47		47				35		35			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	149	0		29	10	S5884_149_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31											78.00	50		50				52.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	149	0		29	10	S5884_149_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	149	0		29	10	S5884_149_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	149	0		29	10	S5884_149_0	1	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31											34.00	25		25				26.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	149	0		29	10	S5884_149_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		0.00				20.00				20.00			0.66	0.13		0.66	0.13	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	150	0		29	10	S5884_150_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	150	0		29	10	S5884_150_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	150	0		29	10	S5884_150_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31											89.00	50		50				61.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	150	0		29	10	S5884_150_0	1	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31											31.00	25		25				24.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	150	0		29	10	S5884_150_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		0.00				20.00				20.00			0.66	0.13		0.66	0.13	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	151	0		29	10	S5884_151_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	151	0		29	10	S5884_151_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		0.00				20.00				20.00			0.66	0.13		0.66	0.13	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	151	0		29	10	S5884_151_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31											78.00	50		50				56.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	151	0		29	10	S5884_151_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	151	0		29	10	S5884_151_0	1	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31											35.00	25		25				27.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	152	0		29	10	S5884_152_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	152	0		29	10	S5884_152_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		0.00				20.00				20.00			0.66	0.13		0.66	0.13	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	152	0		29	10	S5884_152_0	1	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31											32.00	25		25				26.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	152	0		29	10	S5884_152_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	152	0		29	10	S5884_152_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31											75.00	50		50				51.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	153	0		29	10	S5884_153_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	153	0		29	10	S5884_153_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31											78.00	50		50				50.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	153	0		29	10	S5884_153_0	1	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31											31.00	25		25				24.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	153	0		29	10	S5884_153_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		0.00				20.00				20.00			0.66	0.13		0.66	0.13	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	153	0		29	10	S5884_153_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	154	0		29	10	S5884_154_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	154	0		29	10	S5884_154_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31											77.00	50		50				48.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	154	0		29	10	S5884_154_0	1	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31											32.00	25		25				24.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	154	0		29	10	S5884_154_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		0.00				20.00				20.00			0.66	0.13		0.66	0.13	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	154	0		29	10	S5884_154_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, 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, 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											91.00	50		50				49.00	35		35										50		50				35		35			50			50								Preferred Generic, 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											31.00	25		25				24.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	155	0		29	10	S5884_155_0	2	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		0.00				20.00				20.00			0.66	0.13		0.66	0.13	0.64	Preferred Generic, 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								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	156	0		29	10	S5884_156_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		0.00				20.00				20.00			0.66	0.13		0.66	0.13	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	156	0		29	10	S5884_156_0	1	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31											30.00	25		25				24.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	156	0		29	10	S5884_156_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31											78.00	50		50				53.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	156	0		29	10	S5884_156_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	156	0		29	10	S5884_156_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	157	0		29	10	S5884_157_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	157	0		29	10	S5884_157_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31											68.00	48		48				50.00	35		35										48		48				35		35			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	157	0		29	10	S5884_157_0	1	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31											29.00	25		25				23.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	157	0		29	10	S5884_157_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		0.00				20.00				20.00			0.66	0.13		0.66	0.13	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	157	0		29	10	S5884_157_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	158	0		29	10	S5884_158_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	158	0		29	10	S5884_158_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31											74.00	50		50				49.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	158	0		29	10	S5884_158_0	1	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31											29.00	25		25				24.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	158	0		29	10	S5884_158_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		0.00				20.00				20.00			0.66	0.13		0.66	0.13	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	158	0		29	10	S5884_158_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	159	0		29	10	S5884_159_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	159	0		29	10	S5884_159_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31											99.00	46		46				51.00	35		35										46		46				35		35			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	159	0		29	10	S5884_159_0	1	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31											30.00	25		25				24.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	159	0		29	10	S5884_159_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		0.00				20.00				20.00			0.66	0.13		0.66	0.13	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	159	0		29	10	S5884_159_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	160	0		29	10	S5884_160_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31											87.00	50		50				53.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	160	0		29	10	S5884_160_0	1	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31											30.00	25		25				25.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	160	0		29	10	S5884_160_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		0.00				20.00				20.00			0.66	0.13		0.66	0.13	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	160	0		29	10	S5884_160_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	160	0		29	10	S5884_160_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	161	0		29	10	S5884_161_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31											92.00	50		50				50.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	161	0		29	10	S5884_161_0	1	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31											33.00	25		25				25.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	161	0		29	10	S5884_161_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		0.00				20.00				20.00			0.66	0.13		0.66	0.13	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	161	0		29	10	S5884_161_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	161	0		29	10	S5884_161_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	162	0		29	10	S5884_162_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	162	0		29	10	S5884_162_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		0.00				20.00				20.00			0.66	0.13		0.66	0.13	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	162	0		29	10	S5884_162_0	1	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31											34.00	25		25				26.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	162	0		29	10	S5884_162_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31											74.00	50		50				49.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	162	0		29	10	S5884_162_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	163	0		29	10	S5884_163_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	163	0		29	10	S5884_163_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		0.00				20.00				20.00			0.66	0.13		0.66	0.13	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	163	0		29	10	S5884_163_0	1	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31											31.00	25		25				25.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	163	0		29	10	S5884_163_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31											80.00	50		50				52.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	163	0		29	10	S5884_163_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	164	0		29	10	S5884_164_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	164	0		29	10	S5884_164_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	164	0		29	10	S5884_164_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31											89.00	50		50				53.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	164	0		29	10	S5884_164_0	1	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31											32.00	25		25				25.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	164	0		29	10	S5884_164_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		0.00				20.00				20.00			0.66	0.13		0.66	0.13	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	165	0		29	10	S5884_165_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	165	0		29	10	S5884_165_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	165	0		29	10	S5884_165_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31											81.00	50		50				48.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	165	0		29	10	S5884_165_0	1	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31											29.00	25		25				23.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	165	0		29	10	S5884_165_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		0.00				20.00				20.00			0.66	0.13		0.66	0.13	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	166	0		29	10	S5884_166_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	166	0		29	10	S5884_166_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31											79.00	50		50				54.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	166	0		29	10	S5884_166_0	1	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31											32.00	25		25				23.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	166	0		29	10	S5884_166_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	166	0		29	10	S5884_166_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		0.00				20.00				20.00			0.66	0.13		0.66	0.13	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	167	0		29	10	S5884_167_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31											80.00	50		50				49.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	167	0		29	10	S5884_167_0	1	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31											30.00	25		25				23.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	167	0		29	10	S5884_167_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		0.00				20.00				20.00			0.66	0.13		0.66	0.13	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	167	0		29	10	S5884_167_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	167	0		29	10	S5884_167_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	168	0		29	10	S5884_168_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	168	0		29	10	S5884_168_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31											78.00	50		50				50.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	168	0		29	10	S5884_168_0	1	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31											32.00	25		25				24.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	168	0		29	10	S5884_168_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	168	0		29	10	S5884_168_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		0.00				20.00				20.00			0.66	0.13		0.66	0.13	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	169	0		29	10	S5884_169_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31											71.00	50		50				42.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	169	0		29	10	S5884_169_0	1	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31											32.00	25		25				25.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	169	0		29	10	S5884_169_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		0.00				20.00				20.00			0.66	0.13		0.66	0.13	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	169	0		29	10	S5884_169_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	169	0		29	10	S5884_169_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	170	0		29	10	S5884_170_0	1	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31											32.00	25		25				25.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	170	0		29	10	S5884_170_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31											74.00	50		50				48.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	170	0		29	10	S5884_170_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	170	0		29	10	S5884_170_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		0.00				20.00				20.00			0.66	0.13		0.66	0.13	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	170	0		29	10	S5884_170_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	171	0		29	10	S5884_171_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	171	0		29	10	S5884_171_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		0.00				20.00				20.00			0.66	0.13		0.66	0.13	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	171	0		29	10	S5884_171_0	1	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31											34.00	25		25				27.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	171	0		29	10	S5884_171_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31											77.00	50		50				51.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	171	0		29	10	S5884_171_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	172	0		29	10	S5884_172_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	172	0		29	10	S5884_172_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	172	0		29	10	S5884_172_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		0.00				20.00				20.00			0.66	0.13		0.66	0.13	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	172	0		29	10	S5884_172_0	1	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31											36.00	25		25				24.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	172	0		29	10	S5884_172_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31											79.00	50		50				51.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	173	0		29	10	S5884_173_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		0.00				20.00				20.00			0.66	0.13		0.66	0.13	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	173	0		29	10	S5884_173_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	173	0		29	10	S5884_173_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31											75.00	50		50				53.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	173	0		29	10	S5884_173_0	1	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31											32.00	25		25				25.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	173	0		29	10	S5884_173_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	174	0		29	10	S5884_174_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	174	0		29	10	S5884_174_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	174	0		29	10	S5884_174_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		0.00				20.00				20.00			0.66	0.13		0.66	0.13	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	174	0		29	10	S5884_174_0	1	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31											32.00	25		25				23.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	174	0		29	10	S5884_174_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31											84.00	50		50				58.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	175	0		29	10	S5884_175_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		0.00				20.00				20.00			0.66	0.13		0.66	0.13	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	175	0		29	10	S5884_175_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	175	0		29	10	S5884_175_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31											79.00	48		48				52.00	35		35										48		48				35		35			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	175	0		29	10	S5884_175_0	1	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31											27.00	25		25				23.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	175	0		29	10	S5884_175_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	176	0		29	10	S5884_176_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31											78.00	50		50				51.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	176	0		29	10	S5884_176_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	176	0		29	10	S5884_176_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	176	0		29	10	S5884_176_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		0.00				20.00				20.00			0.66	0.13		0.66	0.13	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	176	0		29	10	S5884_176_0	1	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31											30.00	25		25				23.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	177	0		29	10	S5884_177_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31											69.00	50		50				45.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	177	0		29	10	S5884_177_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	177	0		29	10	S5884_177_0	1	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31											33.00	25		25				26.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	177	0		29	10	S5884_177_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		0.00				20.00				20.00			0.66	0.13		0.66	0.13	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	177	0		29	10	S5884_177_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	178	0		29	10	S5884_178_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	178	0		29	10	S5884_178_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31											86.00	50		50				56.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	178	0		29	10	S5884_178_0	1	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31											30.00	25		25				23.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	178	0		29	10	S5884_178_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		0.00				20.00				20.00			0.66	0.13		0.66	0.13	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	178	0		29	10	S5884_178_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	179	0		29	10	S5884_179_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	179	0		29	10	S5884_179_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		0.00				20.00				20.00			0.66	0.13		0.66	0.13	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	179	0		29	10	S5884_179_0	1	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31											35.00	25		25				26.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	179	0		29	10	S5884_179_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31											64.00	45		45				51.00	35		35										45		45				35		35			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	179	0		29	10	S5884_179_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	180	0		29	10	S5884_180_0	1	1	Preferred Generic	1	4	001010	1	2		110	01		110	1				30		90	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	180	0		29	10	S5884_180_0	1	2	Generic	1	4	000101	1	2		110	01		110	1				30		90	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		0.00				20.00				20.00			0.66	0.13		0.66	0.13	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	180	0		29	10	S5884_180_0	1	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	180	0		29	10	S5884_180_0	1	4	Non-Preferred Brand	1	4	110000	1	1		110	01		110	1				30		90	2				30		90	30		31											66.00	50		50				50.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5884	180	0		29	10	S5884_180_0	1	3	Preferred Brand	1	4	000101	1	1		110	01		110	1				30		90	2				30		90	30		31											37.00	25		25				26.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5904	001	0		29	10	S5904_001_0	5	1	Preferred Generic	1	3	001000	1	2		110	01	110		1				31		90	1	31		90				31		31								7.00		21.00					2.00		6.00					2.00		6.00																7.00				2.00			0.23	0.06	0.06			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5904	001	0		29	10	S5904_001_0	5	5	Specialty Tier	1	3	110001	1	1		010	01	010		1				31				31						31		31											383.38	25						383.38	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5904	001	0		29	10	S5904_001_0	5	4	Non-Preferred Brand	1	3	110000	1	2		110	01	110		1				31		90	1	31		90				31		31								100.00		300.00					95.00		285.00					95.00		285.00																100.00				95.00			3.23	3.06	3.06			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5904	001	0		29	10	S5904_001_0	5	3	Preferred Brand	1	3	010001	1	2		110	01	110		1				31		90	1	31		90				31		31								47.00		141.00					42.00		126.00					42.00		126.00																47.00				42.00			1.52	1.35	1.35			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5904	001	0		29	10	S5904_001_0	5	2	Generic	1	3	000100	1	2		110	01	110		1				31		90	1	31		90				31		31								20.00		60.00					15.00		45.00					15.00		45.00																20.00				15.00			0.65	0.48	0.48			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5904	002	0		29	10	S5904_002_0	4	1	Preferred Generic	3	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31								8.00		24.00					3.00		9.00					3.00		9.00																8.00				3.00			.25	.09	.09			.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5904	002	0		29	10	S5904_002_0	4	5	Specialty Tier	1	4	110001	1	1		010	01	010		1				31				31						31		31											734.32	33						734.32	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5904	002	0		29	10	S5904_002_0	4	4	Non-Preferred Brand	1	4	110000	1	2		110	01	110		1				31		90	1	31		90				31		31								100.00		300.00					95.00		285.00					95.00		285.00																100.00				95.00			3.23	3.06	3.06			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5904	002	0		29	10	S5904_002_0	4	3	Preferred Brand	1	4	010001	1	2		110	01	110		1				31		90	1	31		90				31		31								47.00		141.00					42.00		126.00					42.00		126.00																47.00				42.00			1.52	1.35	1.35			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5904	002	0		29	10	S5904_002_0	4	2	Generic	1	4	000100	1	2		110	01	110		1				31		90	1	31		90				31		31								15.00		45.00					10.00		30.00					10.00		30.00																15.00				10.00			0.48	0.32	0.32			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5904	002	0		29	10	S5904_002_0	4	2	Generic	3	4	000100	1	2		110	01	110		1				31		90	1	31		90				31		31								15.00		45.00					10.00		30.00					10.00		30.00																15.00				10.00			.48	.32	.32			.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5904	002	0		29	10	S5904_002_0	4	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				31		90	1	31		90				31		31								8.00		24.00					3.00		9.00					3.00		9.00																8.00				3.00			0.26	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5916	001	0		29	10	S5916_001_0	3	6	Select Care Drugs	1	3	010000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5916	001	0		29	10	S5916_001_0	3	5	Specialty Tier	1	3	010010	1	1	010		01	010		1	30							30						30		31					26																				26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5916	001	0		29	10	S5916_001_0	3	4	Non-Preferred Brand	1	3	110000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	100.00	200.00	250.00																			100.00	200.00	250.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5916	001	0		29	10	S5916_001_0	3	3	Preferred Brand	1	3	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	94.00	117.50																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5916	001	0		29	10	S5916_001_0	3	2	Generic	1	3	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	15.00	30.00	30.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5916	001	0		29	10	S5916_001_0	3	1	Preferred Generic	1	3	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	10.00	20.00	20.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5916	002	0		29	10	S5916_002_0	4	1	Preferred Generic	1	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	5.00	10.00	10.00																			5.00	10.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5916	002	0		29	10	S5916_002_0	4	1	Preferred Generic	3	4	001000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	5.00	10.00	10.00																			5.00	10.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5916	002	0		29	10	S5916_002_0	4	6	Select Care Drugs	1	4	010000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5916	002	0		29	10	S5916_002_0	4	5	Specialty Tier	1	4	010010	1	1	010		01	010		1	30							30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5916	002	0		29	10	S5916_002_0	4	4	Non-Preferred Brand	1	4	110000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	100.00	200.00	250.00																			100.00	200.00	250.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5916	002	0		29	10	S5916_002_0	4	3	Preferred Brand	1	4	000001	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	47.00	94.00	117.50																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5916	002	0		29	10	S5916_002_0	4	2	Generic	1	4	000100	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	12.00	24.00	24.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
