"Procedure"|"Code Type"|"Revenue Code"|"Procedure Description"|"Payer"|"Plan"|"Inpatient Gross Charges"|"Inpatient Expected Reimbursement"|"Inpatient Max Reimbursement"|"Inpatient Minimal Reimbursement"|"Outpatient Gross Charges"|"Outpatient Expected Reimbursement"|"Outpatient Max Reimbursement"|"Outpatient Minimal Reimbursement" 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|LEWER AGENCY [1565]|LEWER AGENCY [156500]|35.60||||35.60|24.92|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|18.00||||18.00|13.09|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|18.00||||18.00|2.07|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|35.60||||35.60|25.85|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|35.60||||35.60|25.88|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|GUARDIAN [1465]|GUARDIAN [146500]|18.00||||18.00|12.6|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|35.60||||35.60|30.26|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UMR [2035]|UMR CORE [203505]|18.00||||18.00|7.7|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|18.00||||18.00|13.5|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AETNA [1015]|AMERICAN CONTINENTAL [101507]|35.60||||35.60|26.7|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|35.60||||35.60|30.26|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|35.60||||35.60|30.26|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|35.60||||35.60|17.09|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|35.60||||35.60|4.1|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|18.00||||18.00|3.48|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|18.00||||18.00|12.6|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|18.00||||18.00|3.48|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|35.60||||35.60|17.8|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|35.60||||35.60|24.92|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|||18.00||||18.00|13.5|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CBSA [1215]|CBSA [121500]|18.00||||18.00|12.6|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|35.60||||35.60|24.92|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|35.60||||35.60|16.73|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|18.00||||18.00|12.6|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|18.00||||18.00|13.07|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|35.60||||35.60|17.09|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|35.60||||35.60|24.92|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|35.60||||35.60|26.7|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|35.60||||35.60|26.7|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|18.00||||18.00|13.07|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|18.00||||18.00|15.3|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PHCS [1780]|FREEDOM LIFE [178009]|35.60||||35.60|30.26|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|18.00||||18.00|2.07|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PHCS [1780]|FREEDOM LIFE [178009]|35.60||||35.60|30.26|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|18.00||||18.00|7.56|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|LEWER AGENCY [1565]|LEWER AGENCY [156500]|18.00||||18.00|12.6|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|WEB TPA [2115]|WEB TPA [211501]|35.60||||35.60|24.92|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UMR [2035]|UMR CHOICE [203500]|18.00||||18.00|11.03|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|18.00||||18.00|12.6|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|35.60||||35.60|17.8|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|18.00||||18.00|15.3|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|35.60||||35.60|21.82|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|TML [1980]|TML [198000]|18.00||||18.00|11.03|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|35.60||||35.60|24.92|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MAILHANDLERS [1595]|MAILHANDLERS [159500]|35.60||||35.60|26.7|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|18.00||||18.00|15.3|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|35.60||||35.60|7.75|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|35.60||||35.60|12.46|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MAILHANDLERS [1595]|MAILHANDLERS [159500]|35.60||||35.60|26.7|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|35.60||||35.60|24.92|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|18.00||||18.00|12.6|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|35.60||||35.60|24.92|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|35.60||||35.60|18.16|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|18.00||||18.00|8.64|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|35.60||||35.60|24.92|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|35.60||||35.60|24.92|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|18.00||||18.00|7.56|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|35.60||||35.60|25.85|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|35.60||||35.60|15.24|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|18.00||||18.00|9|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|35.60||||35.60|24.92|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|35.60||||35.60|4.1|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|35.60||||35.60|4.1|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|35.60||||35.60|26.7|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PHCS [1780]|PHCS MULTIPLAN [178000]|35.60||||35.60|24.92|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|18.00||||18.00|3.48|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|18.00||||18.00|12.6|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|35.60||||35.60|25.85|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA [126008]|18.00||||18.00|13.07|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|18.00||||18.00|12.6|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|NRECA [1735]|NRECA [173500]|35.60||||35.60|21.82|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|35.60||||35.60|26.7|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|LEWER AGENCY [1565]|LEWER AGENCY [156500]|18.00||||18.00|12.6|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|35.60||||35.60|11.04|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|EQUITABLE [1355]|EQUITABLE INS [135500]|18.00||||18.00|12.6|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|18.00||||18.00|12.6|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MEDICA [2910]|MEDICA HARMONY [291000]|35.60||||35.60|24.92|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|18.00||||18.00|13.5|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|35.60||||35.60|24.92|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|GILSBAR [1425]|GILSBAR [142500]|35.60||||35.60|26.7|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|35.60||||35.60|4.1|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|18.00||||18.00|12.6|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|18.00||||18.00|13.07|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|||18.00||||18.00|13.5|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|18.00||||18.00|12.6|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|TML [1980]|TML [198000]|18.00||||18.00|11.03|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|18.00||||18.00|13.5|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|EQUITABLE [1355]|EQUITABLE INS [135500]|35.60||||35.60|24.92|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|18.00||||18.00|12.6|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CELTIC LIFE [1220]|CELTIC LIFE [122000]|18.00||||18.00|12.6|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|18.00||||18.00|15.3|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|35.60||||35.60|14.95|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|LEWER AGENCY [1565]|LEWER AGENCY [156500]|35.60||||35.60|24.92|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|35.60||||35.60|6.89|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|18.00||||18.00|3.48|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|18.00||||18.00|3.92|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|18.00||||18.00|11.03|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|18.00||||18.00|7.7|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA PANTEX [126003]|18.00||||18.00|8.46|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|18.00||||18.00||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|18.00||||18.00||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|35.60||||35.60||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|18.00||||18.00||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|35.60||||35.60||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|18.00||||18.00||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|35.60||||35.60||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|35.60||||35.60||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|18.00||||18.00||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|35.60||||35.60||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|18.00||||18.00||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|35.60||||35.60||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|35.60||||35.60||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|18.00||||18.00||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|35.60||||35.60||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|18.00||||18.00||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|18.00||||18.00||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|18.00||||18.00||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|18.00||||18.00||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|18.00||||18.00||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|18.00||||18.00||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|35.60||||35.60||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|35.60||||35.60||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|18.00||||18.00||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|35.60||||35.60||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|18.00||||18.00||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|18.00||||18.00||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|18.00||||18.00|10.26|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|18.00||||18.00|13.5|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|18.00||||18.00|8.64|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|18.00||||18.00|13.5|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|35.60||||35.60|26.7|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|35.60||||35.60|20.29|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|35.60||||35.60|21.82|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|35.60||||35.60|24.92|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|18.00||||18.00|15.3|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|35.60||||35.60|21.36|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|18.00||||18.00|15.3|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|18.00||||18.00|15.3|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|18.00||||18.00|10.8|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|18.00||||18.00|10.8|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|35.60||||35.60|25.85|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA [126008]|35.60||||35.60|25.85|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|35.60||||35.60|30.26|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PHCS [1780]|PHCS MULTIPLAN [178000]|35.60||||35.60|24.92|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|18.00||||18.00|12.6|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|18.00||||18.00|9|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|35.60||||35.60|6.89|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|18.00||||18.00|12.6|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|18.00||||18.00|2.07|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|35.60||||35.60|24.92|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|18.00||||18.00|13.5|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|18.00||||18.00|15.3|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|18.00||||18.00|13.5|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|35.60||||35.60|6.89|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|18.00||||18.00|12.6|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|18.00||||18.00|15.3|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MEDICA [2910]|MEDICA HARMONY [291000]|18.00||||18.00|12.6|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|18.00||||18.00|15.3|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|35.60||||35.60|11.87|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|18.00||||18.00|12.6|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|35.60||||35.60|4.1|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|35.60||||35.60|26.7|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|35.60||||35.60|24.92|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|18.00||||18.00|6|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|35.60||||35.60|24.92|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|18.00||||18.00|13.07|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PHCS [1780]|FREEDOM LIFE [178009]|18.00||||18.00|15.3|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|18.00||||18.00|12.6|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MEDICA [2910]|MEDICA HARMONY [291000]|35.60||||35.60|24.92|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|18.00||||18.00|10.26|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|GUARDIAN [1465]|GUARDIAN [146500]|35.60||||35.60|24.92|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA TRS [101506]|35.60||||35.60|23.14|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|WEB TPA [2115]|WEB TPA [211501]|18.00||||18.00|12.6|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|35.60||||35.60|26.7|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|35.60||||35.60|24.92|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|18.00||||18.00|15.3|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|35.60||||35.60|30.26|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|EQUITABLE [1355]|EQUITABLE INS [135500]|18.00||||18.00|12.6|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|WEB TPA [2115]|WEB TPA [211500]|35.60||||35.60|26.7|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CBSA [1215]|CBSA [121500]|18.00||||18.00|12.6|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|WEB TPA [2115]|WEB TPA [211500]|35.60||||35.60|26.7|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|18.00||||18.00|9|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|18.00||||18.00|13.07|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|35.60||||35.60|26.7|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|18.00||||18.00|13.5|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|18.00||||18.00|12.6|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|18.00||||18.00|12.6|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|GILSBAR [1425]|GILSBAR [142500]|18.00||||18.00|13.5|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|18.00||||18.00|2.07|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|35.60||||35.60|11.04|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|18.00||||18.00|9|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|TML [1980]|TML [198000]|35.60||||35.60|21.82|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|18.00||||18.00|12.6|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|18.00||||18.00|12.6|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CBSA [1215]|CBSA [121500]|35.60||||35.60|24.92|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|35.60||||35.60|24.92|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|18.00||||18.00|9|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|35.60||||35.60|25.88|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|35.60||||35.60|17.8|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UMR [2035]|UMR CHOICE [203500]|35.60||||35.60|21.82|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|35.60||||35.60|30.26|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|18.00||||18.00|13.09|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|18.00||||18.00|13.5|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|35.60||||35.60|24.92|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|18.00||||18.00|9|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|EQUITABLE [1355]|EQUITABLE INS [135500]|35.60||||35.60|24.92|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|18.00||||18.00|12.6|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|35.60||||35.60|24.92|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|18.00||||18.00|12.6|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|35.60||||35.60|7.75|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|35.60||||35.60|6.89|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|35.60||||35.60|26.7|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|35.60||||35.60|14.95|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|35.60||||35.60|12.46|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|18.00||||18.00|7.56|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|18.00||||18.00|7.56|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MAILHANDLERS [1595]|MAILHANDLERS [159500]|18.00||||18.00|13.5|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|18.00||||18.00|12.6|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|GROUP HEALTH [2165]|GROUP HEALTH [216500]|35.60||||35.60|30.26|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|35.60||||35.60|20.29|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|18.00||||18.00|9.18|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|35.60||||35.60|25.88|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|35.60||||35.60|26.7|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|35.60||||35.60||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|18.00||||18.00||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|35.60||||35.60||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|35.60||||35.60||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|35.60||||35.60||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|18.00||||18.00||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|35.60||||35.60||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|18.00||||18.00||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|35.60||||35.60||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|18.00||||18.00||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|35.60||||35.60||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|35.60||||35.60||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|18.00||||18.00||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|18.00||||18.00||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|18.00||||18.00||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|18.00||||18.00||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|18.00||||18.00||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|35.60||||35.60||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|35.60||||35.60||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|35.60||||35.60||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UMR [2035]|UMR CHEROKEE MLR [203504]|35.60||||35.60||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|18.00||||18.00||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|35.60||||35.60||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|18.00||||18.00||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|35.60||||35.60||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|18.00||||18.00||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|18.00||||18.00||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|35.60||||35.60||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|18.00||||18.00||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|35.60||||35.60|25.85|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|35.60||||35.60|18.16|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|35.60||||35.60|30.26|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|18.00||||18.00|11.03|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|35.60||||35.60|30.26|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|18.00||||18.00|13.5|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|18.00||||18.00|13.5|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|18.00||||18.00|15.3|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|18.00||||18.00|13.5|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|18.00||||18.00|9.18|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA PANTEX [126003]|18.00||||18.00|8.46|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|18.00||||18.00|15.3|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|35.60||||35.60|24.92|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|18.00||||18.00|13.5|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|18.00||||18.00|10.26|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|35.60||||35.60|16.73|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|18.00||||18.00|9|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|18.00||||18.00|12.6|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|35.60||||35.60|30.26|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|18.00||||18.00|13.07|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|18.00||||18.00|12.6|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|35.60||||35.60|26.7|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|18.00||||18.00|15.3|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|18.00||||18.00|6|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|35.60||||35.60|30.26|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|18.00||||18.00|15.3|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|35.60||||35.60|14.95|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|18.00||||18.00|8.46|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|18.00||||18.00|12.6|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|35.60||||35.60|30.26|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA PANTEX [126003]|35.60||||35.60|16.73|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|18.00||||18.00|12.6|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|35.60||||35.60|14.95|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|18.00||||18.00|7.7|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|18.00||||18.00|7.56|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|35.60||||35.60|20.29|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|35.60||||35.60|26.7|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|35.60||||35.60|26.7|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|35.60||||35.60|17.8|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|35.60||||35.60|21.82|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|18.00||||18.00|13.5|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|35.60||||35.60|21.36|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|35.60||||35.60|24.92|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|35.60||||35.60|24.92|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|18.00||||18.00|12.6|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PHCS [1780]|PHCS MULTIPLAN [178000]|18.00||||18.00|12.6|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|18.00||||18.00|12.6|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|18.00||||18.00|13.09|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|18.00||||18.00|12.6|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|18.00||||18.00|12.6|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|35.60||||35.60|24.92|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|35.60||||35.60|24.92|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|35.60||||35.60|11.87|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PHCS [1780]|FREEDOM LIFE [178009]|18.00||||18.00|15.3|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|35.60||||35.60|26.7|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|35.60||||35.60|30.26|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PHCS [1780]|PHCS MULTIPLAN [178000]|18.00||||18.00|12.6|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|GUARDIAN [1465]|GUARDIAN [146500]|18.00||||18.00|12.6|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA [126008]|18.00||||18.00|13.07|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|18.00||||18.00|13.5|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|18.00||||18.00|12.6|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|35.60||||35.60|30.26|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|35.60||||35.60|26.7|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|35.60||||35.60|26.7|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|18.00||||18.00|13.5|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|18.00||||18.00|2.07|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|18.00||||18.00|13.07|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA [126008]|35.60||||35.60|25.85|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|35.60||||35.60|24.92|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|35.60||||35.60|24.92|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|18.00||||18.00|2.07|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|35.60||||35.60|24.92|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|35.60||||35.60|15.24|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|35.60||||35.60|24.92|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|35.60||||35.60|30.26|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|18.00||||18.00|12.6|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|35.60||||35.60|25.85|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|35.60||||35.60|24.92|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|18.00||||18.00|13.5|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MAILHANDLERS [1595]|MAILHANDLERS [159500]|18.00||||18.00|13.5|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|35.60||||35.60|20.29|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|18.00||||18.00|13.07|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|35.60||||35.60|25.85|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|35.60||||35.60|17.8|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|GUARDIAN [1465]|GUARDIAN [146500]|35.60||||35.60|24.92|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|18.00||||18.00|15.3|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|35.60||||35.60|14.95|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|35.60||||35.60|26.7|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|18.00||||18.00|13.5|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CELTIC LIFE [1220]|CELTIC LIFE [122000]|35.60||||35.60|24.92|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|NRECA [1735]|NRECA [173500]|35.60||||35.60|21.82|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|35.60||||35.60|24.92|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|18.00||||18.00|13.5|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|35.60||||35.60||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|35.60||||35.60||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|18.00||||18.00||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|18.00||||18.00||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|35.60||||35.60||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|35.60||||35.60||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|35.60||||35.60||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|35.60||||35.60||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|35.60||||35.60||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|18.00||||18.00||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|18.00||||18.00||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|35.60||||35.60||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|18.00||||18.00||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|35.60||||35.60||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|18.00||||18.00||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|18.00||||18.00||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|18.00||||18.00||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|35.60||||35.60||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|18.00||||18.00||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|35.60||||35.60||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|18.00||||18.00||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|35.60||||35.60||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|35.60||||35.60||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|35.60||||35.60||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|18.00||||18.00||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|18.00||||18.00||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|18.00||||18.00||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|35.60||||35.60||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|18.00||||18.00||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|35.60||||35.60||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|18.00||||18.00||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|35.60||||35.60||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|18.00||||18.00||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|35.60||||35.60|24.92|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|18.00||||18.00|13.5|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|18.00||||18.00|13.5|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA TRS [101506]|35.60||||35.60|23.14|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CELTIC LIFE [1220]|CELTIC LIFE [122000]|35.60||||35.60|24.92|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|35.60||||35.60|26.7|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|35.60||||35.60|25.85|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|35.60||||35.60|24.92|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|18.00||||18.00|12.6|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|NRECA [1735]|NRECA [173500]|18.00||||18.00|11.03|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|WEB TPA [2115]|WEB TPA [211501]|18.00||||18.00|12.6|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|35.60||||35.60|30.26|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|35.60||||35.60|17.8|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|35.60||||35.60|26.7|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|WEB TPA [2115]|WEB TPA [211500]|18.00||||18.00|13.5|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|18.00||||18.00|13.5|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UMR [2035]|UMR CHOICE [203500]|35.60||||35.60|21.82|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|35.60||||35.60|26.7|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|35.60||||35.60|30.26|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|18.00||||18.00|5.58|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|GILSBAR [1425]|GILSBAR [142500]|18.00||||18.00|13.5|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UMR [2035]|UMR CORE [203505]|35.60||||35.60|15.24|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|18.00||||18.00|13.09|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UMR [2035]|UMR CORE [203505]|35.60||||35.60|15.24|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|35.60||||35.60|17.8|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|TDH BCCS [2341]|TDH BCCS [234100]|18.00||||18.00|2.07|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|35.60||||35.60|24.92|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|35.60||||35.60|24.92|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|35.60||||35.60|4.1|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|35.60||||35.60|30.26|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|18.00||||18.00|11.03|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|18.00||||18.00|11.03|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|35.60||||35.60|30.26|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|||35.60||||35.60|26.7|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|TDH BCCS [2341]|TDH BCCS [234100]|35.60||||35.60|4.1|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|18.00||||18.00|9|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|35.60||||35.60|21.82|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|18.00||||18.00|15.3|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|TDH BCCS [2341]|TDH BCCS [234100]|35.60||||35.60|4.1|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|18.00||||18.00|5.58|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|35.60||||35.60|17.8|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|35.60||||35.60|24.92|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|GILSBAR [1425]|GILSBAR [142500]|35.60||||35.60|26.7|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UMR [2035]|UMR CORE [203505]|18.00||||18.00|7.7|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|35.60||||35.60|30.26|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|18.00||||18.00|12.6|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|35.60||||35.60|24.92|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|35.60||||35.60|24.92|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|35.60||||35.60|17.8|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|18.00||||18.00|6.3|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|||35.60||||35.60|26.7|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|35.60||||35.60|26.7|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA TRS [101506]|18.00||||18.00|11.7|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|18.00||||18.00|12.6|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|35.60||||35.60|25.88|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|18.00||||18.00|15.3|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UMR [2035]|UMR CHOICE [203500]|18.00||||18.00|11.03|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|18.00||||18.00|13.5|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CBSA [1215]|CBSA [121500]|35.60||||35.60|24.92|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|35.60||||35.60|26.7|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|18.00||||18.00|12.6|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|35.60||||35.60|24.92|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MEDICA [2910]|MEDICA HARMONY [291000]|18.00||||18.00|12.6|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|18.00||||18.00|12.6|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|18.00||||18.00|9|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|18.00||||18.00|7.56|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|WEB TPA [2115]|WEB TPA [211500]|18.00||||18.00|13.5|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|18.00||||18.00|10.26|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|TDH BCCS [2341]|TDH BCCS [234100]|18.00||||18.00|2.07|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|WEB TPA [2115]|WEB TPA [211501]|35.60||||35.60|24.92|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|TML [1980]|TML [198000]|35.60||||35.60|21.82|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|35.60||||35.60|26.7|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|18.00||||18.00|12.6|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AETNA [1015]|AMERICAN CONTINENTAL [101507]|18.00||||18.00|13.5|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|35.60||||35.60|24.92|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|35.60||||35.60|30.26|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CELTIC LIFE [1220]|CELTIC LIFE [122000]|18.00||||18.00|12.6|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|GROUP HEALTH [2165]|GROUP HEALTH [216500]|18.00||||18.00|15.3|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|18.00||||18.00|15.3|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|35.60||||35.60|17.8|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|18.00||||18.00|13.5|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|18.00||||18.00|15.3|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|18.00||||18.00|15.3|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|18.00||||18.00|9|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|35.60||||35.60|26.7|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AETNA [1015]|AMERICAN CONTINENTAL [101507]|18.00||||18.00|13.5|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|35.60||||35.60|30.26|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AETNA [1015]|AMERICAN CONTINENTAL [101507]|35.60||||35.60|26.7|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|GROUP HEALTH [2165]|GROUP HEALTH [216500]|35.60||||35.60|30.26|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|35.60||||35.60|14.95|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|18.00||||18.00|6.3|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|NRECA [1735]|NRECA [173500]|18.00||||18.00|11.03|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|18.00||||18.00|3.92|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|18.00||||18.00|8.46|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|18.00||||18.00|15.3|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|35.60||||35.60|30.26|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA TRS [101506]|18.00||||18.00|11.7|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA PANTEX [126003]|35.60||||35.60|16.73|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|GROUP HEALTH [2165]|GROUP HEALTH [216500]|18.00||||18.00|15.3|30.26|2.07 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|35.60||||35.60||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|18.00||||18.00||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|35.60||||35.60||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|18.00||||18.00||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|35.60||||35.60||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|18.00||||18.00||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|35.60||||35.60||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UMR [2035]|UMR CHEROKEE MLR [203504]|18.00||||18.00||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|35.60||||35.60||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|35.60||||35.60||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UMR [2035]|UMR CHEROKEE MLR [203504]|35.60||||35.60||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|35.60||||35.60||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|35.60||||35.60||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UMR [2035]|UMR CHEROKEE MLR [203504]|18.00||||18.00||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|35.60||||35.60||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|35.60||||35.60||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|35.60||||35.60||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|18.00||||18.00||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|18.00||||18.00||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|18.00||||18.00||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|35.60||||35.60||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|18.00||||18.00||| 10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|18.00||||18.00||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|1.44||||1.44|1.08|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|1.44||||1.44|1.08|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA TRS [101506]|1.44||||1.44|0.94|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AMERICAN CONTINENTAL [101507]|1.44||||1.44|1.08|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|1.44||||1.44|1.22|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NRECA [1735]|NRECA [173500]|1.44||||1.44|0.88|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|1.44||||1.44|0.28|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1.44||||1.44|1.01|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|1.44||||1.44|1.08|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|1.44||||1.44|0.72|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1.44||||1.44|1.22|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|1.44||||1.44|1.08|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|1.44||||1.44|1.01|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|||1.44||||1.44|1.08|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1.44||||1.44|1.08|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|1.44||||1.44|1.01|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|1.44||||1.44|1.22|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|1.44||||1.44|1.01|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|1.44||||1.44|1.01|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|FREEDOM LIFE [178009]|1.44||||1.44|1.22|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TDH BCCS [2341]|TDH BCCS [234100]|1.44||||1.44|0.17|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|1.44||||1.44|0.17|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1.44||||1.44|1.05|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GUARDIAN [1465]|GUARDIAN [146500]|1.44||||1.44|1.01|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|1.44||||1.44|0.82|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|1.44||||1.44|1.01|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1.44||||1.44|1.08|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|1.44||||1.44|0.72|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|1.44||||1.44|1.22|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|PHCS MULTIPLAN [178000]|1.44||||1.44|1.01|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|1.44||||1.44|1.01|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1.44||||1.44|1.05|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA [126008]|1.44||||1.44|1.05|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CELTIC LIFE [1220]|CELTIC LIFE [122000]|1.44||||1.44|1.01|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|1.44||||1.44|0.17|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA PANTEX [126003]|1.44||||1.44|0.68|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EQUITABLE [1355]|EQUITABLE INS [135500]|1.44||||1.44|1.01|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|1.44||||1.44|1.05|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1.44||||1.44|1.22|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1.44||||1.44|1.01|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|1.44||||1.44|1.08|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|1.44||||1.44|1.01|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|1.44||||1.44|0.5|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAILHANDLERS [1595]|MAILHANDLERS [159500]|1.44||||1.44|1.08|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|1.44||||1.44|0.6|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|1.44||||1.44|1.01|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|1.44||||1.44|1.22|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|1.44||||1.44|1.08|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|1.44||||1.44|1.08|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1.44||||1.44|1.05|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GILSBAR [1425]|GILSBAR [142500]|1.44||||1.44|1.08|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|1.44||||1.44|1.22|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|1.44||||1.44|1.22|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TML [1980]|TML [198000]|1.44||||1.44|0.88|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|1.44||||1.44|1.01|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CBSA [1215]|CBSA [121500]|1.44||||1.44|1.01|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|1.44||||1.44|0.73|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1.44||||1.44|0.88|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|1.44||||1.44|1.05|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|1.44||||1.44|0.72|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|1.44||||1.44|1.01|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WEB TPA [2115]|WEB TPA [211501]|1.44||||1.44|1.01|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|1.44||||1.44|1.01|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|1.44||||1.44|0.6|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|1.44||||1.44|1.01|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|1.44||||1.44|1.01|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1.44||||1.44|1.08|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|LEWER AGENCY [1565]|LEWER AGENCY [156500]|1.44||||1.44|1.01|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|1.44||||1.44|1.01|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1.44||||1.44|0.72|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|1.44||||1.44|1.08|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|1.44||||1.44|1.22|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|1.44||||1.44|0.28|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1.44||||1.44|0.48|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|1.44||||1.44|1.08|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MEDICA [2910]|MEDICA HARMONY [291000]|1.44||||1.44|1.01|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|1.44||||1.44|0.62|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WEB TPA [2115]|WEB TPA [211500]|1.44||||1.44|1.08|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR CHOICE [203500]|1.44||||1.44|0.88|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|1.44||||1.44|1.01|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR CORE [203505]|1.44||||1.44|0.62|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|1.44||||1.44|0.72|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|1.44||||1.44|0.69|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|1.44||||1.44|1.05|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|1.44||||1.44|0.31|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1.44||||1.44|0.17|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|1.44||||1.44|0.88|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|1.44||||1.44|1.22|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1.44||||1.44|0.6|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|1.44||||1.44|0.86|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|1.44||||1.44|1.22|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GROUP HEALTH [2165]|GROUP HEALTH [216500]|1.44||||1.44|1.22|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|1.44||||1.44|1.01|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|1.44||||1.44|0.82|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|1.44||||1.44|0.45|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|1.44||||1.44|0.68|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|1.44||||1.44|1.01|1.22|0.17 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1.44||||1.44||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1.44||||1.44||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1.44||||1.44||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|1.44||||1.44||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|1.44||||1.44||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|1.44||||1.44||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|1.44||||1.44||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1.44||||1.44||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|1.44||||1.44||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1.44||||1.44||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|1.44||||1.44||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|1.44||||1.44||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|1.44||||1.44||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|1.44||||1.44||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|1.44||||1.44||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1.44||||1.44||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|1.44||||1.44||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|1.44||||1.44||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|1.44||||1.44||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1.44||||1.44||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|1.44||||1.44||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|1.44||||1.44||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|1.44||||1.44||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|1.44||||1.44||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|1.44||||1.44||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1.44||||1.44||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR CHEROKEE MLR [203504]|1.44||||1.44||| 10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|1.44||||1.44||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|AETNA [1015]|AETNA TRS [101506]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|GILSBAR [1425]|GILSBAR [142500]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|UMR [2035]|UMR CHEROKEE MLR [203504]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|UMR [2035]|UMR CHOICE [203500]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|MEDICA [2910]|MEDICA HARMONY [291000]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|NRECA [1735]|NRECA [173500]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|EQUITABLE [1355]|EQUITABLE INS [135500]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|PHCS [1780]|FREEDOM LIFE [178009]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|GROUP HEALTH [2165]|GROUP HEALTH [216500]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|PHCS [1780]|PHCS MULTIPLAN [178000]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|UMR [2035]|UMR CORE [203505]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|||0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|LEWER AGENCY [1565]|LEWER AGENCY [156500]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|WEB TPA [2115]|WEB TPA [211501]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|GUARDIAN [1465]|GUARDIAN [146500]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|TDH BCCS [2341]|TDH BCCS [234100]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|CBSA [1215]|CBSA [121500]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|CIGNA [1260]|CIGNA [126008]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|CIGNA [1260]|CIGNA PANTEX [126003]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|WEB TPA [2115]|WEB TPA [211500]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|AETNA [1015]|AMERICAN CONTINENTAL [101507]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|TML [1980]|TML [198000]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|CELTIC LIFE [1220]|CELTIC LIFE [122000]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|MAILHANDLERS [1595]|MAILHANDLERS [159500]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|0.00||||0.00||| 100992|ERX|0255 - PHARMACY-DRUGS INCIDENT TO RADIOLOGY|BARIUM SULFATE 700 MG TABLET|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|0.00||||0.00||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|MAILHANDLERS [1595]|MAILHANDLERS [159500]|1.44||||1.44|1.08|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|MAILHANDLERS [1595]|MAILHANDLERS [159500]|1.44||||1.44|1.08|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|TML [1980]|TML [198000]|1.44||||1.44|0.88|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|1.44||||1.44|1.01|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|1.44||||1.44|1.01|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|1.44||||1.44|0.72|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|1.44||||1.44|1.08|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|1.44||||1.44|1.01|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1.44||||1.44|1.05|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|1.44||||1.44|0.17|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|1.44||||1.44|1.01|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|1.44||||1.44|1.08|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|CIGNA [1260]|CIGNA PANTEX [126003]|1.44||||1.44|0.68|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|1.44||||1.44|1.01|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1.44||||1.44|1.22|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|1.44||||1.44|1.22|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1.44||||1.44|1.22|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|1.44||||1.44|1.22|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|1.44||||1.44|0.31|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|CIGNA [1260]|CIGNA [126008]|1.44||||1.44|1.05|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|CIGNA [1260]|CIGNA [126008]|1.44||||1.44|1.05|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|CIGNA [1260]|CIGNA PANTEX [126003]|1.44||||1.44|0.68|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|1.44||||1.44|1.01|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|1.44||||1.44|0.17|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|1.44||||1.44|1.01|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|1.44||||1.44|1.08|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|1.44||||1.44|1.08|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|1.44||||1.44|1.01|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|1.44||||1.44|1.01|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|CBSA [1215]|CBSA [121500]|1.44||||1.44|1.01|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|1.44||||1.44|0.72|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1.44||||1.44|1.22|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|TDH BCCS [2341]|TDH BCCS [234100]|1.44||||1.44|0.17|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|TDH BCCS [2341]|TDH BCCS [234100]|1.44||||1.44|0.17|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|TML [1980]|TML [198000]|1.44||||1.44|0.88|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|1.44||||1.44|0.72|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|1.44||||1.44|0.72|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|GUARDIAN [1465]|GUARDIAN [146500]|1.44||||1.44|1.01|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|1.44||||1.44|0.82|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|1.44||||1.44|1.08|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|1.44||||1.44|0.82|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|1.44||||1.44|1.01|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1.44||||1.44|1.08|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1.44||||1.44|1.08|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|PHCS [1780]|PHCS MULTIPLAN [178000]|1.44||||1.44|1.01|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1.44||||1.44|1.05|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|1.44||||1.44|0.17|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|1.44||||1.44|1.01|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|1.44||||1.44|0.17|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1.44||||1.44|1.05|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|1.44||||1.44|1.01|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|CELTIC LIFE [1220]|CELTIC LIFE [122000]|1.44||||1.44|1.01|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|EQUITABLE [1355]|EQUITABLE INS [135500]|1.44||||1.44|1.01|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|1.44||||1.44|1.05|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|1.44||||1.44|1.05|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|1.44||||1.44|1.01|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|1.44||||1.44|1.08|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1.44||||1.44|1.01|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|CELTIC LIFE [1220]|CELTIC LIFE [122000]|1.44||||1.44|1.01|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|1.44||||1.44|0.6|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1.44||||1.44|0.88|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|1.44||||1.44|0.69|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|1.44||||1.44|0.68|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|1.44||||1.44|1.05|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|1.44||||1.44|1.01|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1.44||||1.44|0.6|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|1.44||||1.44|1.01|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1.44||||1.44|0.6|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|1.44||||1.44|1.22|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|1.44||||1.44|1.22|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|1.44||||1.44|0.82|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|1.44||||1.44|0.73|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|1.44||||1.44|0.69|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|1.44||||1.44|0.86|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|GROUP HEALTH [2165]|GROUP HEALTH [216500]|1.44||||1.44|1.22|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|1.44||||1.44|1.01|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|1.44||||1.44|0.86|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|1.44||||1.44|0.82|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|1.44||||1.44|1.22|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|EQUITABLE [1355]|EQUITABLE INS [135500]|1.44||||1.44|1.01|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|1.44||||1.44|0.5|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|1.44||||1.44|1.22|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|1.44||||1.44|0.6|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|1.44||||1.44|1.08|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|1.44||||1.44|1.01|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|||1.44||||1.44|1.08|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|1.44||||1.44|0.62|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1.44||||1.44|1.01|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|GROUP HEALTH [2165]|GROUP HEALTH [216500]|1.44||||1.44|1.22|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|||1.44||||1.44|1.08|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|1.44||||1.44|0.68|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|1.44||||1.44|0.73|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1.44||||1.44|0.88|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|1.44||||1.44|0.6|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|1.44||||1.44|0.62|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|1.44||||1.44|0.6|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|1.44||||1.44|1.22|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1.44||||1.44|0.72|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|1.44||||1.44|1.05|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1.44||||1.44||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1.44||||1.44||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1.44||||1.44||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1.44||||1.44||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1.44||||1.44||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|1.44||||1.44||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|1.44||||1.44||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|1.44||||1.44||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|1.44||||1.44||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|1.44||||1.44||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|1.44||||1.44||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|1.44||||1.44||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1.44||||1.44||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1.44||||1.44||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|1.44||||1.44||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|1.44||||1.44||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|1.44||||1.44||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|1.44||||1.44||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|1.44||||1.44||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|1.44||||1.44||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|1.44||||1.44||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|1.44||||1.44||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1.44||||1.44||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|1.44||||1.44||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|1.44||||1.44||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|1.44||||1.44||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|1.44||||1.44||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1.44||||1.44|0.72|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|1.44||||1.44|1.01|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|1.44||||1.44|1.01|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|1.44||||1.44|1.01|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|1.44||||1.44|1.01|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|1.44||||1.44|1.01|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|1.44||||1.44|1.08|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|1.44||||1.44|0.28|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|PHCS [1780]|PHCS MULTIPLAN [178000]|1.44||||1.44|1.01|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1.44||||1.44|1.08|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|1.44||||1.44|0.28|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|PHCS [1780]|FREEDOM LIFE [178009]|1.44||||1.44|1.22|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|1.44||||1.44|1.08|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|1.44||||1.44|1.22|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|1.44||||1.44|1.01|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1.44||||1.44|1.05|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|PHCS [1780]|FREEDOM LIFE [178009]|1.44||||1.44|1.22|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|1.44||||1.44|1.08|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1.44||||1.44|0.48|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1.44||||1.44|0.48|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|1.44||||1.44|1.22|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|1.44||||1.44|1.01|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|1.44||||1.44|1.01|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|1.44||||1.44|1.01|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|1.44||||1.44|1.01|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1.44||||1.44|1.08|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|1.44||||1.44|1.22|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|1.44||||1.44|1.22|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|LEWER AGENCY [1565]|LEWER AGENCY [156500]|1.44||||1.44|1.01|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|1.44||||1.44|1.22|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|MEDICA [2910]|MEDICA HARMONY [291000]|1.44||||1.44|1.01|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1.44||||1.44|0.17|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|WEB TPA [2115]|WEB TPA [211500]|1.44||||1.44|1.08|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|WEB TPA [2115]|WEB TPA [211501]|1.44||||1.44|1.01|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|1.44||||1.44|0.72|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1.44||||1.44|1.05|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|1.44||||1.44|0.72|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|GUARDIAN [1465]|GUARDIAN [146500]|1.44||||1.44|1.01|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|UMR [2035]|UMR CHOICE [203500]|1.44||||1.44|0.88|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|UMR [2035]|UMR CHOICE [203500]|1.44||||1.44|0.88|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|1.44||||1.44|1.01|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|1.44||||1.44|1.05|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|UMR [2035]|UMR CORE [203505]|1.44||||1.44|0.62|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1.44||||1.44|0.17|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|1.44||||1.44|1.01|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|1.44||||1.44|1.08|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1.44||||1.44|1.22|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|1.44||||1.44|0.72|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|CBSA [1215]|CBSA [121500]|1.44||||1.44|1.01|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|1.44||||1.44|1.01|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|1.44||||1.44|1.01|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|1.44||||1.44|0.31|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1.44||||1.44|1.05|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|1.44||||1.44|0.45|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|1.44||||1.44|1.08|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|1.44||||1.44|1.01|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|1.44||||1.44|0.28|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|1.44||||1.44|0.45|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|1.44||||1.44|1.22|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|1.44||||1.44|1.08|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|1.44||||1.44|1.22|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|1.44||||1.44|1.01|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1.44||||1.44|1.01|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|1.44||||1.44|1.08|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|1.44||||1.44|0.5|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1.44||||1.44|1.01|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|WEB TPA [2115]|WEB TPA [211500]|1.44||||1.44|1.08|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|AETNA [1015]|AETNA TRS [101506]|1.44||||1.44|0.94|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1.44||||1.44|1.08|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|AETNA [1015]|AETNA TRS [101506]|1.44||||1.44|0.94|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|1.44||||1.44|0.72|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|AETNA [1015]|AMERICAN CONTINENTAL [101507]|1.44||||1.44|1.08|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|1.44||||1.44|1.05|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|AETNA [1015]|AMERICAN CONTINENTAL [101507]|1.44||||1.44|1.08|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|1.44||||1.44|0.88|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|1.44||||1.44|1.08|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|1.44||||1.44|1.08|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|1.44||||1.44|0.88|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|1.44||||1.44|1.22|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|LEWER AGENCY [1565]|LEWER AGENCY [156500]|1.44||||1.44|1.01|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|WEB TPA [2115]|WEB TPA [211501]|1.44||||1.44|1.01|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|MEDICA [2910]|MEDICA HARMONY [291000]|1.44||||1.44|1.01|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|1.44||||1.44|1.08|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|1.44||||1.44|1.01|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|1.44||||1.44|1.22|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|1.44||||1.44|1.22|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1.44||||1.44|1.08|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|1.44||||1.44|0.28|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|NRECA [1735]|NRECA [173500]|1.44||||1.44|0.88|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|NRECA [1735]|NRECA [173500]|1.44||||1.44|0.88|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|UMR [2035]|UMR CORE [203505]|1.44||||1.44|0.62|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|1.44||||1.44|1.08|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|GILSBAR [1425]|GILSBAR [142500]|1.44||||1.44|1.08|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|1.44||||1.44|1.22|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|GILSBAR [1425]|GILSBAR [142500]|1.44||||1.44|1.08|1.22|0.17 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|1.44||||1.44||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|1.44||||1.44||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1.44||||1.44||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1.44||||1.44||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|1.44||||1.44||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|1.44||||1.44||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|1.44||||1.44||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1.44||||1.44||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|1.44||||1.44||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|1.44||||1.44||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|1.44||||1.44||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|1.44||||1.44||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|1.44||||1.44||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|1.44||||1.44||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|1.44||||1.44||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|1.44||||1.44||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1.44||||1.44||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|UMR [2035]|UMR CHEROKEE MLR [203504]|1.44||||1.44||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|1.44||||1.44||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|1.44||||1.44||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|1.44||||1.44||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|1.44||||1.44||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1.44||||1.44||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|1.44||||1.44||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|1.44||||1.44||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1.44||||1.44||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1.44||||1.44||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1.44||||1.44||| 101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|UMR [2035]|UMR CHEROKEE MLR [203504]|1.44||||1.44||| 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|1272.05||||1272.05|1081.24|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|CIGNA [1260]|CIGNA PANTEX [126003]|1272.05||||1272.05|597.86|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|1272.05||||1272.05|276.93|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1272.05||||1272.05|1081.24|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1272.05||||1272.05|923.51|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|1272.05||||1272.05|954.04|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|1272.05||||1272.05|890.44|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|1272.05||||1272.05|890.44|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|1272.05||||1272.05|636.03|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1272.05||||1272.05|1081.24|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|1272.05||||1272.05|954.04|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|CIGNA [1260]|CIGNA [126008]|1272.05||||1272.05|923.51|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|1272.05||||1272.05|954.04|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|1272.05||||1272.05|146.54|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|1272.05||||1272.05|636.03|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|1272.05||||1272.05|1081.24|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|1272.05||||1272.05|890.44|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|MAILHANDLERS [1595]|MAILHANDLERS [159500]|1272.05||||1272.05|954.04|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|1272.05||||1272.05|890.44|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|1272.05||||1272.05|246.14|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|1272.05||||1272.05|1081.24|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1272.05||||1272.05|890.44|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|1272.05||||1272.05|954.04|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|1272.05||||1272.05|954.04|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|1272.05||||1272.05|890.44|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|1272.05||||1272.05|394.34|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|1272.05||||1272.05|1081.24|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|1272.05||||1272.05|779.77|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|UMR [2035]|UMR CHOICE [203500]|1272.05||||1272.05|779.77|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|UMR [2035]|UMR OPTIONS [203501]|1272.05||||1272.05|924.78|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|WEB TPA [2115]|WEB TPA [211501]|1272.05||||1272.05|890.44|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|MEDICA [2910]|MEDICA HARMONY [291000]|1272.05||||1272.05|890.44|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|1272.05||||1272.05|1081.24|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|1272.05||||1272.05|890.44|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1272.05||||1272.05|636.03|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1272.05||||1272.05|423.97|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|1272.05||||1272.05|954.04|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|1272.05||||1272.05|890.44|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|1272.05||||1272.05|954.04|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|1272.05||||1272.05|544.44|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|1272.05||||1272.05|213.55|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|1272.05||||1272.05|763.23|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|1272.05||||1272.05|250.99|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|1272.05||||1272.05|1081.24|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|1272.05||||1272.05|890.44|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|1272.05||||1272.05|1081.24|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|1272.05||||1272.05|648.75|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1272.05||||1272.05|534.26|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1272.05||||1272.05|779.77|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|1272.05||||1272.05|597.86|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|1272.05||||1272.05|890.44|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|GROUP HEALTH [2165]|GROUP HEALTH [216500]|1272.05||||1272.05|1081.24|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|1272.05||||1272.05|924.78|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|1272.05||||1272.05|890.44|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|1272.05||||1272.05|445.22|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|1272.05||||1272.05|246.14|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|1272.05||||1272.05|534.26|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|1272.05||||1272.05|636.03|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|1272.05||||1272.05|534.26|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|1272.05||||1272.05|954.04|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|1272.05||||1272.05|890.44|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|1272.05||||1272.05|169.3|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|||1272.05||||1272.05|954.04|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1272.05||||1272.05|890.44|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1272.05||||1272.05|954.04|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|1272.05||||1272.05|923.51|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|LEWER AGENCY [1565]|LEWER AGENCY [156500]|1272.05||||1272.05|890.44|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|EQUITABLE [1355]|EQUITABLE INS [135500]|1272.05||||1272.05|890.44|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|WEB TPA [2115]|WEB TPA [211500]|1272.05||||1272.05|954.04|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|CELTIC LIFE [1220]|CELTIC LIFE [122000]|1272.05||||1272.05|890.44|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|UMR [2035]|UMR CORE [203505]|1272.05||||1272.05|544.44|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1272.05||||1272.05|923.51|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|1272.05||||1272.05|636.03|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|1272.05||||1272.05|890.44|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|PHCS [1780]|PHCS MULTIPLAN [178000]|1272.05||||1272.05|890.44|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|PHCS [1780]|FREEDOM LIFE [178009]|1272.05||||1272.05|1081.24|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|1272.05||||1272.05|1081.24|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|1272.05||||1272.05|146.54|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1272.05||||1272.05|146.54|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|GILSBAR [1425]|GILSBAR [142500]|1272.05||||1272.05|954.04|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|1272.05||||1272.05|890.44|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1272.05||||1272.05|923.51|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|1272.05||||1272.05|169.3|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|AETNA [1015]|AMERICAN CONTINENTAL [101507]|1272.05||||1272.05|954.04|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|1272.05||||1272.05|890.44|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1272.05||||1272.05|954.04|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1272.05||||1272.05|954.04|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|1272.05||||1272.05|109.54|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|1272.05||||1272.05|890.44|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|AETNA [1015]|AETNA TRS [101506]|1272.05||||1272.05|826.83|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|1272.05||||1272.05|725.07|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|GUARDIAN [1465]|GUARDIAN [146500]|1272.05||||1272.05|890.44|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|1272.05||||1272.05|954.04|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|TML [1980]|TML [198000]|1272.05||||1272.05|779.77|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|TDH BCCS [2341]|TDH BCCS [234100]|1272.05||||1272.05|146.54|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|1272.05||||1272.05|636.03|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|CBSA [1215]|CBSA [121500]|1272.05||||1272.05|890.44|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|1272.05||||1272.05|1081.24|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|NRECA [1735]|NRECA [173500]|1272.05||||1272.05|779.77|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|1272.05||||1272.05|890.44|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|1272.05||||1272.05|890.44|1081.24|109.54 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1272.05||||1272.05||| 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|1272.05||||1272.05||| 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1272.05||||1272.05||| 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|1272.05||||1272.05||| 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1272.05||||1272.05||| 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1272.05||||1272.05||| 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|UMR [2035]|UMR CHEROKEE MLR [203504]|1272.05||||1272.05||| 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|1272.05||||1272.05||| 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1272.05||||1272.05||| 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|1272.05||||1272.05||| 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|1272.05||||1272.05||| 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|1272.05||||1272.05||| 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1272.05||||1272.05||| 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|1272.05||||1272.05||| 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|1272.05||||1272.05||| 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|1272.05||||1272.05||| 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|1272.05||||1272.05||| 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|1272.05||||1272.05||| 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|1272.05||||1272.05||| 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1272.05||||1272.05||| 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|1272.05||||1272.05||| 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|1272.05||||1272.05||| 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|1272.05||||1272.05||| 101034|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MENINGOCOCCAL A CONJ VACC 1 OF 2(PF) 10 MCG/0.5 ML (FINAL) IM SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1272.05||||1272.05||| 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|MAILHANDLERS [1595]|MAILHANDLERS [159500]|5747.50||||5747.50|4310.63|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|5747.50||||5747.50|2873.75|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|5747.50||||5747.50|4023.25|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|HEALTHNET [1495]|HEALTHNET [149500]|5747.50||||5747.50|4310.63|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|5747.50||||5747.50|4023.25|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|5747.50||||5747.50|2873.75|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|5747.50||||5747.50|4172.69|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|CHAMPVA [1240]|CHAMP VA [124000]|5747.50||||5747.50|493.51|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5747.50||||5747.50|4885.38|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|5747.50||||5747.50|4885.38|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|5747.50||||5747.50|4885.38|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|CIGNA [1260]|CIGNA PANTEX [126003]|5747.50||||5747.50|2701.33|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|5747.50||||5747.50|4023.25|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|5747.50||||5747.50|662.11|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|5747.50||||5747.50|4023.25|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|5747.50||||5747.50|2873.75|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|CBSA [1215]|CBSA [121500]|5747.50||||5747.50|4023.25|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|GUARDIAN [1465]|GUARDIAN [146500]|5747.50||||5747.50|4023.25|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|5747.50||||5747.50|4023.25|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|5747.50||||5747.50|315.13|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5747.50||||5747.50|4310.63|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5747.50||||5747.50|4310.63|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|5747.50||||5747.50|4172.69|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|5747.50||||5747.50|662.11|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|PHCS [1780]|FREEDOM LIFE [178009]|5747.50||||5747.50|4885.38|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|CELTIC LIFE [1220]|CELTIC LIFE [122000]|5747.50||||5747.50|4023.25|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|5747.50||||5747.50|513.66|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5747.50||||5747.50|4172.69|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|EQUITABLE [1355]|EQUITABLE INS [135500]|5747.50||||5747.50|4023.25|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|CORESOURCE [1315]|CORESOURCE [131500]|5747.50||||5747.50|4172.69|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|5747.50||||5747.50|503.59|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|||5747.50||||5747.50|4310.62|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|5747.50||||5747.50|574.9|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|5747.50||||5747.50|1133.07|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|5747.50||||5747.50|2413.95|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|5747.50||||5747.50|2011.63|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|5747.50||||5747.50|503.59|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|5747.50||||5747.50|2701.33|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5747.50||||5747.50|2413.95|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|5747.50||||5747.50|4885.38|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|5747.50||||5747.50|3448.5|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|5747.50||||5747.50|1116.1|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|5747.50||||5747.50|949.63|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|5747.50||||5747.50|2413.95|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|5747.50||||5747.50|2931.23|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|5747.50||||5747.50|4885.38|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|5747.50||||5747.50|4023.25|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|GROUP