S5916	002	0		29	10	S5916_002_0	4	6	Select Care Drugs	3	4	010000	1	2	111		01	111		1	30	60	90				1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
S5921	348	0		29	10	S5921_348_0	2	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31								2.00		6.00					1.00		3.00													6.00						0.00				2.00				2.00			0.06	0.03				0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	348	0		29	10	S5921_348_0	2	2	Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31								6.00		18.00					2.00		6.00													18.00						0.00				6.00				6.00			0.20	0.06				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	348	0		29	10	S5921_348_0	2	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31								30.00		90.00					18.00		54.00													90.00						49.00				30.00				30.00			1.00	0.60				0.96	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	348	0		29	10	S5921_348_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											91.00	40		40				67.00	30		30												40						30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	348	0		29	10	S5921_348_0	2	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31											350.00	25		25				350.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	349	0		29	10	S5921_349_0	2	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31								3.00		9.00					1.00		3.00													9.00						0.00				3.00				3.00			0.10	0.03				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	349	0		29	10	S5921_349_0	2	2	Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31								6.00		18.00					2.00		6.00													18.00						0.00				6.00				6.00			0.20	0.06				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	349	0		29	10	S5921_349_0	2	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31								30.00		90.00					20.00		60.00													90.00						55.00				30.00				30.00			1.00	0.66				0.96	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	349	0		29	10	S5921_349_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											88.00	40		40				62.00	30		30												40						30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	349	0		29	10	S5921_349_0	2	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31											431.00	25		25				431.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	350	0		29	10	S5921_350_0	2	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31								33.00		99.00					20.00		60.00													99.00						55.00				33.00				33.00			1.10	0.66				1.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	350	0		29	10	S5921_350_0	2	2	Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31								8.00		24.00					2.00		6.00													24.00						0.00				8.00				8.00			0.26	0.06				0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	350	0		29	10	S5921_350_0	2	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31								3.00		9.00					1.00		3.00													9.00						0.00				3.00				3.00			0.10	0.03				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	350	0		29	10	S5921_350_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											86.00	40		40				58.00	30		30												40						30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	350	0		29	10	S5921_350_0	2	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31											386.00	25		25				386.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	351	0		29	10	S5921_351_0	2	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31								2.00		6.00					1.00		3.00													6.00						0.00				2.00				2.00			0.06	0.03				0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	351	0		29	10	S5921_351_0	2	2	Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31								6.00		18.00					2.00		6.00													18.00						0.00				6.00				6.00			0.20	0.06				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	351	0		29	10	S5921_351_0	2	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31								30.00		90.00					18.00		54.00													90.00						49.00				30.00				30.00			1.00	0.60				0.96	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	351	0		29	10	S5921_351_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											81.00	40		40				58.00	30		30												40						30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	351	0		29	10	S5921_351_0	2	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31											379.00	25		25				379.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	352	0		29	10	S5921_352_0	2	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31											384.00	25		25				384.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	352	0		29	10	S5921_352_0	2	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31								3.00		9.00					1.00		3.00													9.00						0.00				3.00				3.00			0.10	0.03				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	352	0		29	10	S5921_352_0	2	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31								38.00		114.00					25.00		75.00													114.00						70.00				38.00				38.00			1.26	0.83				1.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	352	0		29	10	S5921_352_0	2	2	Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31								6.00		18.00					2.00		6.00													18.00						0.00				6.00				6.00			0.20	0.06				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	352	0		29	10	S5921_352_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											78.00	40		40				54.00	30		30												40						30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	353	0		29	10	S5921_353_0	2	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31								3.00		9.00					1.00		3.00													9.00						0.00				3.00				3.00			0.10	0.03				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	353	0		29	10	S5921_353_0	2	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31											373.00	25		25				373.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	353	0		29	10	S5921_353_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											83.00	40		40				54.00	30		30												40						30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	353	0		29	10	S5921_353_0	2	2	Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31								5.00		15.00					2.00		6.00													15.00						0.00				5.00				5.00			0.16	0.06				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	353	0		29	10	S5921_353_0	2	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31								32.00		96.00					20.00		60.00													96.00						55.00				32.00				32.00			1.06	0.66				1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	354	0		29	10	S5921_354_0	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	354	0		29	10	S5921_354_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											72.00	40		40				51.00	30		30												40						30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	354	0		29	10	S5921_354_0	2	2	Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31								5.00		15.00					2.00		6.00													15.00						0.00				5.00				5.00			0.16	0.06				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	354	0		29	10	S5921_354_0	2	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31								30.00		90.00					20.00		60.00													90.00						55.00				30.00				30.00			1.00	0.66				0.96	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	354	0		29	10	S5921_354_0	2	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31								3.00		9.00					1.00		3.00													9.00						0.00				3.00				3.00			0.10	0.03				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	355	0		29	10	S5921_355_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											70.00	40		40				53.00	30		30												40						30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	355	0		29	10	S5921_355_0	2	2	Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31								5.00		15.00					2.00		6.00													15.00						0.00				5.00				5.00			0.16	0.06				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	355	0		29	10	S5921_355_0	2	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31								32.00		96.00					20.00		60.00													96.00						55.00				32.00				32.00			1.06	0.66				1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	355	0		29	10	S5921_355_0	2	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31								3.00		9.00					1.00		3.00													9.00						0.00				3.00				3.00			0.10	0.03				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	355	0		29	10	S5921_355_0	2	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31											402.00	25		25				402.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	356	0		29	10	S5921_356_0	2	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31											380.00	25		25				380.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	356	0		29	10	S5921_356_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											74.00	40		40				54.00	30		30												40						30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	356	0		29	10	S5921_356_0	2	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31								3.00		9.00					1.00		3.00													9.00						0.00				3.00				3.00			0.10	0.03				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	356	0		29	10	S5921_356_0	2	2	Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31								7.00		21.00					2.00		6.00													21.00						0.00				7.00				7.00			0.23	0.06				0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	356	0		29	10	S5921_356_0	2	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31								30.00		90.00					23.00		69.00													90.00						64.00				30.00				30.00			1.00	0.76				0.96	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	357	0		29	10	S5921_357_0	2	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31											404.00	25		25				404.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	357	0		29	10	S5921_357_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											73.00	40		40				51.00	30		30												40						30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	357	0		29	10	S5921_357_0	2	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31								30.00		90.00					15.00		45.00													90.00						40.00				30.00				30.00			1.00	0.50				0.96	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	357	0		29	10	S5921_357_0	2	2	Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31								6.00		18.00					2.00		6.00													18.00						0.00				6.00				6.00			0.20	0.06				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	357	0		29	10	S5921_357_0	2	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31								3.00		9.00					1.00		3.00													9.00						0.00				3.00				3.00			0.10	0.03				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	358	0		29	10	S5921_358_0	2	2	Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31								7.00		21.00					2.00		6.00													21.00						0.00				7.00				7.00			0.23	0.06				0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	358	0		29	10	S5921_358_0	2	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31								2.00		6.00					1.00		3.00													6.00						0.00				2.00				2.00			0.06	0.03				0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	358	0		29	10	S5921_358_0	2	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31								30.00		90.00					15.00		45.00													90.00						40.00				30.00				30.00			1.00	0.50				0.96	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	358	0		29	10	S5921_358_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											81.00	40		40				55.00	30		30												40						30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	358	0		29	10	S5921_358_0	2	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31											366.00	25		25				366.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	359	0		29	10	S5921_359_0	2	2	Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31								6.00		18.00					2.00		6.00													18.00						0.00				6.00				6.00			0.20	0.06				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	359	0		29	10	S5921_359_0	2	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31								30.00		90.00					17.00		51.00													90.00						46.00				30.00				30.00			1.00	0.56				0.96	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	359	0		29	10	S5921_359_0	2	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31											328.00	25		25				328.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	359	0		29	10	S5921_359_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											83.00	40		40				58.00	30		30												40						30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	359	0		29	10	S5921_359_0	2	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31								3.00		9.00					1.00		3.00													9.00						0.00				3.00				3.00			0.10	0.03				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	360	0		29	10	S5921_360_0	2	2	Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31								8.00		24.00					2.00		6.00													24.00						0.00				8.00				8.00			0.26	0.06				0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	360	0		29	10	S5921_360_0	2	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31								3.00		9.00					1.00		3.00													9.00						0.00				3.00				3.00			0.10	0.03				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	360	0		29	10	S5921_360_0	2	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31								30.00		90.00					17.00		51.00													90.00						46.00				30.00				30.00			1.00	0.56				0.96	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	360	0		29	10	S5921_360_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											75.00	40		40				52.00	30		30												40						30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	360	0		29	10	S5921_360_0	2	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31											387.00	25		25				387.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	361	0		29	10	S5921_361_0	2	2	Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31								6.00		18.00					2.00		6.00													18.00						0.00				6.00				6.00			0.20	0.06				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	361	0		29	10	S5921_361_0	2	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31								3.00		9.00					1.00		3.00													9.00						0.00				3.00				3.00			0.10	0.03				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	361	0		29	10	S5921_361_0	2	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31								35.00		105.00					25.00		75.00													105.00						70.00				35.00				35.00			1.16	0.83				1.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	361	0		29	10	S5921_361_0	2	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31											307.00	25		25				307.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	361	0		29	10	S5921_361_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											88.00	40		40				59.00	30		30												40						30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	362	0		29	10	S5921_362_0	2	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31								3.00		9.00					1.00		3.00													9.00						0.00				3.00				3.00			0.10	0.03				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	362	0		29	10	S5921_362_0	2	2	Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31								6.00		18.00					2.00		6.00													18.00						0.00				6.00				6.00			0.20	0.06				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	362	0		29	10	S5921_362_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											77.00	40		40				56.00	30		30												40						30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	362	0		29	10	S5921_362_0	2	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31								38.00		114.00					27.00		81.00													114.00						76.00				38.00				38.00			1.26	0.90				1.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	362	0		29	10	S5921_362_0	2	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31											377.00	25		25				377.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	363	0		29	10	S5921_363_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											82.00	40		40				54.00	30		30												40						30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	363	0		29	10	S5921_363_0	2	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31											370.00	25		25				370.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	363	0		29	10	S5921_363_0	2	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31								3.00		9.00					1.00		3.00													9.00						0.00				3.00				3.00			0.10	0.03				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	363	0		29	10	S5921_363_0	2	2	Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31								6.00		18.00					2.00		6.00													18.00						0.00				6.00				6.00			0.20	0.06				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	363	0		29	10	S5921_363_0	2	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31								38.00		114.00					23.00		69.00													114.00						64.00				38.00				38.00			1.26	0.76				1.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	364	0		29	10	S5921_364_0	2	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31								30.00		90.00					20.00		60.00													90.00						55.00				30.00				30.00			1.00	0.66				0.96	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	364	0		29	10	S5921_364_0	2	2	Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31								8.00		24.00					3.00		9.00													24.00						0.00				8.00				8.00			0.26	0.10				0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	364	0		29	10	S5921_364_0	2	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31								3.00		9.00					1.00		3.00													9.00						0.00				3.00				3.00			0.10	0.03				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	364	0		29	10	S5921_364_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											65.00	40		40				45.00	30		30												40						30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	364	0		29	10	S5921_364_0	2	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31											364.00	25		25				364.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	365	0		29	10	S5921_365_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											66.00	40		40				47.00	30		30												40						30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	365	0		29	10	S5921_365_0	2	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31								29.00		87.00					19.00		57.00													87.00						52.00				29.00				29.00			0.96	0.63				0.93	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	365	0		29	10	S5921_365_0	2	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31											362.00	25		25				362.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	365	0		29	10	S5921_365_0	2	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31								2.00		6.00					1.00		3.00													6.00						0.00				2.00				2.00			0.06	0.03				0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	365	0		29	10	S5921_365_0	2	2	Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31								8.00		24.00					2.00		6.00													24.00						0.00				8.00				8.00			0.26	0.06				0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	366	0		29	10	S5921_366_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											74.00	40		40				46.00	30		30												40						30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	366	0		29	10	S5921_366_0	2	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31								29.00		87.00					19.00		57.00													87.00						52.00				29.00				29.00			0.96	0.63				0.93	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	366	0		29	10	S5921_366_0	2	2	Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31								8.00		24.00					2.00		6.00													24.00						0.00				8.00				8.00			0.26	0.06				0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	366	0		29	10	S5921_366_0	2	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31								2.00		6.00					1.00		3.00													6.00						0.00				2.00				2.00			0.06	0.03				0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	366	0		29	10	S5921_366_0	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	367	0		29	10	S5921_367_0	2	2	Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31								7.00		21.00					2.00		6.00													21.00						0.00				7.00				7.00			0.23	0.06				0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	367	0		29	10	S5921_367_0	2	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31								3.00		9.00					1.00		3.00													9.00						0.00				3.00				3.00			0.10	0.03				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	367	0		29	10	S5921_367_0	2	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31								42.00		126.00					27.00		81.00													126.00						76.00				42.00				42.00			1.40	0.90				1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	367	0		29	10	S5921_367_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											82.00	40		40				53.00	30		30												40						30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	367	0		29	10	S5921_367_0	2	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31											417.00	25		25				417.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	368	0		29	10	S5921_368_0	2	2	Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31								5.00		15.00					2.00		6.00													15.00						0.00				5.00				5.00			0.16	0.06				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	368	0		29	10	S5921_368_0	2	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31								2.00		6.00					1.00		3.00													6.00						0.00				2.00				2.00			0.06	0.03				0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	368	0		29	10	S5921_368_0	2	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31								33.00		99.00					23.00		69.00													99.00						64.00				33.00				33.00			1.10	0.76				1.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	368	0		29	10	S5921_368_0	2	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31											360.00	25		25				360.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	368	0		29	10	S5921_368_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											70.00	40		40				46.00	30		30												40						30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	369	0		29	10	S5921_369_0	2	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31								3.00		9.00					1.00		3.00													9.00						0.00				3.00				3.00			0.10	0.03				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	369	0		29	10	S5921_369_0	2	2	Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31								6.00		18.00					2.00		6.00													18.00						0.00				6.00				6.00			0.20	0.06				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	369	0		29	10	S5921_369_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											80.00	40		40				49.00	30		30												40						30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	369	0		29	10	S5921_369_0	2	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31								35.00		105.00					24.00		72.00													105.00						67.00				35.00				35.00			1.16	0.80				1.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	369	0		29	10	S5921_369_0	2	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31											352.00	25		25				352.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	370	0		29	10	S5921_370_0	2	2	Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31								6.00		18.00					2.00		6.00													18.00						0.00				6.00				6.00			0.20	0.06				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	370	0		29	10	S5921_370_0	2	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31								3.00		9.00					1.00		3.00													9.00						0.00				3.00				3.00			0.10	0.03				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	370	0		29	10	S5921_370_0	2	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31								36.00		108.00					20.00		60.00													108.00						55.00				36.00				36.00			1.20	0.66				1.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	370	0		29	10	S5921_370_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											81.00	40		40				58.00	30		30												40						30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	370	0		29	10	S5921_370_0	2	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31											320.00	25		25				320.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	371	0		29	10	S5921_371_0	2	2	Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31								5.00		15.00					2.00		6.00													15.00						0.00				5.00				5.00			0.16	0.06				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	371	0		29	10	S5921_371_0	2	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31								3.00		9.00					1.00		3.00													9.00						0.00				3.00				3.00			0.10	0.03				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	371	0		29	10	S5921_371_0	2	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31								35.00		105.00					24.00		72.00													105.00						67.00				35.00				35.00			1.16	0.80				1.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	371	0		29	10	S5921_371_0	2	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31											359.00	25		25				359.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	371	0		29	10	S5921_371_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											72.00	40		40				57.00	30		30												40						30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	372	0		29	10	S5921_372_0	2	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31								3.00		9.00					1.00		3.00													9.00						0.00				3.00				3.00			0.10	0.03				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	372	0		29	10	S5921_372_0	2	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31											349.00	25		25				349.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	372	0		29	10	S5921_372_0	2	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31								43.00		129.00					25.00		75.00													129.00						70.00				43.00				43.00			1.43	0.83				1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	372	0		29	10	S5921_372_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											90.00	40		40				58.00	30		30												40						30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	372	0		29	10	S5921_372_0	2	2	Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31								7.00		21.00					2.00		6.00													21.00						0.00				7.00				7.00			0.23	0.06				0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	373	0		29	10	S5921_373_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											74.00	40		40				56.00	30		30												40						30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	373	0		29	10	S5921_373_0	2	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31											439.00	25		25				439.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	373	0		29	10	S5921_373_0	2	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31								36.00		108.00					23.00		69.00													108.00						64.00				36.00				36.00			1.20	0.76				1.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	373	0		29	10	S5921_373_0	2	2	Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31								6.00		18.00					2.00		6.00													18.00						0.00				6.00				6.00			0.20	0.06				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	373	0		29	10	S5921_373_0	2	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31								3.00		9.00					1.00		3.00													9.00						0.00				3.00				3.00			0.10	0.03				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	374	0		29	10	S5921_374_0	2	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31								35.00		105.00					25.00		75.00													105.00						70.00				35.00				35.00			1.16	0.83				1.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	374	0		29	10	S5921_374_0	2	2	Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31								5.00		15.00					2.00		6.00													15.00						0.00				5.00				5.00			0.16	0.06				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	374	0		29	10	S5921_374_0	2	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31								3.00		9.00					1.00		3.00													9.00						0.00				3.00				3.00			0.10	0.03				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	374	0		29	10	S5921_374_0	2	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31											347.00	25		25				347.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	374	0		29	10	S5921_374_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											78.00	40		40				52.00	30		30												40						30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	375	0		29	10	S5921_375_0	2	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31											412.00	25		25				412.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	375	0		29	10	S5921_375_0	2	2	Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31								5.00		15.00					2.00		6.00													15.00						0.00				5.00				5.00			0.16	0.06				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	375	0		29	10	S5921_375_0	2	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31								35.00		105.00					25.00		75.00													105.00						70.00				35.00				35.00			1.16	0.83				1.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	375	0		29	10	S5921_375_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											73.00	40		40				50.00	30		30												40						30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	375	0		29	10	S5921_375_0	2	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31								3.00		9.00					1.00		3.00													9.00						0.00				3.00				3.00			0.10	0.03				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	376	0		29	10	S5921_376_0	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	376	0		29	10	S5921_376_0	2	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31								31.00		93.00					21.00		63.00													93.00						58.00				31.00				31.00			1.03	0.70				1.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	376	0		29	10	S5921_376_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											89.00	40		40				60.00	30		30												40						30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	376	0		29	10	S5921_376_0	2	2	Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31								4.00		12.00					2.00		6.00													12.00						0.00				4.00				4.00			0.13	0.06				0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	376	0		29	10	S5921_376_0	2	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31								3.00		9.00					1.00		3.00													9.00						0.00				3.00				3.00			0.10	0.03				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	377	0		29	10	S5921_377_0	2	2	Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31								6.00		18.00					2.00		6.00													18.00						0.00				6.00				6.00			0.20	0.06				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	377	0		29	10	S5921_377_0	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	377	0		29	10	S5921_377_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											67.00	40		40				57.00	30		30												40						30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	377	0		29	10	S5921_377_0	2	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31								35.00		105.00					25.00		75.00													105.00						70.00				35.00				35.00			1.16	0.83				1.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	377	0		29	10	S5921_377_0	2	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31								3.00		9.00					1.00		3.00													9.00						0.00				3.00				3.00			0.10	0.03				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	378	0		29	10	S5921_378_0	2	2	Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31								7.00		21.00					2.00		6.00													21.00						0.00				7.00				7.00			0.23	0.06				0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	378	0		29	10	S5921_378_0	2	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31								3.00		9.00					1.00		3.00													9.00						0.00				3.00				3.00			0.10	0.03				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	378	0		29	10	S5921_378_0	2	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31											298.00	25		25				298.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	378	0		29	10	S5921_378_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											83.00	40		40				55.00	30		30												40						30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	378	0		29	10	S5921_378_0	2	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31								30.00		90.00					20.00		60.00													90.00						55.00				30.00				30.00			1.00	0.66				0.96	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	379	0		29	10	S5921_379_0	2	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31								3.00		9.00					1.00		3.00													9.00						0.00				3.00				3.00			0.10	0.03				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	379	0		29	10	S5921_379_0	2	2	Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31								5.00		15.00					2.00		6.00													15.00						0.00				5.00				5.00			0.16	0.06				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	379	0		29	10	S5921_379_0	2	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31								30.00		90.00					20.00		60.00													90.00						55.00				30.00				30.00			1.00	0.66				0.96	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	379	0		29	10	S5921_379_0	2	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31											370.00	25		25				370.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	379	0		29	10	S5921_379_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											94.00	40		40				64.00	30		30												40						30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	380	0		29	10	S5921_380_0	2	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31								5.00		15.00					1.00		3.00													15.00						0.00				5.00				5.00			0.16	0.03				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	380	0		29	10	S5921_380_0	2	2	Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31								12.00		36.00					2.00		6.00													36.00						0.00				12.00				12.00			0.40	0.06				0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	380	0		29	10	S5921_380_0	2	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31								40.00		120.00					28.00		84.00													120.00						79.00				40.00				40.00			1.33	0.93				1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	380	0		29	10	S5921_380_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											79.00	40		40				57.00	30		30												40						30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	380	0		29	10	S5921_380_0	2	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31											407.00	25		25				407.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	381	0		29	10	S5921_381_0	2	1	Preferred Generic	1	2	001000	1	2		110	01		100	1				30		90	1						90	30		31								3.00		9.00					1.00		3.00													9.00						0.00				3.00				3.00			0.10	0.03				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	381	0		29	10	S5921_381_0	2	2	Generic	1	2	000100	1	2		110	01		100	1				30		90	1						90	30		31								5.00		15.00					2.00		6.00													15.00						0.00				5.00				5.00			0.16	0.06				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	381	0		29	10	S5921_381_0	2	3	Preferred Brand	1	2	010001	1	2		110	01		100	1				30		90	1						90	30		31								35.00		105.00					20.00		60.00													105.00						55.00				35.00				35.00			1.16	0.66				1.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	381	0		29	10	S5921_381_0	2	4	Non-Preferred Brand	1	2	110000	1	1		110	01		100	1				30		90	1						90	30		31											96.00	40		40				76.00	30		30												40						30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5921	381	0		29	10	S5921_381_0	2	5	Specialty Tier	1	2	010010	1	1		110	01		100	1				30		90	1						90	30		31											504.00	25		25				504.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5953	001	0		29	10	S5953_001_0	3	1	Preferred Generic	1	3	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00	14.00	21.00				2.00	4.00	4.00				7.00				2.00			0.23	0.07		0.23	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5953	001	0		29	10	S5953_001_0	3	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	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5953	001	0		29	10	S5953_001_0	3	4	Non-Preferred Brand	1	3	110000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	237.50				100.00				95.00			3.33	3.17		3.33	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5953	001	0		29	10	S5953_001_0	3	3	Preferred Brand	1	3	010001	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								38.00	76.00	114.00					32.00	64.00	96.00											38.00	76.00	114.00				32.00	64.00	80.00				38.00				32.00			1.27	1.07		1.27	1.07	1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5953	001	0		29	10	S5953_001_0	3	2	Generic	1	3	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	36.00				7.00	14.00	17.50				12.00				7.00			0.40	0.23		0.40	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5953	002	0		29	10	S5953_002_0	2	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				0.00				0.00		.00				.00	.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5953	002	0		29	10	S5953_002_0	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5953	002	0		29	10	S5953_002_0	2	4	Non-Preferred Brand	1	4	110000	1	2	111		01		111	1	30	60	90				1				30	60	90	30		31	95.00	190.00	285.00																									95.00	190.00	285.00				95.00	190.00	237.50				95.00				95.00		3.16				3.16	3.16	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5953	002	0		29	10	S5953_002_0	2	3	Preferred Brand	1	4	010001	1	2	111		01		111	1	30	60	90				1				30	60	90	30		31	30.00	60.00	90.00																									30.00	60.00	90.00				30.00	60.00	75.00				30.00				30.00		1.00				1.00	1.00	.96	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5953	002	0		29	10	S5953_002_0	2	2	Generic	1	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		31	7.00	14.00	21.00																									7.00	14.00	21.00				7.00	14.00	17.50				7.00				7.00		.23				.23	.23	.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5953	002	0		29	10	S5953_002_0	2	2	Generic	3	4	000100	1	2	111		01		111	1	30	60	90				1				30	60	90	30		31	7.00	14.00	21.00																									7.00	14.00	21.00				7.00	14.00	17.50				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5953	002	0		29	10	S5953_002_0	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	138	0		29	10	S5967_138_0	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	138	0		29	10	S5967_138_0	5	2	Generic	1	3	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		10.00				4.00				4.00		0.13				0.13	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	138	0		29	10	S5967_138_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	138	0		29	10	S5967_138_0	5	3	Preferred Brand	1	3	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	138	0		29	10	S5967_138_0	5	4	Non-Preferred Brand	1	3	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				75.80	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	139	0		29	10	S5967_139_0	5	4	Non-Preferred Brand	1	3	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				79.60	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	139	0		29	10	S5967_139_0	5	1	Preferred Generic	1	3	001000	1	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	139	0		29	10	S5967_139_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	139	0		29	10	S5967_139_0	5	2	Generic	1	3	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		15.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	139	0		29	10	S5967_139_0	5	3	Preferred Brand	1	3	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	140	0		29	10	S5967_140_0	5	4	Non-Preferred Brand	1	3	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				81.30	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	140	0		29	10	S5967_140_0	5	1	Preferred Generic	1	3	001000	1	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	140	0		29	10	S5967_140_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	140	0		29	10	S5967_140_0	5	2	Generic	1	3	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		25.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	140	0		29	10	S5967_140_0	5	3	Preferred Brand	1	3	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	141	0		29	10	S5967_141_0	5	4	Non-Preferred Brand	1	3	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				83.60	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	141	0		29	10	S5967_141_0	5	1	Preferred Generic	1	3	001000	1	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	141	0		29	10	S5967_141_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	141	0		29	10	S5967_141_0	5	2	Generic	1	3	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	141	0		29	10	S5967_141_0	5	3	Preferred Brand	1	3	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	142	0		29	10	S5967_142_0	5	2	Generic	1	3	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	142	0		29	10	S5967_142_0	5	3	Preferred Brand	1	3	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	142	0		29	10	S5967_142_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	142	0		29	10	S5967_142_0	5	4	Non-Preferred Brand	1	3	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				74.70	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	142	0		29	10	S5967_142_0	5	1	Preferred Generic	1	3	001000	1	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	143	0		29	10	S5967_143_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	143	0		29	10	S5967_143_0	5	4	Non-Preferred Brand	1	3	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				75.40	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	143	0		29	10	S5967_143_0	5	2	Generic	1	3	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	9.00		27.00																									9.00		27.00				9.00		22.50				9.00				9.00		0.30				0.30	0.30	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	143	0		29	10	S5967_143_0	5	1	Preferred Generic	1	3	001000	1	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	143	0		29	10	S5967_143_0	5	3	Preferred Brand	1	3	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	144	0		29	10	S5967_144_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	144	0		29	10	S5967_144_0	5	3	Preferred Brand	1	3	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	144	0		29	10	S5967_144_0	5	4	Non-Preferred Brand	1	3	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				70.50	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	144	0		29	10	S5967_144_0	5	2	Generic	1	3	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	144	0		29	10	S5967_144_0	5	1	Preferred Generic	1	3	001000	1	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	145	0		29	10	S5967_145_0	5	2	Generic	1	3	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	13.00		39.00																									13.00		39.00				13.00		32.50				13.00				13.00		0.43				0.43	0.43	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	145	0		29	10	S5967_145_0	5	3	Preferred Brand	1	3	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	145	0		29	10	S5967_145_0	5	4	Non-Preferred Brand	1	3	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				70.20	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	145	0		29	10	S5967_145_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	145	0		29	10	S5967_145_0	5	1	Preferred Generic	1	3	001000	1	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	146	0		29	10	S5967_146_0	5	4	Non-Preferred Brand	1	3	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				70.40	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	146	0		29	10	S5967_146_0	5	3	Preferred Brand	1	3	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	146	0		29	10	S5967_146_0	5	2	Generic	1	3	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	14.00		42.00																									14.00		42.00				14.00		35.00				14.00				14.00		0.47				0.47	0.47	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	146	0		29	10	S5967_146_0	5	1	Preferred Generic	1	3	001000	1	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	146	0		29	10	S5967_146_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	147	0		29	10	S5967_147_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	147	0		29	10	S5967_147_0	5	4	Non-Preferred Brand	1	3	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				63.20	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	147	0		29	10	S5967_147_0	5	3	Preferred Brand	1	3	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	147	0		29	10	S5967_147_0	5	2	Generic	1	3	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	11.00		33.00																									11.00		33.00				11.00		27.50				11.00				11.00		0.37				0.37	0.37	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	147	0		29	10	S5967_147_0	5	1	Preferred Generic	1	3	001000	1	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	148	0		29	10	S5967_148_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	148	0		29	10	S5967_148_0	5	1	Preferred Generic	1	3	001000	1	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	148	0		29	10	S5967_148_0	5	2	Generic	1	3	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	9.00		27.00																									9.00		27.00				9.00		22.50				9.00				9.00		0.30				0.30	0.30	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	148	0		29	10	S5967_148_0	5	3	Preferred Brand	1	3	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	148	0		29	10	S5967_148_0	5	4	Non-Preferred Brand	1	3	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				78.50	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	149	0		29	10	S5967_149_0	5	4	Non-Preferred Brand	1	3	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				66.60	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	149	0		29	10	S5967_149_0	5	1	Preferred Generic	1	3	001000	1	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	149	0		29	10	S5967_149_0	5	2	Generic	1	3	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		17.50				7.00				7.00		0.23				0.23	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	149	0		29	10	S5967_149_0	5	3	Preferred Brand	1	3	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	149	0		29	10	S5967_149_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	150	0		29	10	S5967_150_0	5	1	Preferred Generic	1	3	001000	1	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	150	0		29	10	S5967_150_0	5	2	Generic	1	3	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		12.50				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	150	0		29	10	S5967_150_0	5	3	Preferred Brand	1	3	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	150	0		29	10	S5967_150_0	5	4	Non-Preferred Brand	1	3	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				79.90	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	150	0		29	10	S5967_150_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	151	0		29	10	S5967_151_0	5	3	Preferred Brand	1	3	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		112.50				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	151	0		29	10	S5967_151_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	151	0		29	10	S5967_151_0	5	2	Generic	1	3	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		25.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	151	0		29	10	S5967_151_0	5	1	Preferred Generic	1	3	001000	1	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	151	0		29	10	S5967_151_0	5	4	Non-Preferred Brand	1	3	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				79.50	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	152	0		29	10	S5967_152_0	5	1	Preferred Generic	1	3	001000	1	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	152	0		29	10	S5967_152_0	5	2	Generic	1	3	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		15.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	152	0		29	10	S5967_152_0	5	4	Non-Preferred Brand	1	3	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				72.50	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	152	0		29	10	S5967_152_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	152	0		29	10	S5967_152_0	5	3	Preferred Brand	1	3	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	154	0		29	10	S5967_154_0	5	4	Non-Preferred Brand	1	3	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				72.70	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	154	0		29	10	S5967_154_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	154	0		29	10	S5967_154_0	5	3	Preferred Brand	1	3	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	154	0		29	10	S5967_154_0	5	2	Generic	1	3	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		25.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	154	0		29	10	S5967_154_0	5	1	Preferred Generic	1	3	001000	1	2	110		01		110	1	30		90				1				30		90	30		31	1.00		3.00																									1.00		3.00				1.00		0.00				1.00				1.00		0.03				0.03	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	155	0		29	10	S5967_155_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	155	0		29	10	S5967_155_0	5	4	Non-Preferred Brand	1	3	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				66.00	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	155	0		29	10	S5967_155_0	5	3	Preferred Brand	1	3	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	155	0		29	10	S5967_155_0	5	2	Generic	1	3	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	13.00		39.00																									13.00		39.00				13.00		32.50				13.00				13.00		0.43				0.43	0.43	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	155	0		29	10	S5967_155_0	5	1	Preferred Generic	1	3	001000	1	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	156	0		29	10	S5967_156_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	156	0		29	10	S5967_156_0	5	3	Preferred Brand	1	3	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	156	0		29	10	S5967_156_0	5	4	Non-Preferred Brand	1	3	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				60.20	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	156	0		29	10	S5967_156_0	5	2	Generic	1	3	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	9.00		27.00																									9.00		27.00				9.00		22.50				9.00				9.00		0.30				0.30	0.30	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	156	0		29	10	S5967_156_0	5	1	Preferred Generic	1	3	001000	1	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	157	0		29	10	S5967_157_0	5	3	Preferred Brand	1	3	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	157	0		29	10	S5967_157_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	157	0		29	10	S5967_157_0	5	4	Non-Preferred Brand	1	3	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				57.50	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	157	0		29	10	S5967_157_0	5	2	Generic	1	3	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	16.00		48.00																									16.00		48.00				16.00		40.00				16.00				16.00		0.53				0.53	0.53	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	157	0		29	10	S5967_157_0	5	1	Preferred Generic	1	3	001000	1	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	158	0		29	10	S5967_158_0	5	2	Generic	1	3	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	9.00		27.00																									9.00		27.00				9.00		22.50				9.00				9.00		0.30				0.30	0.30	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	158	0		29	10	S5967_158_0	5	3	Preferred Brand	1	3	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	158	0		29	10	S5967_158_0	5	1	Preferred Generic	1	3	001000	1	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	158	0		29	10	S5967_158_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	158	0		29	10	S5967_158_0	5	4	Non-Preferred Brand	1	3	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				67.60	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	159	0		29	10	S5967_159_0	5	1	Preferred Generic	1	3	001000	1	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	159	0		29	10	S5967_159_0	5	2	Generic	1	3	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	16.00		48.00																									16.00		48.00				16.00		40.00				16.00				16.00		0.53				0.53	0.53	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	159	0		29	10	S5967_159_0	5	3	Preferred Brand	1	3	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	159	0		29	10	S5967_159_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	159	0		29	10	S5967_159_0	5	4	Non-Preferred Brand	1	3	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				76.90	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	160	0		29	10	S5967_160_0	5	4	Non-Preferred Brand	1	3	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				62.40	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	160	0		29	10	S5967_160_0	5	3	Preferred Brand	1	3	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	160	0		29	10	S5967_160_0	5	2	Generic	1	3	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		17.50				7.00				7.00		0.23				0.23	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	160	0		29	10	S5967_160_0	5	1	Preferred Generic	1	3	001000	1	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	160	0		29	10	S5967_160_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	161	0		29	10	S5967_161_0	5	2	Generic	1	3	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		17.50				7.00				7.00		0.23				0.23	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	161	0		29	10	S5967_161_0	5	3	Preferred Brand	1	3	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	161	0		29	10	S5967_161_0	5	4	Non-Preferred Brand	1	3	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				73.00	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	161	0		29	10	S5967_161_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	161	0		29	10	S5967_161_0	5	1	Preferred Generic	1	3	001000	1	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	162	0		29	10	S5967_162_0	5	4	Non-Preferred Brand	1	3	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				70.00	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	162	0		29	10	S5967_162_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	162	0		29	10	S5967_162_0	5	3	Preferred Brand	1	3	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	162	0		29	10	S5967_162_0	5	2	Generic	1	3	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	14.00		42.00																									14.00		42.00				14.00		35.00				14.00				14.00		0.47				0.47	0.47	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	162	0		29	10	S5967_162_0	5	1	Preferred Generic	1	3	001000	1	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	163	0		29	10	S5967_163_0	5	3	Preferred Brand	1	3	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	163	0		29	10	S5967_163_0	5	2	Generic	1	3	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	18.00		54.00																									18.00		54.00				18.00		45.00				18.00				18.00		0.60				0.60	0.60	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	163	0		29	10	S5967_163_0	5	1	Preferred Generic	1	3	001000	1	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	163	0		29	10	S5967_163_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	163	0		29	10	S5967_163_0	5	4	Non-Preferred Brand	1	3	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				62.10	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	164	0		29	10	S5967_164_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	164	0		29	10	S5967_164_0	5	4	Non-Preferred Brand	1	3	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				68.70	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	164	0		29	10	S5967_164_0	5	2	Generic	1	3	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	8.00		24.00																									8.00		24.00				8.00		20.00				8.00				8.00		0.27				0.27	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	164	0		29	10	S5967_164_0	5	3	Preferred Brand	1	3	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	164	0		29	10	S5967_164_0	5	1	Preferred Generic	1	3	001000	1	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	165	0		29	10	S5967_165_0	5	2	Generic	1	3	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	165	0		29	10	S5967_165_0	5	1	Preferred Generic	1	3	001000	1	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	165	0		29	10	S5967_165_0	5	3	Preferred Brand	1	3	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	165	0		29	10	S5967_165_0	5	4	Non-Preferred Brand	1	3	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				58.80	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	165	0		29	10	S5967_165_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	166	0		29	10	S5967_166_0	5	1	Preferred Generic	1	3	001000	1	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	166	0		29	10	S5967_166_0	5	2	Generic	1	3	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		17.50				7.00				7.00		0.23				0.23	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	166	0		29	10	S5967_166_0	5	3	Preferred Brand	1	3	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	166	0		29	10	S5967_166_0	5	4	Non-Preferred Brand	1	3	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				63.90	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	166	0		29	10	S5967_166_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	167	0		29	10	S5967_167_0	5	2	Generic	1	3	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		10.00				4.00				4.00		0.13				0.13	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	167	0		29	10	S5967_167_0	5	1	Preferred Generic	1	3	001000	1	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	167	0		29	10	S5967_167_0	5	3	Preferred Brand	1	3	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	167	0		29	10	S5967_167_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	167	0		29	10	S5967_167_0	5	4	Non-Preferred Brand	1	3	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				69.40	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	168	0		29	10	S5967_168_0	5	1	Preferred Generic	1	3	001000	1	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	168	0		29	10	S5967_168_0	5	2	Generic	1	3	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		17.50				7.00				7.00		0.23				0.23	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	168	0		29	10	S5967_168_0	5	3	Preferred Brand	1	3	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	168	0		29	10	S5967_168_0	5	4	Non-Preferred Brand	1	3	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				67.70	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	168	0		29	10	S5967_168_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	169	0		29	10	S5967_169_0	5	1	Preferred Generic	1	3	001000	1	2	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	169	0		29	10	S5967_169_0	5	2	Generic	1	3	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	169	0		29	10	S5967_169_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	169	0		29	10	S5967_169_0	5	3	Preferred Brand	1	3	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	169	0		29	10	S5967_169_0	5	4	Non-Preferred Brand	1	3	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				74.10	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	170	0		29	10	S5967_170_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	170	0		29	10	S5967_170_0	5	4	Non-Preferred Brand	1	3	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				86.60	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	170	0		29	10	S5967_170_0	5	1	Preferred Generic	1	3	001000	1	2	110		01		110	1	30		90				1				30		90	30		31	1.00		3.00																									1.00		3.00				1.00		0.00				1.00				1.00		0.03				0.03	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	170	0		29	10	S5967_170_0	5	3	Preferred Brand	1	3	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	46.00		138.00																									46.00		138.00				46.00		115.00				46.00				46.00		1.53				1.53	1.53	1.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	170	0		29	10	S5967_170_0	5	2	Generic	1	3	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	14.00		42.00																									14.00		42.00				14.00		35.00				14.00				14.00		0.47				0.47	0.47	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	171	0		29	10	S5967_171_0	5	4	Non-Preferred Brand	1	3	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				90.80	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	171	0		29	10	S5967_171_0	5	3	Preferred Brand	1	3	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	171	0		29	10	S5967_171_0	5	2	Generic	1	3	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		37.50				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	171	0		29	10	S5967_171_0	5	1	Preferred Generic	1	3	001000	1	2	110		01		110	1	30		90				1				30		90	30		31	1.00		3.00																									1.00		3.00				1.00		0.00				1.00				1.00		0.03				0.03	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	171	0		29	10	S5967_171_0	5	5	Specialty Tier	1	3	010010	1	1	010		01		010	1	30										30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	173	0		29	10	S5967_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	173	0		29	10	S5967_173_0	5	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	3.00		9.00																									3.00		9.00				3.00		7.50				3.00				3.00		0.10				0.10	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	173	0		29	10	S5967_173_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	32.00		96.00																									32.00		96.00				32.00		80.00				32.00				32.00		1.07				1.07	1.07	1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	173	0		29	10	S5967_173_0	5	4	Non-Preferred Brand	1	4	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				37.20	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	173	0		29	10	S5967_173_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	174	0		29	10	S5967_174_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	174	0		29	10	S5967_174_0	5	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		10.00				4.00				4.00		0.13				0.13	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	174	0		29	10	S5967_174_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	32.00		96.00																									32.00		96.00				32.00		80.00				32.00				32.00		1.07				1.07	1.07	1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	174	0		29	10	S5967_174_0	5	4	Non-Preferred Brand	1	4	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				44.20	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	174	0		29	10	S5967_174_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	175	0		29	10	S5967_175_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	175	0		29	10	S5967_175_0	5	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		15.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	175	0		29	10	S5967_175_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	33.00		99.00																									33.00		99.00				33.00		82.50				33.00				33.00		1.10				1.10	1.10	1.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	175	0		29	10	S5967_175_0	5	4	Non-Preferred Brand	1	4	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				47.50	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	175	0		29	10	S5967_175_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	176	0		29	10	S5967_176_0	5	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		25.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	176	0		29	10	S5967_176_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	30.00		90.00																									30.00		90.00				30.00		75.00				30.00				30.00		1.00				1.00	1.00	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	176	0		29	10	S5967_176_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	176	0		29	10	S5967_176_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	176	0		29	10	S5967_176_0	5	4	Non-Preferred Brand	1	4	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				42.40	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	177	0		29	10	S5967_177_0	5	4	Non-Preferred Brand	1	4	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				45.40	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	177	0		29	10	S5967_177_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	177	0		29	10	S5967_177_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	31.00		93.00																									31.00		93.00				31.00		77.50				31.00				31.00		1.03				1.03	1.03	1.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	177	0		29	10	S5967_177_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	177	0		29	10	S5967_177_0	5	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		25.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	178	0		29	10	S5967_178_0	5	4	Non-Preferred Brand	1	4	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				36.30	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	178	0		29	10	S5967_178_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	32.00		96.00																									32.00		96.00				32.00		80.00				32.00				32.00		1.07				1.07	1.07	1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	178	0		29	10	S5967_178_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	178	0		29	10	S5967_178_0	5	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		15.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	178	0		29	10	S5967_178_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	179	0		29	10	S5967_179_0	5	4	Non-Preferred Brand	1	4	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				37.00	45		45																								45		45				45		45			45			45								Preferred Generic, 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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	179	0		29	10	S5967_179_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	30.00		90.00																									30.00		90.00				30.00		75.00				30.00				30.00		1.00				1.00	1.00	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	179	0		29	10	S5967_179_0	5	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	9.00		27.00																									9.00		27.00				9.00		22.50				9.00				9.00		0.30				0.30	0.30	0.29	Preferred Generic, 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	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	180	0		29	10	S5967_180_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	180	0		29	10	S5967_180_0	5	4	Non-Preferred Brand	1	4	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				37.40	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	180	0		29	10	S5967_180_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	31.00		93.00																									31.00		93.00				31.00		77.50				31.00				31.00		1.03				1.03	1.03	1.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	180	0		29	10	S5967_180_0	5	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	9.00		27.00																									9.00		27.00				9.00		22.50				9.00				9.00		0.30				0.30	0.30	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	180	0		29	10	S5967_180_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	Preferred Generic, 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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	181	0		29	10	S5967_181_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	28.00		84.00																									28.00		84.00				28.00		70.00				28.00				28.00		0.93				0.93	0.93	0.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	181	0		29	10	S5967_181_0	5	4	Non-Preferred Brand	1	4	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				39.50	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	181	0		29	10	S5967_181_0	5	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	9.00		27.00																									9.00		27.00				9.00		22.50				9.00				9.00		0.30				0.30	0.30	0.29	Preferred Generic, 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	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	182	0		29	10	S5967_182_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	182	0		29	10	S5967_182_0	5	4	Non-Preferred Brand	1	4	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				34.30	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	182	0		29	10	S5967_182_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	30.00		90.00																									30.00		90.00				30.00		75.00				30.00				30.00		1.00				1.00	1.00	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	182	0		29	10	S5967_182_0	5	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	8.00		24.00																									8.00		24.00				8.00		20.00				8.00				8.00		0.27				0.27	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	182	0		29	10	S5967_182_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	183	0		29	10	S5967_183_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	183	0		29	10	S5967_183_0	5	4	Non-Preferred Brand	1	4	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				48.90	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	183	0		29	10	S5967_183_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	32.00		96.00																									32.00		96.00				32.00		80.00				32.00				32.00		1.07				1.07	1.07	1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	183	0		29	10	S5967_183_0	5	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		15.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	183	0		29	10	S5967_183_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	184	0		29	10	S5967_184_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	184	0		29	10	S5967_184_0	5	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		12.50				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	184	0		29	10	S5967_184_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	31.00		93.00																									31.00		93.00				31.00		77.50				31.00				31.00		1.03				1.03	1.03	1.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	184	0		29	10	S5967_184_0	5	4	Non-Preferred Brand	1	4	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				36.40	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	184	0		29	10	S5967_184_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	185	0		29	10	S5967_185_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	185	0		29	10	S5967_185_0	5	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	3.00		9.00																									3.00		9.00				3.00		7.50				3.00				3.00		0.10				0.10	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	185	0		29	10	S5967_185_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	33.00		99.00																									33.00		99.00				33.00		82.50				33.00				33.00		1.10				1.10	1.10	1.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	185	0		29	10	S5967_185_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	185	0		29	10	S5967_185_0	5	4	Non-Preferred Brand	1	4	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				40.00	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	186	0		29	10	S5967_186_0	5	4	Non-Preferred Brand	1	4	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				41.00	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	186	0		29	10	S5967_186_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	186	0		29	10	S5967_186_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	186	0		29	10	S5967_186_0	5	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		15.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	186	0		29	10	S5967_186_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	32.00		96.00																									32.00		96.00				32.00		80.00				32.00				32.00		1.07				1.07	1.07	1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	187	0		29	10	S5967_187_0	5	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		10.00				4.00				4.00		0.13				0.13	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	187	0		29	10	S5967_187_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	187	0		29	10	S5967_187_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	32.00		96.00																									32.00		96.00				32.00		80.00				32.00				32.00		1.07				1.07	1.07	1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	187	0		29	10	S5967_187_0	5	4	Non-Preferred Brand	1	4	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				37.10	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	187	0		29	10	S5967_187_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	188	0		29	10	S5967_188_0	5	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	8.00		24.00																									8.00		24.00				8.00		20.00				8.00				8.00		0.27				0.27	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	188	0		29	10	S5967_188_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	188	0		29	10	S5967_188_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	34.00		102.00																									34.00		102.00				34.00		85.00				34.00				34.00		1.13				1.13	1.13	1.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	188	0		29	10	S5967_188_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	188	0		29	10	S5967_188_0	5	4	Non-Preferred Brand	1	4	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				39.50	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	189	0		29	10	S5967_189_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	189	0		29	10	S5967_189_0	5	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	9.00		27.00																									9.00		27.00				9.00		22.50				9.00				9.00		0.30				0.30	0.30	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	189	0		29	10	S5967_189_0	5	4	Non-Preferred Brand	1	4	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				38.60	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	189	0		29	10	S5967_189_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	31.00		93.00																									31.00		93.00				31.00		77.50				31.00				31.00		1.03				1.03	1.03	1.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	189	0		29	10	S5967_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, 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	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	190	0		29	10	S5967_190_0	5	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		15.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	190	0		29	10	S5967_190_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	32.00		96.00																									32.00		96.00				32.00		80.00				32.00				32.00		1.07				1.07	1.07	1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	190	0		29	10	S5967_190_0	5	4	Non-Preferred Brand	1	4	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				32.20	45		45																								45		45				45		45			45			45								Preferred Generic, 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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	191	0		29	10	S5967_191_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	191	0		29	10	S5967_191_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	31.00		93.00																									31.00		93.00				31.00		77.50				31.00				31.00		1.03				1.03	1.03	1.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	191	0		29	10	S5967_191_0	5	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		25.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	191	0		29	10	S5967_191_0	5	4	Non-Preferred Brand	1	4	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				37.60	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	191	0		29	10	S5967_191_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	192	0		29	10	S5967_192_0	5	4	Non-Preferred Brand	1	4	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				40.10	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	192	0		29	10	S5967_192_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	32.00		96.00																									32.00		96.00				32.00		80.00				32.00				32.00		1.07				1.07	1.07	1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	192	0		29	10	S5967_192_0	5	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		15.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	192	0		29	10	S5967_192_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	192	0		29	10	S5967_192_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	193	0		29	10	S5967_193_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	193	0		29	10	S5967_193_0	5	4	Non-Preferred Brand	1	4	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				35.10	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	193	0		29	10	S5967_193_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	31.00		93.00																									31.00		93.00				31.00		77.50				31.00				31.00		1.03				1.03	1.03	1.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	193	0		29	10	S5967_193_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	193	0		29	10	S5967_193_0	5	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		25.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	194	0		29	10	S5967_194_0	5	4	Non-Preferred Brand	1	4	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				31.20	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	194	0		29	10	S5967_194_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	31.00		93.00																									31.00		93.00				31.00		77.50				31.00				31.00		1.03				1.03	1.03	1.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	194	0		29	10	S5967_194_0	5	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		12.50				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	194	0		29	10	S5967_194_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	194	0		29	10	S5967_194_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	195	0		29	10	S5967_195_0	5	4	Non-Preferred Brand	1	4	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				38.70	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	195	0		29	10	S5967_195_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	31.00		93.00																									31.00		93.00				31.00		77.50				31.00				31.00		1.03				1.03	1.03	1.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	195	0		29	10	S5967_195_0	5	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		12.50				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	195	0		29	10	S5967_195_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	195	0		29	10	S5967_195_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	196	0		29	10	S5967_196_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	196	0		29	10	S5967_196_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	196	0		29	10	S5967_196_0	5	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	9.00		27.00																									9.00		27.00				9.00		22.50				9.00				9.00		0.30				0.30	0.30	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	196	0		29	10	S5967_196_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	32.00		96.00																									32.00		96.00				32.00		80.00				32.00				32.00		1.07				1.07	1.07	1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	196	0		29	10	S5967_196_0	5	4	Non-Preferred Brand	1	4	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				39.50	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	197	0		29	10	S5967_197_0	5	4	Non-Preferred Brand	1	4	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				43.50	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	197	0		29	10	S5967_197_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	31.00		93.00																									31.00		93.00				31.00		77.50				31.00				31.00		1.03				1.03	1.03	1.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	197	0		29	10	S5967_197_0	5	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		25.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	197	0		29	10	S5967_197_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	197	0		29	10	S5967_197_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	198	0		29	10	S5967_198_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	198	0		29	10	S5967_198_0	5	4	Non-Preferred Brand	1	4	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				41.20	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	198	0		29	10	S5967_198_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	31.00		93.00																									31.00		93.00				31.00		77.50				31.00				31.00		1.03				1.03	1.03	1.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	198	0		29	10	S5967_198_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	198	0		29	10	S5967_198_0	5	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		15.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	199	0		29	10	S5967_199_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	199	0		29	10	S5967_199_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	199	0		29	10	S5967_199_0	5	4	Non-Preferred Brand	1	4	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				36.70	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	199	0		29	10	S5967_199_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	31.00		93.00																									31.00		93.00				31.00		77.50				31.00				31.00		1.03				1.03	1.03	1.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	199	0		29	10	S5967_199_0	5	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		25.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	200	0		29	10	S5967_200_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	200	0		29	10	S5967_200_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	31.00		93.00																									31.00		93.00				31.00		77.50				31.00				31.00		1.03				1.03	1.03	1.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	200	0		29	10	S5967_200_0	5	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		12.50				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	200	0		29	10	S5967_200_0	5	4	Non-Preferred Brand	1	4	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				35.10	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	200	0		29	10	S5967_200_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	201	0		29	10	S5967_201_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	32.00		96.00																									32.00		96.00				32.00		80.00				32.00				32.00		1.07				1.07	1.07	1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	201	0		29	10	S5967_201_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	201	0		29	10	S5967_201_0	5	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	3.00		9.00																									3.00		9.00				3.00		7.50				3.00				3.00		0.10				0.10	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	201	0		29	10	S5967_201_0	5	4	Non-Preferred Brand	1	4	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				35.40	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	201	0		29	10	S5967_201_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	202	0		29	10	S5967_202_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	202	0		29	10	S5967_202_0	5	4	Non-Preferred Brand	1	4	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				37.90	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	202	0		29	10	S5967_202_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	31.00		93.00																									31.00		93.00				31.00		77.50				31.00				31.00		1.03				1.03	1.03	1.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	202	0		29	10	S5967_202_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	202	0		29	10	S5967_202_0	5	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		12.50				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	203	0		29	10	S5967_203_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	31.00		93.00																									31.00		93.00				31.00		77.50				31.00				31.00		1.03				1.03	1.03	1.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	203	0		29	10	S5967_203_0	5	4	Non-Preferred Brand	1	4	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				41.50	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	203	0		29	10	S5967_203_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	203	0		29	10	S5967_203_0	5	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		25.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	203	0		29	10	S5967_203_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	204	0		29	10	S5967_204_0	5	4	Non-Preferred Brand	1	4	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				60.40	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	204	0		29	10	S5967_204_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	204	0		29	10	S5967_204_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	204	0		29	10	S5967_204_0	5	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		25.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	204	0		29	10	S5967_204_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	31.00		93.00																									31.00		93.00				31.00		77.50				31.00				31.00		1.03				1.03	1.03	1.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	205	0		29	10	S5967_205_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	205	0		29	10	S5967_205_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	205	0		29	10	S5967_205_0	5	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		25.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	205	0		29	10	S5967_205_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	31.00		93.00																									31.00		93.00				31.00		77.50				31.00				31.00		1.03				1.03	1.03	1.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	205	0		29	10	S5967_205_0	5	4	Non-Preferred Brand	1	4	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				41.20	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	210	0		29	10	S5967_210_0	5	4	Non-Preferred Brand	1	3	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				62.00	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	210	0		29	10	S5967_210_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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	210	0		29	10	S5967_210_0	5	3	Preferred Brand	1	3	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	210	0		29	10	S5967_210_0	5	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	210	0		29	10	S5967_210_0	5	2	Generic	1	3	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		15.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	211	0		29	10	S5967_211_0	5	2	Generic	1	4	000100	1	2	110		01		110	1	30		90				1				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		10.00				4.00				4.00		0.13				0.13	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	211	0		29	10	S5967_211_0	5	3	Preferred Brand	1	4	010001	1	2	110		01		110	1	30		90				1				30		90	30		31	32.00		96.00																									32.00		96.00				32.00		80.00				32.00				32.00		1.07				1.07	1.07	1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	211	0		29	10	S5967_211_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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	211	0		29	10	S5967_211_0	5	4	Non-Preferred Brand	1	4	110000	1	1	110		01		110	1	30		90				1				30		90	30		31				35.80	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5967	211	0		29	10	S5967_211_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, 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	1						90	31		31								5.00		15.00					0.00		0.00													8.00						3.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5983	004	0		29	10	S5983_004_0	2	2	Generic	1	2	000110	1	2		110	01		100	1				31		90	1						90	31		31								15.00		45.00					7.00		21.00													26.00						21.00				15.00				15.00			0.48	0.23				0.48	Preferred Generic, 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	1						90	31		31											45.72	24		24				41.91	22		22												25						25			24			24								Preferred Generic, 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	1						90	31		31											85.24	50		50				81.84	48		48												50						50			50			50								Preferred Generic, 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, 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	1						90	31		31								10.00		30.00					1.00		3.00													5.00						0.00				10.00				10.00			0.32	0.03				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5983	006	0		29	10	S5983_006_0	1	2	Generic	1	4	000110	1	2		110	01		100	1				31		90	1						90	31		31								20.00		60.00					5.00		15.00													10.00						5.00				20.00				20.00			0.65	0.16				0.65	Preferred Generic, 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	1						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, 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	1						90	31		31											99.15	47		47				94.95	45		45												47						47			47			47								Preferred Generic, 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												25							25												25						25					25			25								Preferred Generic, 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								12.00	24.00	36.00					0.00	0.00	0.00					6.00	12.00	18.00																12.00				12.00			0.40	0.00	0.20			0.38	Preferred Generic, 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, 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								92.00	184.00	276.00					72.00	144.00	216.00					92.00	184.00	276.00																92.00				92.00			3.06	2.40	3.06			2.96	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5993	001	0		29	10	S5993_001_0	4	3	Preferred Brand	1	2	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								46.00	92.00	138.00					36.00	72.00	108.00					46.00	92.00	138.00																46.00				46.00			1.53	1.20	1.53			1.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5993	001	0		29	10	S5993_001_0	4	2	Generic	1	2	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								20.00	40.00	60.00					14.00	28.00	42.00					10.00	20.00	30.00																20.00				20.00			0.66	0.33	0.33			0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5993	003	0		29	10	S5993_003_0	2	1	Preferred Generic	3	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								12.00	24.00	36.00					0.00	0.00	0.00					6.00	12.00	18.00																12.00				12.00			0.40	0.00	0.20			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5993	003	0		29	10	S5993_003_0	2	5	Specialty Tier	1	4	010010	1	1		010	01			1				30										30		31												33							33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5993	003	0		29	10	S5993_003_0	2	4	Non-Preferred Brand	1	4	110000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								94.00	188.00	282.00					74.00	148.00	222.00					94.00	188.00	282.00																94.00				94.00			3.13	2.46	3.13			3.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5993	003	0		29	10	S5993_003_0	2	3	Preferred Brand	1	4	010001	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					47.00	94.00	141.00																47.00				47.00			1.56	1.23	1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5993	003	0		29	10	S5993_003_0	2	2	Generic	1	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					10.00	20.00	30.00																20.00				20.00			0.66	0.50	0.33			0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5993	003	0		29	10	S5993_003_0	2	2	Generic	3	4	000100	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					10.00	20.00	30.00																20.00				20.00			0.66	0.50	0.33			0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5993	003	0		29	10	S5993_003_0	2	1	Preferred Generic	1	4	001000	1	2		111	01	111		1				30	60	90	1	30	60	90				30		31								12.00	24.00	36.00					0.00	0.00	0.00					6.00	12.00	18.00																12.00				12.00			0.40	0.00	0.20			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S6311	001	0		29	10	S6311_001_0	3	2	Generic	1	3	000100	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	20.00	40.00	50.00																			20.00	40.00	60.00																20.00				20.00		0.65			0.65			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S6311	001	0		29	10	S6311_001_0	3	1	Preferred Generic	1	3	001000	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	9.00	18.00	22.50																			9.00	18.00	27.00																9.00				9.00		0.29			0.29			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S6311	001	0		29	10	S6311_001_0	3	3	Preferred Brand	1	3	000001	1	2	111		01	111		1	31	62	93				2	31	62	93				31		31	47.00	94.00	117.50																			47.00	94.00	141.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S6311	001	0		29	10	S6311_001_0	3	4	Non-Preferred Brand	1	3	100000	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31				97.97	35	35	35																		35	35	35															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S6311	001	0		29	10	S6311_001_0	3	5	Specialty Tier	1	3	000010	1	1	111		01	111		1	31	62	93				2	31	62	93				31		31					25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S6506	001	0		29	10	S6506_001_0	2	2	Generic	1	2	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								7.00	14.00	21.00					3.00	6.00	9.00											7.00	14.00	21.00				3.00	6.00	9.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S6506	001	0		29	10	S6506_001_0	2	1	Preferred Generic	1	2	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								4.00	8.00	12.00					0.00	0.00	0.00											4.00	8.00	12.00				0.00	0.00	0.00				4.00				4.00			0.13	0.00		0.13	0.00	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S6506	001	0		29	10	S6506_001_0	2	3	Preferred Brand	1	2	010001	1	1		111	01		111	1				30	60	90	1				30	60	90	30		31											27.36	22	22	22				20.88	17	17	17										22	22	22				17	17	17			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S6506	001	0		29	10	S6506_001_0	2	5	Specialty Tier	1	2	010010	1	1		111	01		111	1				30	60	90	1				30	60	90	30		31											180.59	25	25	25				178.37	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S6506	001	0		29	10	S6506_001_0	2	4	Non-Preferred Brand	1	2	110000	1	1		111	01		111	1				30	60	90	1				30	60	90	30		31											64.77	45	45	45				57.03	40	40	40										45	45	45				40	40	40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S6506	002	0		29	10	S6506_002_0	2	1	Preferred Generic	1	4	001000	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								8.00	16.00	20.00					2.00	4.00	5.00											8.00	16.00	20.00				2.00	4.00	5.00				8.00				8.00			0.27	0.07		0.27	0.07	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S6506	002	0		29	10	S6506_002_0	2	2	Generic	1	4	000100	1	2		111	01		111	1				30	60	90	1				30	60	90	30		31								15.00	30.00	37.50					10.00	20.00	25.00											15.00	30.00	37.50				10.00	20.00	25.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S6506	002	0		29	10	S6506_002_0	2	4	Non-Preferred Brand	1	4	100000	1	1		111	01		111	1				30	60	90	1				30	60	90	30		31											74.37	50	50	50				66.06	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S6506	002	0		29	10	S6506_002_0	2	3	Preferred Brand	1	4	000001	1	1		111	01		111	1				30	60	90	1				30	60	90	30		31											65.65	25	25	25				51.81	20	20	20										25	25	25				20	20	20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S6506	002	0		29	10	S6506_002_0	2	5	Specialty Tier	1	4	010010	1	1		111	01		111	1				30	60	90	1				30	60	90	30		31											299.22	33	33	33				295.45	33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7230	001	0		29	10	S7230_001_0	3	4	Non-Preferred Brand	1	2	100000	1	1	110		01	100		1	31		90				2			90				31		31				99.57	36		36																				36															36			36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7230	001	0		29	10	S7230_001_0	3	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7230	001	0		29	10	S7230_001_0	3	1	Preferred Generic	1	2	001000	1	2	110		01	100		1	31		90				2			90				31		31	4.00		12.00																					10.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7230	001	0		29	10	S7230_001_0	3	2	Generic	1	2	000100	1	2	110		01	100		1	31		90				2			90				31		31	12.00		36.00																					30.00																12.00				12.00		0.39						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7230	001	0		29	10	S7230_001_0	3	3	Preferred Brand	1	2	000001	1	1	110		01	100		1	31		90				2			90				31		31				1.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7230	002	0		29	10	S7230_002_0	2	4	Non-Preferred Brand	1	2	100000	1	1	110		01	100		1	31		90				2			90				31		31				98.69	29		29																				29															29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7230	002	0		29	10	S7230_002_0	2	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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7230	002	0		29	10	S7230_002_0	2	3	Preferred Brand	1	2	000001	1	1	110		01	100		1	31		90				2			90				31		31				1.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7230	002	0		29	10	S7230_002_0	2	2	Generic	1	2	000100	1	2	110		01	100		1	31		90				2			90				31		31	13.00		39.00																					32.50																13.00				13.00		0.42						0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7230	002	0		29	10	S7230_002_0	2	1	Preferred Generic	1	2	001000	1	2	110		01	100		1	31		90				2			90				31		31	4.00		12.00																					10.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7230	003	0		29	10	S7230_003_0	2	1	Preferred Generic	1	2	001000	1	2	110		01	100		1	31		90				2			90				31		31	4.00		12.00																					10.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7230	003	0		29	10	S7230_003_0	2	4	Non-Preferred Brand	1	2	100000	1	1	110		01	100		1	31		90				2			90				31		31				97.86	36		36																				36															36			36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7230	003	0		29	10	S7230_003_0	2	3	Preferred Brand	1	2	000001	1	1	110		01	100		1	31		90				2			90				31		31				1.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7230	003	0		29	10	S7230_003_0	2	2	Generic	1	2	000100	1	2	110		01	100		1	31		90				2			90				31		31	13.00		39.00																					32.50																13.00				13.00		0.42						0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7230	003	0		29	10	S7230_003_0	2	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, 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	4.00		12.00																					10.00																4.00				4.00		0.13						0.13	Preferred Generic, 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, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7610	001	0		29	10	S7610_001_0	4	2	Generic	1	2	000100	1	2	110		01	100		1	31		90				2			90				31		31	14.00		42.00																					35.00																14.00				14.00		0.45						.45	Preferred Generic, 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	1	110		01	100		1	31		90				2			90				31		31				97.09	30		30																				30															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7610	001	0		29	10	S7610_001_0	4	3	Preferred Brand	1	2	000001	1	1	110		01	100		1	31		90				2			90				31		31				1.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	001	0		29	10	S7694_001_0	4	3	Non-Preferred Brand	1	2	100100	1	1		110	01		110	1				30		90	2				30		90	30		31											27.03	45		45				24.03	40		40										45		45				40		40			45			45								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	001	0		29	10	S7694_001_0	4	2	Preferred Brand	1	2	000001	1	1		110	01		110	1				30		90	1				30		90	30		31											79.14	25		25				37.99	12		12										25		25				12		12			25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	001	0		29	10	S7694_001_0	4	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31											1274.34	25						1274.34	25												25						25					25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	001	0		29	10	S7694_001_0	4	1	Generic	1	2	001000	1	2		110	01		110	1				30		90	1				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		6.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	002	0		29	10	S7694_002_0	4	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31											1312.26	25						1312.26	25												25						25					25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	002	0		29	10	S7694_002_0	4	3	Non-Preferred Brand	1	2	100100	1	1		110	01		110	1				30		90	2				30		90	30		31											36.45	45		45				32.40	40		40										45		45				40		40			45			45								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	002	0		29	10	S7694_002_0	4	2	Preferred Brand	1	2	000001	1	1		110	01		110	1				30		90	1				30		90	30		31											95.10	25		25				45.65	12		12										25		25				12		12			25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	002	0		29	10	S7694_002_0	4	1	Generic	1	2	001000	1	2		110	01		110	1				30		90	1				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		6.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	003	0		29	10	S7694_003_0	4	2	Preferred Brand	1	2	000001	1	1		110	01		110	1				30		90	1				30		90	30		31											79.23	25		25				31.69	10		10										25		25				10		10			25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	003	0		29	10	S7694_003_0	4	1	Generic	1	2	001000	1	2		110	01		110	1				30		90	1				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		6.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	003	0		29	10	S7694_003_0	4	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31											991.13	25						991.13	25												25						25					25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	003	0		29	10	S7694_003_0	4	3	Non-Preferred Brand	1	2	100100	1	1		110	01		110	1				30		90	2				30		90	30		31											44.09	45		45				39.19	40		40										45		45				40		40			45			45								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	004	0		29	10	S7694_004_0	4	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31											928.22	25						928.22	25												25						25					25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	004	0		29	10	S7694_004_0	4	3	Non-Preferred Brand	1	2	100100	1	1		110	01		110	1				30		90	2				30		90	30		31											46.31	45		45				41.16	40		40										45		45				40		40			45			45								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	004	0		29	10	S7694_004_0	4	2	Preferred Brand	1	2	000001	1	1		110	01		110	1				30		90	1				30		90	30		31											57.31	19		19				30.16	10		10										19		19				10		10			19			19								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	004	0		29	10	S7694_004_0	4	1	Generic	1	2	001000	1	2		110	01		110	1				30		90	1				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		6.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	005	0		29	10	S7694_005_0	4	1	Generic	1	2	001000	1	2		110	01		110	1				30		90	1				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		6.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	005	0		29	10	S7694_005_0	4	2	Preferred Brand	1	2	000001	1	1		110	01		110	1				30		90	1				30		90	30		31											48.61	16		16				27.34	9		9										16		16				9		9			16			16								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	005	0		29	10	S7694_005_0	4	3	Non-Preferred Brand	1	2	100100	1	1		110	01		110	1				30		90	2				30		90	30		31											41.45	45		45				36.84	40		40										45		45				40		40			45			45								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	005	0		29	10	S7694_005_0	4	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31											416.44	25						416.44	25												25						25					25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	006	0		29	10	S7694_006_0	4	2	Preferred Brand	1	2	000001	1	1		110	01		110	1				30		90	1				30		90	30		31											54.26	18		18				30.15	10		10										18		18				10		10			18			18								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	006	0		29	10	S7694_006_0	4	3	Non-Preferred Brand	1	2	100100	1	1		110	01		110	1				30		90	2				30		90	30		31											32.14	45		45				28.57	40		40										45		45				40		40			45			45								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	006	0		29	10	S7694_006_0	4	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31											992.34	25						992.34	25												25						25					25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	006	0		29	10	S7694_006_0	4	1	Generic	1	2	001000	1	2		110	01		110	1				30		90	1				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		6.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	007	0		29	10	S7694_007_0	4	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31											740.49	25						740.49	25												25						25					25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	007	0		29	10	S7694_007_0	4	3	Non-Preferred Brand	1	2	100100	1	1		110	01		110	1				30		90	2				30		90	30		31											34.75	45		45				30.89	40		40										45		45				40		40			45			45								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	007	0		29	10	S7694_007_0	4	2	Preferred Brand	1	2	000001	1	1		110	01		110	1				30		90	1				30		90	30		31											58.43	19		19				30.75	10		10										19		19				10		10			19			19								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	007	0		29	10	S7694_007_0	4	1	Generic	1	2	001000	1	2		110	01		110	1				30		90	1				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		6.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	008	0		29	10	S7694_008_0	4	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31											758.08	25						758.08	25												25						25					25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	008	0		29	10	S7694_008_0	4	3	Non-Preferred Brand	1	2	100100	1	1		110	01		110	1				30		90	2				30		90	30		31											34.18	45		45				30.38	40		40										45		45				40		40			45			45								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	008	0		29	10	S7694_008_0	4	2	Preferred Brand	1	2	000001	1	1		110	01		110	1				30		90	1				30		90	30		31											81.55	25		25				45.67	14		14										25		25				14		14			25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	008	0		29	10	S7694_008_0	4	1	Generic	1	2	001000	1	2		110	01		110	1				30		90	1				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		6.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	009	0		29	10	S7694_009_0	4	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31											1222.13	25						1222.13	25												25						25					25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	009	0		29	10	S7694_009_0	4	3	Non-Preferred Brand	1	2	100100	1	1		110	01		110	1				30		90	2				30		90	30		31											43.82	45		45				38.96	40		40										45		45				40		40			45			45								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	009	0		29	10	S7694_009_0	4	2	Preferred Brand	1	2	000001	1	1		110	01		110	1				30		90	1				30		90	30		31											84.84	25		25				40.72	12		12										25		25				12		12			25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	009	0		29	10	S7694_009_0	4	1	Generic	1	2	001000	1	2		110	01		110	1				30		90	1				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		6.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	010	0		29	10	S7694_010_0	4	1	Generic	1	2	001000	1	2		110	01		110	1				30		90	1				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		6.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	010	0		29	10	S7694_010_0	4	2	Preferred Brand	1	2	000001	1	1		110	01		110	1				30		90	1				30		90	30		31											77.94	25		25				49.88	16		16										25		25				16		16			25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	010	0		29	10	S7694_010_0	4	3	Non-Preferred Brand	1	2	100100	1	1		110	01		110	1				30		90	2				30		90	30		31											32.70	45		45				29.06	40		40										45		45				40		40			45			45								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	010	0		29	10	S7694_010_0	4	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31											839.17	25						839.17	25												25						25					25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	011	0		29	10	S7694_011_0	4	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31											1098.59	25						1098.59	25												25						25					25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	011	0		29	10	S7694_011_0	4	3	Non-Preferred Brand	1	2	100100	1	1		110	01		110	1				30		90	2				30		90	30		31											54.82	45		45				48.73	40		40										45		45				40		40			45			45								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	011	0		29	10	S7694_011_0	4	2	Preferred Brand	1	2	000001	1	1		110	01		110	1				30		90	1				30		90	30		31											87.82	25		25				42.15	12		12										25		25				12		12			25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	011	0		29	10	S7694_011_0	4	1	Generic	1	2	001000	1	2		110	01		110	1				30		90	1				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		6.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	012	0		29	10	S7694_012_0	4	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31											1145.93	25						1145.93	25												25						25					25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	012	0		29	10	S7694_012_0	4	2	Preferred Brand	1	2	000001	1	1		110	01		110	1				30		90	1				30		90	30		31											79.55	25		25				50.91	16		16										25		25				16		16			25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	012	0		29	10	S7694_012_0	4	1	Generic	1	2	001000	1	2		110	01		110	1				30		90	1				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		6.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	012	0		29	10	S7694_012_0	4	3	Non-Preferred Brand	1	2	100100	1	1		110	01		110	1				30		90	2				30		90	30		31											29.51	45		45				26.23	40		40										45		45				40		40			45			45								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	014	0		29	10	S7694_014_0	4	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31											890.16	25						890.16	25												25						25					25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	014	0		29	10	S7694_014_0	4	2	Preferred Brand	1	2	000001	1	1		110	01		110	1				30		90	1				30		90	30		31											47.87	16		16				23.94	8		8										16		16				8		8			16			16								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	014	0		29	10	S7694_014_0	4	1	Generic	1	2	001000	1	2		110	01		110	1				30		90	1				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		6.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	014	0		29	10	S7694_014_0	4	3	Non-Preferred Brand	1	2	100100	1	1		110	01		110	1				30		90	2				30		90	30		31											32.98	45		45				29.32	40		40										45		45				40		40			45			45								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	015	0		29	10	S7694_015_0	4	1	Generic	1	2	001000	1	2		110	01		110	1				30		90	1				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		6.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	015	0		29	10	S7694_015_0	4	2	Preferred Brand	1	2	000001	1	1		110	01		110	1				30		90	1				30		90	30		31											75.96	25		25				36.46	12		12										25		25				12		12			25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	015	0		29	10	S7694_015_0	4	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31											978.27	25						978.27	25												25						25					25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	015	0		29	10	S7694_015_0	4	3	Non-Preferred Brand	1	2	100100	1	1		110	01		110	1				30		90	2				30		90	30		31											31.40	45		45				27.91	40		40										45		45				40		40			45			45								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	016	0		29	10	S7694_016_0	4	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31											996.14	25						996.14	25												25						25					25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	016	0		29	10	S7694_016_0	4	1	Generic	1	2	001000	1	2		110	01		110	1				30		90	1				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		6.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	016	0		29	10	S7694_016_0	4	2	Preferred Brand	1	2	000001	1	1		110	01		110	1				30		90	1				30		90	30		31											82.44	25		25				39.57	12		12										25		25				12		12			25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	016	0		29	10	S7694_016_0	4	3	Non-Preferred Brand	1	2	100100	1	1		110	01		110	1				30		90	2				30		90	30		31											32.49	45		45				28.88	40		40										45		45				40		40			45			45								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	017	0		29	10	S7694_017_0	4	3	Non-Preferred Brand	1	2	100100	1	1		110	01		110	1				30		90	2				30		90	30		31											33.38	45		45				29.67	40		40										45		45				40		40			45			45								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	017	0		29	10	S7694_017_0	4	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31											768.49	25						768.49	25												25						25					25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	017	0		29	10	S7694_017_0	4	1	Generic	1	2	001000	1	2		110	01		110	1				30		90	1				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		6.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	017	0		29	10	S7694_017_0	4	2	Preferred Brand	1	2	000001	1	1		110	01		110	1				30		90	1				30		90	30		31											75.02	25		25				36.01	12		12										25		25				12		12			25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	018	0		29	10	S7694_018_0	4	1	Generic	1	2	001000	1	2		110	01		110	1				30		90	1				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		6.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	018	0		29	10	S7694_018_0	4	2	Preferred Brand	1	2	000001	1	1		110	01		110	1				30		90	1				30		90	30		31											79.00	23		23				34.35	10		10										23		23				10		10			23			23								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	018	0		29	10	S7694_018_0	4	3	Non-Preferred Brand	1	2	100100	1	1		110	01		110	1				30		90	2				30		90	30		31											32.43	45		45				28.82	40		40										45		45				40		40			45			45								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	018	0		29	10	S7694_018_0	4	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31											1197.10	25						1197.10	25												25						25					25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	019	0		29	10	S7694_019_0	4	1	Generic	1	2	001000	1	2		110	01		110	1				30		90	1				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		6.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	019	0		29	10	S7694_019_0	4	2	Preferred Brand	1	2	000001	1	1		110	01		110	1				30		90	1				30		90	30		31											81.68	25		25				39.21	12		12										25		25				12		12			25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	019	0		29	10	S7694_019_0	4	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31											1259.13	25						1259.13	25												25						25					25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	019	0		29	10	S7694_019_0	4	3	Non-Preferred Brand	1	2	100100	1	1		110	01		110	1				30		90	2				30		90	30		31											29.19	45		45				25.95	40		40										45		45				40		40			45			45								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	020	0		29	10	S7694_020_0	4	1	Generic	1	2	001000	1	2		110	01		110	1				30		90	1				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		6.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	020	0		29	10	S7694_020_0	4	3	Non-Preferred Brand	1	2	100100	1	1		110	01		110	1				30		90	2				30		90	30		31											31.53	45		45				28.03	40		40										45		45				40		40			45			45								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	020	0		29	10	S7694_020_0	4	2	Preferred Brand	1	2	000001	1	1		110	01		110	1				30		90	1				30		90	30		31											71.01	25		25				39.76	14		14										25		25				14		14			25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	020	0		29	10	S7694_020_0	4	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31											737.28	25						737.28	25												25						25					25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	021	0		29	10	S7694_021_0	4	1	Generic	1	2	001000	1	2		110	01		110	1				30		90	1				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		6.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	021	0		29	10	S7694_021_0	4	2	Preferred Brand	1	2	000001	1	1		110	01		110	1				30		90	1				30		90	30		31											77.11	25		25				37.01	12		12										25		25				12		12			25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	021	0		29	10	S7694_021_0	4	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31											760.23	25						760.23	25												25						25					25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	021	0		29	10	S7694_021_0	4	3	Non-Preferred Brand	1	2	100100	1	1		110	01		110	1				30		90	2				30		90	30		31											41.93	45		45				37.28	40		40										45		45				40		40			45			45								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	022	0		29	10	S7694_022_0	4	1	Generic	1	2	001000	1	2		110	01		110	1				30		90	1				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		6.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	022	0		29	10	S7694_022_0	4	2	Preferred Brand	1	2	000001	1	1		110	01		110	1				30		90	1				30		90	30		31											82.17	25		25				52.59	16		16										25		25				16		16			25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	022	0		29	10	S7694_022_0	4	3	Non-Preferred Brand	1	2	100100	1	1		110	01		110	1				30		90	2				30		90	30		31											37.53	45		45				33.36	40		40										45		45				40		40			45			45								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											831.85	25						831.85	25												25						25					25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	023	0		29	10	S7694_023_0	4	1	Generic	1	2	001000	1	2		110	01		110	1				30		90	1				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		6.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	023	0		29	10	S7694_023_0	4	2	Preferred Brand	1	2	000001	1	1		110	01		110	1				30		90	1				30		90	30		31											86.11	25		25				41.33	12		12										25		25				12		12			25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	023	0		29	10	S7694_023_0	4	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31											1445.05	25						1445.05	25												25						25					25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	023	0		29	10	S7694_023_0	4	3	Non-Preferred Brand	1	2	100100	1	1		110	01		110	1				30		90	2				30		90	30		31											37.64	45		45				33.46	40		40										45		45				40		40			45			45								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	024	0		29	10	S7694_024_0	4	1	Generic	1	2	001000	1	2		110	01		110	1				30		90	1				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		6.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	024	0		29	10	S7694_024_0	4	2	Preferred Brand	1	2	000001	1	1		110	01		110	1				30		90	1				30		90	30		31											83.72	25		25				40.18	12		12										25		25				12		12			25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	024	0		29	10	S7694_024_0	4	3	Non-Preferred Brand	1	2	100100	1	1		110	01		110	1				30		90	2				30		90	30		31											32.00	45		45				28.45	40		40										45		45				40		40			45			45								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	024	0		29	10	S7694_024_0	4	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31											1010.85	25						1010.85	25												25						25					25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	025	0		29	10	S7694_025_0	4	1	Generic	1	2	001000	1	2		110	01		110	1				30		90	1				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		6.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	025	0		29	10	S7694_025_0	4	2	Preferred Brand	1	2	000001	1	1		110	01		110	1				30		90	1				30		90	30		31											82.86	25		25				46.40	14		14										25		25				14		14			25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	025	0		29	10	S7694_025_0	4	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31											1027.44	25						1027.44	25												25						25					25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	025	0		29	10	S7694_025_0	4	3	Non-Preferred Brand	1	2	100100	1	1		110	01		110	1				30		90	2				30		90	30		31											32.30	45		45				28.71	40		40										45		45				40		40			45			45								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	026	0		29	10	S7694_026_0	4	1	Generic	1	2	001000	1	2		110	01		110	1				30		90	1				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		6.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	026	0		29	10	S7694_026_0	4	2	Preferred Brand	1	2	000001	1	1		110	01		110	1				30		90	1				30		90	30		31											81.12	25		25				51.92	16		16										25		25				16		16			25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	026	0		29	10	S7694_026_0	4	3	Non-Preferred Brand	1	2	100100	1	1		110	01		110	1				30		90	2				30		90	30		31											38.70	45		45				34.40	40		40										45		45				40		40			45			45								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	026	0		29	10	S7694_026_0	4	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31											729.30	25						729.30	25												25						25					25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	027	0		29	10	S7694_027_0	4	1	Generic	1	2	001000	1	2		110	01		110	1				30		90	1				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		6.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	027	0		29	10	S7694_027_0	4	2	Preferred Brand	1	2	000001	1	1		110	01		110	1				30		90	1				30		90	30		31											79.09	25		25				37.96	12		12										25		25				12		12			25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	027	0		29	10	S7694_027_0	4	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31											1168.29	25						1168.29	25												25						25					25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	027	0		29	10	S7694_027_0	4	3	Non-Preferred Brand	1	2	100100	1	1		110	01		110	1				30		90	2				30		90	30		31											33.67	45		45				29.93	40		40										45		45				40		40			45			45								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	028	0		29	10	S7694_028_0	4	1	Generic	1	2	001000	1	2		110	01		110	1				30		90	1				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		6.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	028	0		29	10	S7694_028_0	4	3	Non-Preferred Brand	1	2	100100	1	1		110	01		110	1				30		90	2				30		90	30		31											34.84	45		45				30.97	40		40										45		45				40		40			45			45								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	028	0		29	10	S7694_028_0	4	2	Preferred Brand	1	2	000001	1	1		110	01		110	1				30		90	1				30		90	30		31											80.27	25		25				38.53	12		12										25		25				12		12			25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	028	0		29	10	S7694_028_0	4	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31											782.83	25						782.83	25												25						25					25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	029	0		29	10	S7694_029_0	4	1	Generic	1	2	001000	1	2		110	01		110	1				30		90	1				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		6.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	029	0		29	10	S7694_029_0	4	2	Preferred Brand	1	2	000001	1	1		110	01		110	1				30		90	1				30		90	30		31											84.18	23		23				36.60	10		10										23		23				10		10			23			23								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											2188.18	25						2188.18	25												25						25					25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	029	0		29	10	S7694_029_0	4	3	Non-Preferred Brand	1	2	100100	1	1		110	01		110	1				30		90	2				30		90	30		31											44.06	45		45				39.17	40		40										45		45				40		40			45			45								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	030	0		29	10	S7694_030_0	4	1	Generic	1	2	001000	1	2		110	01		110	1				30		90	1				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		6.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	030	0		29	10	S7694_030_0	4	2	Preferred Brand	1	2	000001	1	1		110	01		110	1				30		90	1				30		90	30		31											77.47	25		25				30.99	10		10										25		25				10		10			25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	030	0		29	10	S7694_030_0	4	3	Non-Preferred Brand	1	2	100100	1	1		110	01		110	1				30		90	2				30		90	30		31											32.64	45		45				29.02	40		40										45		45				40		40			45			45								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	030	0		29	10	S7694_030_0	4	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31											1015.52	25						1015.52	25												25						25					25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	031	0		29	10	S7694_031_0	4	1	Generic	1	2	001000	1	2		110	01		110	1				30		90	1				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		6.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	031	0		29	10	S7694_031_0	4	2	Preferred Brand	1	2	000001	1	1		110	01		110	1				30		90	1				30		90	30		31											80.19	25		25				44.90	14		14										25		25				14		14			25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	031	0		29	10	S7694_031_0	4	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31											1016.48	25						1016.48	25												25						25					25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	031	0		29	10	S7694_031_0	4	3	Non-Preferred Brand	1	2	100100	1	1		110	01		110	1				30		90	2				30		90	30		31											31.21	45		45				27.74	40		40										45		45				40		40			45			45								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	032	0		29	10	S7694_032_0	4	1	Generic	1	2	001000	1	2		110	01		110	1				30		90	1				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		6.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	032	0		29	10	S7694_032_0	4	3	Non-Preferred Brand	1	2	100100	1	1		110	01		110	1				30		90	2				30		90	30		31											37.74	45		45				33.55	40		40										45		45				40		40			45			45								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	032	0		29	10	S7694_032_0	4	2	Preferred Brand	1	2	000001	1	1		110	01		110	1				30		90	1				30		90	30		31											74.50	25		25				29.80	10		10										25		25				10		10			25			25								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											778.36	25						778.36	25												25						25					25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	033	0		29	10	S7694_033_0	4	1	Generic	1	2	001000	1	2		110	01		110	1				30		90	1				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		6.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	033	0		29	10	S7694_033_0	4	2	Preferred Brand	1	2	000001	1	1		110	01		110	1				30		90	1				30		90	30		31											94.87	25		25				45.54	12		12										25		25				12		12			25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	033	0		29	10	S7694_033_0	4	3	Non-Preferred Brand	1	2	100100	1	1		110	01		110	1				30		90	2				30		90	30		31											56.72	45		45				50.42	40		40										45		45				40		40			45			45								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	033	0		29	10	S7694_033_0	4	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31											195.81	25						195.81	25												25						25					25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	034	0		29	10	S7694_034_0	4	1	Generic	1	2	001000	1	2		110	01		110	1				30		90	1				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		6.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	034	0		29	10	S7694_034_0	4	2	Preferred Brand	1	2	000001	1	1		110	01		110	1				30		90	1				30		90	30		31											71.54	25		25				34.34	12		12										25		25				12		12			25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	034	0		29	10	S7694_034_0	4	3	Non-Preferred Brand	1	2	100100	1	1		110	01		110	1				30		90	2				30		90	30		31											27.03	45		45				24.02	40		40										45		45				40		40			45			45								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											1049.08	25						1049.08	25												25						25					25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	070	0		29	10	S7694_070_0	4	1	Generic	1	2	001000	1	2		110	01		110	1				30		90	1				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		6.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	070	0		29	10	S7694_070_0	4	2	Preferred Brand	1	2	000001	1	1		110	01		110	1				30		90	1				30		90	30		31											82.10	25		25				32.84	10		10										25		25				10		10			25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	070	0		29	10	S7694_070_0	4	3	Non-Preferred Brand	1	2	100100	1	1		110	01		110	1				30		90	2				30		90	30		31											37.92	45		45				33.71	40		40										45		45				40		40			45			45								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	070	0		29	10	S7694_070_0	4	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31											1004.98	25						1004.98	25												25						25					25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	105	0		29	10	S7694_105_0	4	1	Generic	1	2	001000	1	2		110	01		110	1				30		90	1				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		6.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	105	0		29	10	S7694_105_0	4	2	Preferred Brand	1	2	000001	1	1		110	01		110	1				30		90	1				30		90	30		31											80.26	25		25				38.53	12		12										25		25				12		12			25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	105	0		29	10	S7694_105_0	4	3	Non-Preferred Brand	1	2	100100	1	1		110	01		110	1				30		90	2				30		90	30		31											32.91	45		45				29.25	40		40										45		45				40		40			45			45								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	105	0		29	10	S7694_105_0	4	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31											785.32	25						785.32	25												25						25					25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	106	0		29	10	S7694_106_0	4	1	Generic	1	2	001000	1	2		110	01		110	1				30		90	1				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		6.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	106	0		29	10	S7694_106_0	4	2	Preferred Brand	1	2	000001	1	1		110	01		110	1				30		90	1				30		90	30		31											80.38	25		25				38.58	12		12										25		25				12		12			25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	106	0		29	10	S7694_106_0	4	3	Non-Preferred Brand	1	2	100100	1	1		110	01		110	1				30		90	2				30		90	30		31											39.10	45		45				34.75	40		40										45		45				40		40			45			45								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	106	0		29	10	S7694_106_0	4	4	Specialty Tier	1	2	010010	1	1		010	01		010	1				30							30			30		31											781.94	25						781.94	25												25						25					25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	107	0		29	10	S7694_107_0	2	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		6.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	107	0		29	10	S7694_107_0	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31											1505.34	33						1505.34	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	107	0		29	10	S7694_107_0	2	4	Non-Preferred Brand	1	4	100000	1	1		110	01		110	1				30		90	1				30		90	30		31											95.94	42		42				73.10	32		32										42		42				32		32			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	107	0		29	10	S7694_107_0	2	3	Preferred Brand	1	4	000001	1	1		110	01		110	1				30		90	1				30		90	30		31											91.92	25		25				73.53	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	107	0		29	10	S7694_107_0	2	2	Generic	1	4	000100	1	2		110	01		110	1				30		90	1				30		90	30		31								20.00		60.00					6.00		18.00											20.00		60.00				6.00		18.00				20.00				20.00			0.67	0.20		0.67	0.20	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	115	0		29	10	S7694_115_0	4	4	Non-Preferred Brand	1	4	100000	1	1		110	01		110	1				30		90	1				30		90	30		31											95.12	42		42				72.47	32		32										42		42				32		32			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	115	0		29	10	S7694_115_0	4	3	Preferred Brand	1	4	000001	1	1		110	01		110	1				30		90	1				30		90	30		31											91.60	25		25				73.28	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	115	0		29	10	S7694_115_0	4	2	Generic	1	4	000100	1	2		110	01		110	1				30		90	1				30		90	30		31								20.00		60.00					6.00		18.00											20.00		60.00				6.00		18.00				20.00				20.00			0.67	0.20		0.67	0.20	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	115	0		29	10	S7694_115_0	4	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		6.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	115	0		29	10	S7694_115_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31											1505.10	33						1505.10	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	117	0		29	10	S7694_117_0	2	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		6.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	117	0		29	10	S7694_117_0	2	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31											1502.66	33						1502.66	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	117	0		29	10	S7694_117_0	2	4	Non-Preferred Brand	1	4	100000	1	1		110	01		110	1				30		90	1				30		90	30		31											95.68	42		42				72.90	32		32										42		42				32		32			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	117	0		29	10	S7694_117_0	2	3	Preferred Brand	1	4	000001	1	1		110	01		110	1				30		90	1				30		90	30		31											91.72	25		25				73.37	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	117	0		29	10	S7694_117_0	2	2	Generic	1	4	000100	1	2		110	01		110	1				30		90	1				30		90	30		31								20.00		60.00					6.00		18.00											20.00		60.00				6.00		18.00				20.00				20.00			0.67	0.20		0.67	0.20	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	118	0		29	10	S7694_118_0	4	2	Generic	1	4	000100	1	2		110	01		110	1				30		90	1				30		90	30		31								20.00		60.00					6.00		18.00											20.00		60.00				6.00		18.00				20.00				20.00			0.67	0.20		0.67	0.20	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	118	0		29	10	S7694_118_0	4	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		6.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	118	0		29	10	S7694_118_0	4	3	Preferred Brand	1	4	000001	1	1		110	01		110	1				30		90	1				30		90	30		31											92.05	25		25				73.64	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	118	0		29	10	S7694_118_0	4	4	Non-Preferred Brand	1	4	100000	1	1		110	01		110	1				30		90	1				30		90	30		31											96.30	42		42				73.37	32		32										42		42				32		32			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	118	0		29	10	S7694_118_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31											1504.94	33						1504.94	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	119	0		29	10	S7694_119_0	4	2	Generic	1	4	000100	1	2		110	01		110	1				30		90	1				30		90	30		31								20.00		60.00					6.00		18.00											20.00		60.00				6.00		18.00				20.00				20.00			0.67	0.20		0.67	0.20	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	119	0		29	10	S7694_119_0	4	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		6.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	119	0		29	10	S7694_119_0	4	3	Preferred Brand	1	4	000001	1	1		110	01		110	1				30		90	1				30		90	30		31											91.65	25		25				73.32	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	119	0		29	10	S7694_119_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31											1505.21	33						1505.21	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	119	0		29	10	S7694_119_0	4	4	Non-Preferred Brand	1	4	100000	1	1		110	01		110	1				30		90	1				30		90	30		31											95.34	42		42				72.64	32		32										42		42				32		32			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	120	0		29	10	S7694_120_0	4	4	Non-Preferred Brand	1	4	100000	1	1		110	01		110	1				30		90	1				30		90	30		31											95.53	42		42				72.79	32		32										42		42				32		32			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	120	0		29	10	S7694_120_0	4	3	Preferred Brand	1	4	000001	1	1		110	01		110	1				30		90	1				30		90	30		31											91.79	25		25				73.34	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	120	0		29	10	S7694_120_0	4	1	Preferred Generic	1	4	001000	1	2		110	01		110	1				30		90	1				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		6.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	120	0		29	10	S7694_120_0	4	2	Generic	1	4	000100	1	2		110	01		110	1				30		90	1				30		90	30		31								20.00		60.00					6.00		18.00											20.00		60.00				6.00		18.00				20.00				20.00			0.67	0.20		0.67	0.20	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S7694	120	0		29	10	S7694_120_0	4	5	Specialty Tier	1	4	010010	1	1		010	01		010	1				30							30			30		31											1504.99	33						1504.99	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S8067	001	0		29	10	S8067_001_0	2	3	Preferred Brand	1	3	000101	1	2		110	01	110		1				30		90	1	30		90				30		31								45.00		135.00					38.00		114.00					38.00		114.00																45.00				45.00			1.50	1.27	1.27			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S8067	001	0		29	10	S8067_001_0	2	5	Specialty Tier	1	3	010010	1	1		010	01	010		1				30				30						30		31											546.72	33						546.72	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S8067	001	0		29	10	S8067_001_0	2	4	Non-Preferred Brand	1	3	100100	1	2		110	01	110		1				30		90	1	30		90				30		31								95.00		285.00					89.00		267.00					89.00		267.00																95.00				95.00			3.17	2.97	2.97			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S8067	001	0		29	10	S8067_001_0	2	2	Generic	1	3	000100	1	2		110	01	110		1				30		90	1	30		90				30		31								20.00		60.00					15.00		45.00					15.00		45.00																20.00				20.00			0.67	0.50	0.50			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S8067	001	0		29	10	S8067_001_0	2	1	Preferred Generic	1	3	001000	1	2		110	01	110		1				30		90	1	30		90				30		31								10.00		30.00					4.00		12.00					4.00		12.00																10.00				10.00			0.33	0.13	0.13			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S8067	003	0		29	10	S8067_003_0	2	3	Preferred Brand	1	4	000001	1	2		110	01	110		1				30		90	1	30		90				30		31								45.00		135.00					38.00		114.00					38.00		114.00																45.00				45.00			1.50	1.27	1.27			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S8067	003	0		29	10	S8067_003_0	2	2	Generic	1	4	000100	1	2		110	01	110		1				30		90	1	30		90				30		31								20.00		60.00					15.00		45.00					15.00		45.00																20.00				20.00			0.67	0.50	0.50			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S8067	003	0		29	10	S8067_003_0	2	1	Preferred Generic	1	4	001000	1	2		110	01	110		1				30		90	1	30		90				30		31								9.00		27.00					4.00		12.00					4.00		12.00																9.00				9.00			0.30	0.13	0.13			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S8067	003	0		29	10	S8067_003_0	2	5	Specialty Tier	1	4	010010	1	1		010	01	010		1				30				30						30		31											458.94	33						458.94	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S8067	003	0		29	10	S8067_003_0	2	4	Non-Preferred Brand	1	4	100100	1	2		110	01	110		1				30		90	1	30		90				30		31								95.00		285.00					89.00		267.00					89.00		267.00																95.00				95.00			3.17	2.97	2.97			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	001	0		29	10	S9579_001_0	5	4	Non-Preferred Brand	1	2	100000	1	1		111	01	100		1				30	60	90	1			90				30		31											88.00	35	35	35				88.00	35	35	35						35															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	001	0		29	10	S9579_001_0	5	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						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	001	0		29	10	S9579_001_0	5	3	Preferred Brand	1	2	000001	1	1		111	01	100		1				30	60	90	1			90				30		31											55.00	25	25	25				55.00	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	001	0		29	10	S9579_001_0	5	2	Generic	1	2	000100	1	2		111	01	100		1				30	60	90	1			90				30		31								8.00	16.00	24.00					8.00	16.00	24.00							20.00																8.00				8.00			0.27	0.27				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	001	0		29	10	S9579_001_0	5	1	Preferred Generic	1	2	001000	1	2		111	01	100		1				30	60	90	1			90				30		31								6.00	12.00	18.00					0.00	0.00	0.00							0.00																6.00				6.00			0.20	0.00				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	002	0		29	10	S9579_002_0	5	1	Preferred Generic	1	2	001000	1	2		111	01	100		1				30	60	90	1			90				30		31								6.00	12.00	18.00					0.00	0.00	0.00							0.00																6.00				6.00			0.20	0.00				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	002	0		29	10	S9579_002_0	5	3	Preferred Brand	1	2	000001	1	1		111	01	100		1				30	60	90	1			90				30		31											63.00	25	25	25				63.00	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	002	0		29	10	S9579_002_0	5	4	Non-Preferred Brand	1	2	100000	1	1		111	01	100		1				30	60	90	1			90				30		31											100.00	42	42	42				100.00	42	42	42						42															42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	002	0		29	10	S9579_002_0	5	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						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	002	0		29	10	S9579_002_0	5	2	Generic	1	2	000100	1	2		111	01	100		1				30	60	90	1			90				30		31								8.00	16.00	24.00					8.00	16.00	24.00							20.00																8.00				8.00			0.27	0.27				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	003	0		29	10	S9579_003_0	5	1	Preferred Generic	1	2	001000	1	2		111	01	100		1				30	60	90	1			90				30		31								6.00	12.00	18.00					0.00	0.00	0.00							0.00																6.00				6.00			0.20	0.00				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	003	0		29	10	S9579_003_0	5	2	Generic	1	2	000100	1	2		111	01	100		1				30	60	90	1			90				30		31								8.00	16.00	24.00					8.00	16.00	24.00							20.00																8.00				8.00			0.27	0.27				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	003	0		29	10	S9579_003_0	5	4	Non-Preferred Brand	1	2	100000	1	1		111	01	100		1				30	60	90	1			90				30		31											97.00	30	30	30				97.00	30	30	30						30															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	003	0		29	10	S9579_003_0	5	3	Preferred Brand	1	2	000001	1	1		111	01	100		1				30	60	90	1			90				30		31											51.00	25	25	25				51.00	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	003	0		29	10	S9579_003_0	5	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						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	004	0		29	10	S9579_004_0	5	4	Non-Preferred Brand	1	2	100000	1	1		111	01	100		1				30	60	90	1			90				30		31											100.00	35	35	35				100.00	35	35	35						35															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	004	0		29	10	S9579_004_0	5	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						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	004	0		29	10	S9579_004_0	5	3	Preferred Brand	1	2	000001	1	1		111	01	100		1				30	60	90	1			90				30		31											62.00	25	25	25				62.00	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	004	0		29	10	S9579_004_0	5	1	Preferred Generic	1	2	001000	1	2		111	01	100		1				30	60	90	1			90				30		31								6.00	12.00	18.00					0.00	0.00	0.00							0.00																6.00				6.00			0.20	0.00				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	004	0		29	10	S9579_004_0	5	2	Generic	1	2	000100	1	2		111	01	100		1				30	60	90	1			90				30		31								8.00	16.00	24.00					8.00	16.00	24.00							20.00																8.00				8.00			0.27	0.27				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	005	0		29	10	S9579_005_0	5	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						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	005	0		29	10	S9579_005_0	5	1	Preferred Generic	1	2	001000	1	2		111	01	100		1				30	60	90	1			90				30		31								6.00	12.00	18.00					0.00	0.00	0.00							0.00																6.00				6.00			0.20	0.00				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	005	0		29	10	S9579_005_0	5	4	Non-Preferred Brand	1	2	100000	1	1		111	01	100		1				30	60	90	1			90				30		31											92.00	35	35	35				92.00	35	35	35						35															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	005	0		29	10	S9579_005_0	5	3	Preferred Brand	1	2	000001	1	1		111	01	100		1				30	60	90	1			90				30		31											58.00	25	25	25				58.00	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	005	0		29	10	S9579_005_0	5	2	Generic	1	2	000100	1	2		111	01	100		1				30	60	90	1			90				30		31								8.00	16.00	24.00					8.00	16.00	24.00							20.00																8.00				8.00			0.27	0.27				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	006	0		29	10	S9579_006_0	5	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						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	006	0		29	10	S9579_006_0	5	3	Preferred Brand	1	2	000001	1	1		111	01	100		1				30	60	90	1			90				30		31											60.00	25	25	25				60.00	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	006	0		29	10	S9579_006_0	5	2	Generic	1	2	000100	1	2		111	01	100		1				30	60	90	1			90				30		31								8.00	16.00	24.00					8.00	16.00	24.00							20.00																8.00				8.00			0.27	0.27				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	006	0		29	10	S9579_006_0	5	1	Preferred Generic	1	2	001000	1	2		111	01	100		1				30	60	90	1			90				30		31								6.00	12.00	18.00					0.00	0.00	0.00							0.00																6.00				6.00			0.20	0.00				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	006	0		29	10	S9579_006_0	5	4	Non-Preferred Brand	1	2	100000	1	1		111	01	100		1				30	60	90	1			90				30		31											91.00	39	39	39				91.00	39	39	39						39															39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	007	0		29	10	S9579_007_0	5	2	Generic	1	2	000100	1	2		111	01	100		1				30	60	90	1			90				30		31								8.00	16.00	24.00					8.00	16.00	24.00							20.00																8.00				8.00			0.27	0.27				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	007	0		29	10	S9579_007_0	5	3	Preferred Brand	1	2	000001	1	1		111	01	100		1				30	60	90	1			90				30		31											63.00	25	25	25				63.00	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	007	0		29	10	S9579_007_0	5	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						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	007	0		29	10	S9579_007_0	5	4	Non-Preferred Brand	1	2	100000	1	1		111	01	100		1				30	60	90	1			90				30		31											98.00	44	44	44				98.00	44	44	44						44															44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	007	0		29	10	S9579_007_0	5	1	Preferred Generic	1	2	001000	1	2		111	01	100		1				30	60	90	1			90				30		31								6.00	12.00	18.00					0.00	0.00	0.00							0.00																6.00				6.00			0.20	0.00				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	008	0		29	10	S9579_008_0	5	4	Non-Preferred Brand	1	2	100000	1	1		111	01	100		1				30	60	90	1			90				30		31											98.00	39	39	39				98.00	39	39	39						39															39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	008	0		29	10	S9579_008_0	5	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						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	008	0		29	10	S9579_008_0	5	3	Preferred Brand	1	2	000001	1	1		111	01	100		1				30	60	90	1			90				30		31											67.00	25	25	25				67.00	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	008	0		29	10	S9579_008_0	5	2	Generic	1	2	000100	1	2		111	01	100		1				30	60	90	1			90				30		31								8.00	16.00	24.00					8.00	16.00	24.00							20.00																8.00				8.00			0.27	0.27				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	008	0		29	10	S9579_008_0	5	1	Preferred Generic	1	2	001000	1	2		111	01	100		1				30	60	90	1			90				30		31								6.00	12.00	18.00					0.00	0.00	0.00							0.00																6.00				6.00			0.20	0.00				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	009	0		29	10	S9579_009_0	5	2	Generic	1	2	000100	1	2		111	01	100		1				30	60	90	1			90				30		31								8.00	16.00	24.00					8.00	16.00	24.00							20.00																8.00				8.00			0.27	0.27				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	009	0		29	10	S9579_009_0	5	3	Preferred Brand	1	2	000001	1	1		111	01	100		1				30	60	90	1			90				30		31											61.00	25	25	25				61.00	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	009	0		29	10	S9579_009_0	5	4	Non-Preferred Brand	1	2	100000	1	1		111	01	100		1				30	60	90	1			90				30		31											94.00	35	35	35				94.00	35	35	35						35															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	009	0		29	10	S9579_009_0	5	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						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	009	0		29	10	S9579_009_0	5	1	Preferred Generic	1	2	001000	1	2		111	01	100		1				30	60	90	1			90				30		31								6.00	12.00	18.00					0.00	0.00	0.00							0.00																6.00				6.00			0.20	0.00				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	011	0		29	10	S9579_011_0	5	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						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	011	0		29	10	S9579_011_0	5	4	Non-Preferred Brand	1	2	100000	1	1		111	01	100		1				30	60	90	1			90				30		31											84.00	35	35	35				84.00	35	35	35						35															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	011	0		29	10	S9579_011_0	5	3	Preferred Brand	1	2	000001	1	1		111	01	100		1				30	60	90	1			90				30		31											59.00	25	25	25				59.00	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	011	0		29	10	S9579_011_0	5	2	Generic	1	2	000100	1	2		111	01	100		1				30	60	90	1			90				30		31								8.00	16.00	24.00					8.00	16.00	24.00							20.00																8.00				8.00			0.27	0.27				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	011	0		29	10	S9579_011_0	5	1	Preferred Generic	1	2	001000	1	2		111	01	100		1				30	60	90	1			90				30		31								6.00	12.00	18.00					0.00	0.00	0.00							0.00																6.00				6.00			0.20	0.00				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	012	0		29	10	S9579_012_0	5	1	Preferred Generic	1	2	001000	1	2		111	01	100		1				30	60	90	1			90				30		31								6.00	12.00	18.00					0.00	0.00	0.00							0.00																6.00				6.00			0.20	0.00				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	012	0		29	10	S9579_012_0	5	2	Generic	1	2	000100	1	2		111	01	100		1				30	60	90	1			90				30		31								8.00	16.00	24.00					8.00	16.00	24.00							20.00																8.00				8.00			0.27	0.27				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	012	0		29	10	S9579_012_0	5	3	Preferred Brand	1	2	000001	1	1		111	01	100		1				30	60	90	1			90				30		31											58.00	25	25	25				58.00	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	012	0		29	10	S9579_012_0	5	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						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	012	0		29	10	S9579_012_0	5	4	Non-Preferred Brand	1	2	100000	1	1		111	01	100		1				30	60	90	1			90				30		31											92.00	35	35	35				92.00	35	35	35						35															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	013	0		29	10	S9579_013_0	5	1	Preferred Generic	1	2	001000	1	2		111	01	100		1				30	60	90	1			90				30		31								6.00	12.00	18.00					0.00	0.00	0.00							0.00																6.00				6.00			0.20	0.00				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	013	0		29	10	S9579_013_0	5	2	Generic	1	2	000100	1	2		111	01	100		1				30	60	90	1			90				30		31								8.00	16.00	24.00					8.00	16.00	24.00							20.00																8.00				8.00			0.27	0.27				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	013	0		29	10	S9579_013_0	5	3	Preferred Brand	1	2	000001	1	1		111	01	100		1				30	60	90	1			90				30		31											59.00	25	25	25				59.00	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	013	0		29	10	S9579_013_0	5	4	Non-Preferred Brand	1	2	100000	1	1		111	01	100		1				30	60	90	1			90				30		31											90.00	39	39	39				90.00	39	39	39						39															39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	013	0		29	10	S9579_013_0	5	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						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	014	0		29	10	S9579_014_0	5	1	Preferred Generic	1	2	001000	1	2		111	01	100		1				30	60	90	1			90				30		31								6.00	12.00	18.00					0.00	0.00	0.00							0.00																6.00				6.00			0.20	0.00				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	014	0		29	10	S9579_014_0	5	2	Generic	1	2	000100	1	2		111	01	100		1				30	60	90	1			90				30		31								8.00	16.00	24.00					8.00	16.00	24.00							20.00																8.00				8.00			0.27	0.27				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	014	0		29	10	S9579_014_0	5	3	Preferred Brand	1	2	000001	1	1		111	01	100		1				30	60	90	1			90				30		31											61.00	25	25	25				61.00	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	014	0		29	10	S9579_014_0	5	4	Non-Preferred Brand	1	2	100000	1	1		111	01	100		1				30	60	90	1			90				30		31											99.00	44	44	44				99.00	44	44	44						44															44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	014	0		29	10	S9579_014_0	5	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						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	015	0		29	10	S9579_015_0	5	2	Generic	1	2	000100	1	2		111	01	100		1				30	60	90	1			90				30		31								8.00	16.00	24.00					8.00	16.00	24.00							20.00																8.00				8.00			0.27	0.27				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	015	0		29	10	S9579_015_0	5	1	Preferred Generic	1	2	001000	1	2		111	01	100		1				30	60	90	1			90				30		31								6.00	12.00	18.00					0.00	0.00	0.00							0.00																6.00				6.00			0.20	0.00				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	015	0		29	10	S9579_015_0	5	3	Preferred Brand	1	2	000001	1	1		111	01	100		1				30	60	90	1			90				30		31											59.00	25	25	25				59.00	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	015	0		29	10	S9579_015_0	5	4	Non-Preferred Brand	1	2	100000	1	1		111	01	100		1				30	60	90	1			90				30		31											93.00	44	44	44				93.00	44	44	44						44															44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	015	0		29	10	S9579_015_0	5	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						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	016	0		29	10	S9579_016_0	5	1	Preferred Generic	1	2	001000	1	2		111	01	100		1				30	60	90	1			90				30		31								6.00	12.00	18.00					0.00	0.00	0.00							0.00																6.00				6.00			0.20	0.00				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	016	0		29	10	S9579_016_0	5	2	Generic	1	2	000100	1	2		111	01	100		1				30	60	90	1			90				30		31								8.00	16.00	24.00					8.00	16.00	24.00							20.00																8.00				8.00			0.27	0.27				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	016	0		29	10	S9579_016_0	5	3	Preferred Brand	1	2	000001	1	1		111	01	100		1				30	60	90	1			90				30		31											63.00	25	25	25				63.00	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	016	0		29	10	S9579_016_0	5	4	Non-Preferred Brand	1	2	100000	1	1		111	01	100		1				30	60	90	1			90				30		31											98.00	42	42	42				98.00	42	42	42						42															42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	016	0		29	10	S9579_016_0	5	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						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	017	0		29	10	S9579_017_0	5	2	Generic	1	2	000100	1	2		111	01	100		1				30	60	90	1			90				30		31								8.00	16.00	24.00					8.00	16.00	24.00							20.00																8.00				8.00			0.27	0.27				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	017	0		29	10	S9579_017_0	5	1	Preferred Generic	1	2	001000	1	2		111	01	100		1				30	60	90	1			90				30		31								6.00	12.00	18.00					0.00	0.00	0.00							0.00																6.00				6.00			0.20	0.00				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	017	0		29	10	S9579_017_0	5	3	Preferred Brand	1	2	000001	1	1		111	01	100		1				30	60	90	1			90				30		31											56.00	25	25	25				56.00	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	017	0		29	10	S9579_017_0	5	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						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	017	0		29	10	S9579_017_0	5	4	Non-Preferred Brand	1	2	100000	1	1		111	01	100		1				30	60	90	1			90				30		31											85.00	39	39	39				85.00	39	39	39						39															39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	018	0		29	10	S9579_018_0	5	1	Preferred Generic	1	2	001000	1	2		111	01	100		1				30	60	90	1			90				30		31								6.00	12.00	18.00					0.00	0.00	0.00							0.00																6.00				6.00			0.20	0.00				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	018	0		29	10	S9579_018_0	5	2	Generic	1	2	000100	1	2		111	01	100		1				30	60	90	1			90				30		31								8.00	16.00	24.00					8.00	16.00	24.00							20.00																8.00				8.00			0.27	0.27				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	018	0		29	10	S9579_018_0	5	3	Preferred Brand	1	2	000001	1	1		111	01	100		1				30	60	90	1			90				30		31											35.00	23	23	23				35.00	23	23	23						23															23			23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	018	0		29	10	S9579_018_0	5	4	Non-Preferred Brand	1	2	100000	1	1		111	01	100		1				30	60	90	1			90				30		31											99.00	42	42	42				99.00	42	42	42						42															42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	018	0		29	10	S9579_018_0	5	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						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	019	0		29	10	S9579_019_0	5	1	Preferred Generic	1	2	001000	1	2		111	01	100		1				30	60	90	1			90				30		31								6.00	12.00	18.00					0.00	0.00	0.00							0.00																6.00				6.00			0.20	0.00				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	019	0		29	10	S9579_019_0	5	2	Generic	1	2	000100	1	2		111	01	100		1				30	60	90	1			90				30		31								8.00	16.00	24.00					8.00	16.00	24.00							20.00																8.00				8.00			0.27	0.27				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	019	0		29	10	S9579_019_0	5	4	Non-Preferred Brand	1	2	100000	1	1		111	01	100		1				30	60	90	1			90				30		31											95.00	42	42	42				95.00	42	42	42						42															42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	019	0		29	10	S9579_019_0	5	3	Preferred Brand	1	2	000001	1	1		111	01	100		1				30	60	90	1			90				30		31											51.00	23	23	23				51.00	23	23	23						23															23			23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	019	0		29	10	S9579_019_0	5	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						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	020	0		29	10	S9579_020_0	5	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						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	020	0		29	10	S9579_020_0	5	1	Preferred Generic	1	2	001000	1	2		111	01	100		1				30	60	90	1			90				30		31								6.00	12.00	18.00					0.00	0.00	0.00							0.00																6.00				6.00			0.20	0.00				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	020	0		29	10	S9579_020_0	5	3	Preferred Brand	1	2	000001	1	1		111	01	100		1				30	60	90	1			90				30		31											49.00	23	23	23				49.00	23	23	23						23															23			23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	020	0		29	10	S9579_020_0	5	2	Generic	1	2	000100	1	2		111	01	100		1				30	60	90	1			90				30		31								8.00	16.00	24.00					8.00	16.00	24.00							20.00																8.00				8.00			0.27	0.27				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	020	0		29	10	S9579_020_0	5	4	Non-Preferred Brand	1	2	100000	1	1		111	01	100		1				30	60	90	1			90				30		31											93.00	42	42	42				93.00	42	42	42						42															42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	021	0		29	10	S9579_021_0	5	1	Preferred Generic	1	2	001000	1	2		111	01	100		1				30	60	90	1			90				30		31								6.00	12.00	18.00					0.00	0.00	0.00							0.00																6.00				6.00			0.20	0.00				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	021	0		29	10	S9579_021_0	5	2	Generic	1	2	000100	1	2		111	01	100		1				30	60	90	1			90				30		31								8.00	16.00	24.00					8.00	16.00	24.00							20.00																8.00				8.00			0.27	0.27				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	021	0		29	10	S9579_021_0	5	3	Preferred Brand	1	2	000001	1	1		111	01	100		1				30	60	90	1			90				30		31											62.00	25	25	25				62.00	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	021	0		29	10	S9579_021_0	5	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						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	021	0		29	10	S9579_021_0	5	4	Non-Preferred Brand	1	2	100000	1	1		111	01	100		1				30	60	90	1			90				30		31											91.00	35	35	35				91.00	35	35	35						35															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	022	0		29	10	S9579_022_0	5	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						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	022	0		29	10	S9579_022_0	5	2	Generic	1	2	000100	1	2		111	01	100		1				30	60	90	1			90				30		31								8.00	16.00	24.00					8.00	16.00	24.00							20.00																8.00				8.00			0.27	0.27				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	022	0		29	10	S9579_022_0	5	3	Preferred Brand	1	2	000001	1	1		111	01	100		1				30	60	90	1			90				30		31											59.00	25	25	25				59.00	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	022	0		29	10	S9579_022_0	5	4	Non-Preferred Brand	1	2	100000	1	1		111	01	100		1				30	60	90	1			90				30		31											88.00	39	39	39				88.00	39	39	39						39															39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	022	0		29	10	S9579_022_0	5	1	Preferred Generic	1	2	001000	1	2		111	01	100		1				30	60	90	1			90				30		31								6.00	12.00	18.00					0.00	0.00	0.00							0.00																6.00				6.00			0.20	0.00				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	023	0		29	10	S9579_023_0	5	2	Generic	1	2	000100	1	2		111	01	100		1				30	60	90	1			90				30		31								8.00	16.00	24.00					8.00	16.00	24.00							20.00																8.00				8.00			0.27	0.27				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	023	0		29	10	S9579_023_0	5	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						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	023	0		29	10	S9579_023_0	5	4	Non-Preferred Brand	1	2	100000	1	1		111	01	100		1				30	60	90	1			90				30		31											84.00	35	35	35				84.00	35	35	35						35															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	023	0		29	10	S9579_023_0	5	3	Preferred Brand	1	2	000001	1	1		111	01	100		1				30	60	90	1			90				30		31											60.00	25	25	25				60.00	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	023	0		29	10	S9579_023_0	5	1	Preferred Generic	1	2	001000	1	2		111	01	100		1				30	60	90	1			90				30		31								6.00	12.00	18.00					0.00	0.00	0.00							0.00																6.00				6.00			0.20	0.00				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	024	0		29	10	S9579_024_0	5	2	Generic	1	2	000100	1	2		111	01	100		1				30	60	90	1			90				30		31								8.00	16.00	24.00					8.00	16.00	24.00							20.00																8.00				8.00			0.27	0.27				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	024	0		29	10	S9579_024_0	5	1	Preferred Generic	1	2	001000	1	2		111	01	100		1				30	60	90	1			90				30		31								6.00	12.00	18.00					0.00	0.00	0.00							0.00																6.00				6.00			0.20	0.00				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	024	0		29	10	S9579_024_0	5	3	Preferred Brand	1	2	000001	1	1		111	01	100		1				30	60	90	1			90				30		31											62.00	25	25	25				62.00	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	024	0		29	10	S9579_024_0	5	4	Non-Preferred Brand	1	2	100000	1	1		111	01	100		1				30	60	90	1			90				30		31											96.00	39	39	39				96.00	39	39	39						39															39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	024	0		29	10	S9579_024_0	5	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						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	025	0		29	10	S9579_025_0	5	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						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	025	0		29	10	S9579_025_0	5	1	Preferred Generic	1	2	001000	1	2		111	01	100		1				30	60	90	1			90				30		31								6.00	12.00	18.00					0.00	0.00	0.00							0.00																6.00				6.00			0.20	0.00				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	025	0		29	10	S9579_025_0	5	3	Preferred Brand	1	2	000001	1	1		111	01	100		1				30	60	90	1			90				30		31											48.00	23	23	23				48.00	23	23	23						23															23			23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	025	0		29	10	S9579_025_0	5	4	Non-Preferred Brand	1	2	100000	1	1		111	01	100		1				30	60	90	1			90				30		31											91.00	42	42	42				91.00	42	42	42						42															42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	025	0		29	10	S9579_025_0	5	2	Generic	1	2	000100	1	2		111	01	100		1				30	60	90	1			90				30		31								8.00	16.00	24.00					8.00	16.00	24.00							20.00																8.00				8.00			0.27	0.27				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	026	0		29	10	S9579_026_0	5	2	Generic	1	2	000100	1	2		111	01	100		1				30	60	90	1			90				30		31								8.00	16.00	24.00					8.00	16.00	24.00							20.00																8.00				8.00			0.27	0.27				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	026	0		29	10	S9579_026_0	5	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						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	026	0		29	10	S9579_026_0	5	4	Non-Preferred Brand	1	2	100000	1	1		111	01	100		1				30	60	90	1			90				30		31											96.00	35	35	35				96.00	35	35	35						35															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	026	0		29	10	S9579_026_0	5	3	Preferred Brand	1	2	000001	1	1		111	01	100		1				30	60	90	1			90				30		31											61.00	25	25	25				61.00	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	026	0		29	10	S9579_026_0	5	1	Preferred Generic	1	2	001000	1	2		111	01	100		1				30	60	90	1			90				30		31								6.00	12.00	18.00					0.00	0.00	0.00							0.00																6.00				6.00			0.20	0.00				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	027	0		29	10	S9579_027_0	5	4	Non-Preferred Brand	1	2	100000	1	1		111	01	100		1				30	60	90	1			90				30		31											98.00	39	39	39				98.00	39	39	39						39															39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	027	0		29	10	S9579_027_0	5	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						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	027	0		29	10	S9579_027_0	5	3	Preferred Brand	1	2	000001	1	1		111	01	100		1				30	60	90	1			90				30		31											56.00	25	25	25				56.00	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	027	0		29	10	S9579_027_0	5	2	Generic	1	2	000100	1	2		111	01	100		1				30	60	90	1			90				30		31								8.00	16.00	24.00					8.00	16.00	24.00							20.00																8.00				8.00			0.27	0.27				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	027	0		29	10	S9579_027_0	5	1	Preferred Generic	1	2	001000	1	2		111	01	100		1				30	60	90	1			90				30		31								6.00	12.00	18.00					0.00	0.00	0.00							0.00																6.00				6.00			0.20	0.00				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	028	0		29	10	S9579_028_0	5	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						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	028	0		29	10	S9579_028_0	5	1	Preferred Generic	1	2	001000	1	2		111	01	100		1				30	60	90	1			90				30		31								6.00	12.00	18.00					0.00	0.00	0.00							0.00																6.00				6.00			0.20	0.00				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	028	0		29	10	S9579_028_0	5	3	Preferred Brand	1	2	000001	1	1		111	01	100		1				30	60	90	1			90				30		31											51.00	23	23	23				51.00	23	23	23						23															23			23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	028	0		29	10	S9579_028_0	5	4	Non-Preferred Brand	1	2	100000	1	1		111	01	100		1				30	60	90	1			90				30		31											93.00	42	42	42				93.00	42	42	42						42															42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	028	0		29	10	S9579_028_0	5	2	Generic	1	2	000100	1	2		111	01	100		1				30	60	90	1			90				30		31								8.00	16.00	24.00					8.00	16.00	24.00							20.00																8.00				8.00			0.27	0.27				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	029	0		29	10	S9579_029_0	5	3	Preferred Brand	1	2	000001	1	1		111	01	100		1				30	60	90	1			90				30		31											59.00	25	25	25				59.00	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	029	0		29	10	S9579_029_0	5	2	Generic	1	2	000100	1	2		111	01	100		1				30	60	90	1			90				30		31								8.00	16.00	24.00					8.00	16.00	24.00							20.00																8.00				8.00			0.27	0.27				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	029	0		29	10	S9579_029_0	5	1	Preferred Generic	1	2	001000	1	2		111	01	100		1				30	60	90	1			90				30		31								6.00	12.00	18.00					0.00	0.00	0.00							0.00																6.00				6.00			0.20	0.00				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	029	0		29	10	S9579_029_0	5	4	Non-Preferred Brand	1	2	100000	1	1		111	01	100		1				30	60	90	1			90				30		31											100.00	39	39	39				100.00	39	39	39						39															39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	029	0		29	10	S9579_029_0	5	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						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	030	0		29	10	S9579_030_0	5	1	Preferred Generic	1	2	001000	1	2		111	01	100		1				30	60	90	1			90				30		31								6.00	12.00	18.00					0.00	0.00	0.00							0.00																6.00				6.00			0.20	0.00				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	030	0		29	10	S9579_030_0	5	2	Generic	1	2	000100	1	2		111	01	100		1				30	60	90	1			90				30		31								8.00	16.00	24.00					8.00	16.00	24.00							20.00																8.00				8.00			0.27	0.27				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	030	0		29	10	S9579_030_0	5	3	Preferred Brand	1	2	000001	1	1		111	01	100		1				30	60	90	1			90				30		31											55.00	23	23	23				55.00	23	23	23						23															23			23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	030	0		29	10	S9579_030_0	5	4	Non-Preferred Brand	1	2	100000	1	1		111	01	100		1				30	60	90	1			90				30		31											100.00	42	42	42				100.00	42	42	42						42															42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	030	0		29	10	S9579_030_0	5	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						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	031	0		29	10	S9579_031_0	5	1	Preferred Generic	1	2	001000	1	2		111	01	100		1				30	60	90	1			90				30		31								6.00	12.00	18.00					0.00	0.00	0.00							0.00																6.00				6.00			0.20	0.00				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	031	0		29	10	S9579_031_0	5	2	Generic	1	2	000100	1	2		111	01	100		1				30	60	90	1			90				30		31								10.00	20.00	30.00					10.00	20.00	30.00							25.00																10.00				10.00			0.33	0.33				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	031	0		29	10	S9579_031_0	5	3	Preferred Brand	1	2	000001	1	1		111	01	100		1				30	60	90	1			90				30		31											69.00	25	25	25				69.00	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	031	0		29	10	S9579_031_0	5	4	Non-Preferred Brand	1	2	100000	1	1		111	01	100		1				30	60	90	1			90				30		31											99.00	30	30	30				99.00	30	30	30						30															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S9579	031	0		29	10	S9579_031_0	5	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						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