HEALTH [2165]|GROUP HEALTH [216500]|5747.50||||5747.50|4885.38|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|5747.50||||5747.50|4023.25|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5747.50||||5747.50|503.59|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|5747.50||||5747.50|3523.22|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|5747.50||||5747.50|4023.25|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5747.50||||5747.50|4023.25|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|5747.50||||5747.50|4178.43|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|5747.50||||5747.50|2459.93|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|5747.50||||5747.50|503.59|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|5747.50||||5747.50|503.59|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|5747.50||||5747.50|503.59|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|5747.50||||5747.50|4310.63|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|5747.50||||5747.50|4023.25|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|5747.50||||5747.50|4023.25|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|TRUSTMARK [2030]|STARMARK [203000]|5747.50||||5747.50|4310.63|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|5747.50||||5747.50|4023.25|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|5747.50||||5747.50|1112.14|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|PHCS [1780]|PHCS MULTIPLAN [178000]|5747.50||||5747.50|4023.25|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|5747.50||||5747.50|4310.63|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|5747.50||||5747.50|503.59|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|5747.50||||5747.50|4885.38|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5747.50||||5747.50|1915.64|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5747.50||||5747.50|503.59|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|5747.50||||5747.50|4023.25|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|5747.50||||5747.50|4023.25|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|5747.50||||5747.50|503.59|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|5747.50||||5747.50|503.59|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|5747.50||||5747.50|2873.75|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|5747.50||||5747.50|574.9|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|5747.50||||5747.50|503.59|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|5747.50||||5747.50|4310.63|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5747.50||||5747.50|503.59|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|5747.50||||5747.50|3276.08|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|5747.50||||5747.50|4885.38|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|LEWER AGENCY [1565]|LEWER AGENCY [156500]|5747.50||||5747.50|4023.25|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|MEDICA [2910]|MEDICA HARMONY [291000]|5747.50||||5747.50|4023.25|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|WEB TPA [2115]|WEB TPA [211501]|5747.50||||5747.50|4023.25|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|WEB TPA [2115]|WEB TPA [211500]|5747.50||||5747.50|4310.63|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|5747.50||||5747.50|2873.75|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|UMR [2035]|UMR OPTIONS [203501]|5747.50||||5747.50|4178.43|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|TDH BCCS [2341]|TDH BCCS [234100]|5747.50||||5747.50|662.11|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|5747.50||||5747.50|4023.25|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|UMR [2035]|UMR CORE [203505]|5747.50||||5747.50|2459.93|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|CIGNA [1260]|CIGNA [126008]|5747.50||||5747.50|4172.69|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|UMR [2035]|UMR CHOICE [203500]|5747.50||||5747.50|3523.22|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|UMR [2035]|UMR CHEROKEE MLR [203504]|5747.50||||5747.50|503.59|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|5747.50||||5747.50|662.11|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|5747.50||||5747.50|503.59|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|5747.50||||5747.50|3523.22|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|5747.50||||5747.50|4885.38|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|5747.50||||5747.50|467.58|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|GILSBAR [1425]|GILSBAR [142500]|5747.50||||5747.50|4310.63|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|5747.50||||5747.50|4023.25|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|5747.50||||5747.50|4885.38|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|5747.50||||5747.50|503.59|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|5747.50||||5747.50|4023.25|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|5747.50||||5747.50|1781.73|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|TML [1980]|TML [198000]|5747.50||||5747.50|3523.22|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|5747.50||||5747.50|4023.25|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5747.50||||5747.50|503.59|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|5747.50||||5747.50|4310.63|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|5747.50||||5747.50|4310.63|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|5747.50||||5747.50|4310.63|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|5747.50||||5747.50|4310.63|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5747.50||||5747.50|4023.25|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|AETNA [1015]|AMERICAN CONTINENTAL [101507]|5747.50||||5747.50|4310.63|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5747.50||||5747.50|4885.38|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5747.50||||5747.50|513.66|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|AETNA [1015]|AETNA TRS [101506]|5747.50||||5747.50|3735.88|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5747.50||||5747.50|503.59|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5747.50||||5747.50|503.59|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|5747.50||||5747.50|4885.38|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|FMH BENEFIT SERVICES [1390]|FMH [139000]|5747.50||||5747.50|4310.63|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|5747.50||||5747.50|1112.14|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|NRECA [1735]|NRECA [173500]|5747.50||||5747.50|3523.22|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5747.50||||5747.50|503.59|4885.38|315.13 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|5747.50||||5747.50||| 10137|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|5747.50||||5747.50||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|NRECA [1735]|NRECA [173500]|39.80||||39.80|24.4|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|NRECA [1735]|NRECA [173500]|39.80||||39.80|24.4|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|39.80||||39.80|29.85|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|39.80||||39.80|33.83|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|39.80||||39.80|7.7|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|AETNA [1015]|AETNA TRS [101506]|39.80||||39.80|25.87|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|AETNA [1015]|AMERICAN CONTINENTAL [101507]|39.80||||39.80|29.85|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|39.80||||39.80|27.86|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|39.80||||39.80|29.85|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|39.80||||39.80|29.85|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|39.80||||39.80|12.34|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|39.80||||39.80|12.34|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|39.80||||39.80|27.86|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|39.80||||39.80|27.86|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|39.80||||39.80|27.86|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|39.80||||39.80|33.83|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|GILSBAR [1425]|GILSBAR [142500]|39.80||||39.80|29.85|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|GILSBAR [1425]|GILSBAR [142500]|39.80||||39.80|29.85|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|39.80||||39.80|24.4|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|39.80||||39.80|4.58|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UMR [2035]|UMR CHOICE [203500]|39.80||||39.80|24.4|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UMR [2035]|UMR CORE [203505]|39.80||||39.80|17.03|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UMR [2035]|UMR CORE [203505]|39.80||||39.80|17.03|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|39.80||||39.80|19.9|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|39.80||||39.80|19.9|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|WEB TPA [2115]|WEB TPA [211501]|39.80||||39.80|27.86|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|WEB TPA [2115]|WEB TPA [211500]|39.80||||39.80|29.85|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|WEB TPA [2115]|WEB TPA [211500]|39.80||||39.80|29.85|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|LEWER AGENCY [1565]|LEWER AGENCY [156500]|39.80||||39.80|27.86|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|39.80||||39.80|33.83|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|39.80||||39.80|33.83|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|39.80||||39.80|29.85|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|39.80||||39.80|19.9|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|39.80||||39.80|27.86|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|39.80||||39.80|29.85|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|39.80||||39.80|13.27|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|39.80||||39.80|19.9|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|39.80||||39.80|29.85|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|WEB TPA [2115]|WEB TPA [211501]|39.80||||39.80|27.86|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|39.80||||39.80|7.7|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|39.80||||39.80|27.86|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|39.80||||39.80|29.85|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|39.80||||39.80|27.86|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|39.80||||39.80|27.86|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|39.80||||39.80|27.86|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|39.80||||39.80|4.58|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UMR [2035]|UMR OPTIONS [203501]|39.80||||39.80|28.93|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|39.80||||39.80|24.4|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|39.80||||39.80|17.03|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|39.80||||39.80|28.93|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|39.80||||39.80|17.03|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|39.80||||39.80|33.83|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|39.80||||39.80|27.86|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|39.80||||39.80|33.83|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|39.80||||39.80|33.83|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|39.80||||39.80|23.88|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|39.80||||39.80|1.4|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|39.80||||39.80|23.88|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|39.80||||39.80|27.86|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|39.80||||39.80|20.3|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|39.80||||39.80|1.62|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|39.80||||39.80|1.62|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|39.80||||39.80|33.83|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|39.80||||39.80|33.83|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|39.80||||39.80|16.72|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|39.80||||39.80|18.71|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|39.80||||39.80|7.7|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|39.80||||39.80|27.86|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|39.80||||39.80|27.86|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|GROUP HEALTH [2165]|GROUP HEALTH [216500]|39.80||||39.80|33.83|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|GROUP HEALTH [2165]|GROUP HEALTH [216500]|39.80||||39.80|33.83|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|39.80||||39.80|16.72|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|39.80||||39.80|29.85|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|39.80||||39.80|16.72|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|39.80||||39.80|27.86|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|39.80||||39.80|27.86|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|39.80||||39.80|1.45|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|||39.80||||39.80|29.85|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|||39.80||||39.80|29.85|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|39.80||||39.80|28.89|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|CELTIC LIFE [1220]|CELTIC LIFE [122000]|39.80||||39.80|27.86|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|EQUITABLE [1355]|EQUITABLE INS [135500]|39.80||||39.80|27.86|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|CELTIC LIFE [1220]|CELTIC LIFE [122000]|39.80||||39.80|27.86|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|39.80||||39.80|28.89|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|39.80||||39.80|16.72|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|39.80||||39.80|24.4|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|39.80||||39.80|28.89|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|39.80||||39.80|27.86|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|39.80||||39.80|27.86|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|EQUITABLE [1355]|EQUITABLE INS [135500]|39.80||||39.80|27.86|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|PHCS [1780]|PHCS MULTIPLAN [178000]|39.80||||39.80|27.86|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|39.80||||39.80|29.85|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|39.80||||39.80|18.71|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|39.80||||39.80|16.72|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|39.80||||39.80|28.89|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|PHCS [1780]|PHCS MULTIPLAN [178000]|39.80||||39.80|27.86|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|PHCS [1780]|FREEDOM LIFE [178009]|39.80||||39.80|33.83|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|39.80||||39.80||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|39.80||||39.80||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|39.80||||39.80||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|39.80||||39.80||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|39.80||||39.80||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|39.80||||39.80||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|39.80||||39.80||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|39.80||||39.80||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|39.80||||39.80||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|39.80||||39.80||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|39.80||||39.80||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UMR [2035]|UMR CHEROKEE MLR [203504]|39.80||||39.80||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|39.80||||39.80||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|39.80||||39.80||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|39.80||||39.80||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|39.80||||39.80||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|39.80||||39.80||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|39.80||||39.80||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|39.80||||39.80||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|39.80||||39.80||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|39.80||||39.80||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|39.80||||39.80||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|39.80||||39.80||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|39.80||||39.80||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|39.80||||39.80||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|39.80||||39.80||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|39.80||||39.80||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|39.80||||39.80||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|39.80||||39.80||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|39.80||||39.80|33.83|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|AETNA [1015]|AETNA TRS [101506]|39.80||||39.80|25.87|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|AETNA [1015]|AMERICAN CONTINENTAL [101507]|39.80||||39.80|29.85|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|39.80||||39.80|1.4|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|PHCS [1780]|FREEDOM LIFE [178009]|39.80||||39.80|33.83|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|39.80||||39.80|29.85|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|39.80||||39.80|20.3|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|39.80||||39.80|33.83|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|39.80||||39.80|29.85|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|39.80||||39.80|27.86|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|39.80||||39.80|27.86|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|39.80||||39.80|33.83|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|39.80||||39.80|4.58|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|39.80||||39.80|24.4|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|39.80||||39.80|33.83|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|39.80||||39.80|33.83|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|39.80||||39.80|28.93|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|39.80||||39.80|4.58|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|39.80||||39.80|27.86|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|39.80||||39.80|27.86|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|39.80||||39.80|27.86|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|39.80||||39.80|27.86|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|39.80||||39.80|28.89|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UMR [2035]|UMR OPTIONS [203501]|39.80||||39.80|28.93|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|39.80||||39.80|29.85|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MEDICA [2910]|MEDICA HARMONY [291000]|39.80||||39.80|27.86|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UMR [2035]|UMR CHOICE [203500]|39.80||||39.80|24.4|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|39.80||||39.80|7.7|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MEDICA [2910]|MEDICA HARMONY [291000]|39.80||||39.80|27.86|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|39.80||||39.80|29.85|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|39.80||||39.80|28.89|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|39.80||||39.80|1.45|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|LEWER AGENCY [1565]|LEWER AGENCY [156500]|39.80||||39.80|27.86|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|39.80||||39.80|13.27|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|39.80||||39.80|1.45|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|39.80||||39.80|1.45|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|39.80||||39.80|29.85|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|39.80||||39.80|27.86|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|39.80||||39.80|29.85|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|39.80||||39.80|29.85|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|39.80||||39.80|13.93|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|39.80||||39.80|13.93|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|39.80||||39.80|29.85|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|39.80||||39.80|29.85|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|39.80||||39.80|27.86|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|39.80||||39.80|27.86|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|39.80||||39.80|22.69|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|39.80||||39.80|22.69|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|39.80||||39.80|16.72|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|GUARDIAN [1465]|GUARDIAN [146500]|39.80||||39.80|27.86|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|TML [1980]|TML [198000]|39.80||||39.80|24.4|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|TML [1980]|TML [198000]|39.80||||39.80|24.4|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|CBSA [1215]|CBSA [121500]|39.80||||39.80|27.86|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|39.80||||39.80|19.9|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|39.80||||39.80|19.9|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|39.80||||39.80|27.86|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|39.80||||39.80|27.86|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|39.80||||39.80|4.58|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|39.80||||39.80|27.86|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|CIGNA [1260]|CIGNA [126008]|39.80||||39.80|28.89|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|39.80||||39.80|33.83|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|39.80||||39.80|33.83|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|39.80||||39.80|27.86|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|39.80||||39.80|33.83|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|39.80||||39.80|1|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|39.80||||39.80|1|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|39.80||||39.80|33.83|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|39.80||||39.80|33.83|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|39.80||||39.80|27.86|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|39.80||||39.80|33.83|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|39.80||||39.80|27.86|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|CIGNA [1260]|CIGNA [126008]|39.80||||39.80|28.89|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|39.80||||39.80|28.89|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|39.80||||39.80|28.89|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|39.80||||39.80|27.86|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|39.80||||39.80|29.85|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|39.80||||39.80|4.58|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|39.80||||39.80|29.85|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|39.80||||39.80|27.86|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|39.80||||39.80|27.86|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|39.80||||39.80|27.86|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|39.80||||39.80|19.9|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|39.80||||39.80|19.9|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|CBSA [1215]|CBSA [121500]|39.80||||39.80|27.86|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|39.80||||39.80|29.85|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|TDH BCCS [2341]|TDH BCCS [234100]|39.80||||39.80|4.58|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|39.80||||39.80|29.85|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|39.80||||39.80|33.83|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|39.80||||39.80|33.83|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|39.80||||39.80|29.85|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|39.80||||39.80|29.85|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|TDH BCCS [2341]|TDH BCCS [234100]|39.80||||39.80|4.58|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|39.80||||39.80|27.86|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|39.80||||39.80|27.86|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|39.80||||39.80|19.9|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|GUARDIAN [1465]|GUARDIAN [146500]|39.80||||39.80|27.86|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|39.80||||39.80|19.9|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MAILHANDLERS [1595]|MAILHANDLERS [159500]|39.80||||39.80|29.85|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MAILHANDLERS [1595]|MAILHANDLERS [159500]|39.80||||39.80|29.85|33.83|1 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|39.80||||39.80||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|39.80||||39.80||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|39.80||||39.80||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|39.80||||39.80||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UMR [2035]|UMR CHEROKEE MLR [203504]|39.80||||39.80||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|39.80||||39.80||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|39.80||||39.80||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|39.80||||39.80||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|39.80||||39.80||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|39.80||||39.80||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|39.80||||39.80||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|39.80||||39.80||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|39.80||||39.80||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|39.80||||39.80||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|CIGNA [1260]|CIGNA PANTEX [126003]|39.80||||39.80||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|CIGNA [1260]|CIGNA PANTEX [126003]|39.80||||39.80||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|39.80||||39.80||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|39.80||||39.80||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|39.80||||39.80||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|39.80||||39.80||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|39.80||||39.80||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|39.80||||39.80||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|39.80||||39.80||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|39.80||||39.80||| 10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|39.80||||39.80||| 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|MAILHANDLERS [1595]|MAILHANDLERS [159500]|551.48||||551.48|413.61|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|551.48||||551.48|275.74|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|551.48||||551.48|413.61|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|551.48||||551.48|468.76|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|551.48||||551.48|413.61|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|551.48||||551.48|386.04|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|551.48||||551.48|468.76|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|551.48||||551.48|468.76|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA [126008]|551.48||||551.48|400.37|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|551.48||||551.48|386.04|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|551.48||||551.48|400.37|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|551.48||||551.48|386.04|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|CBSA [1215]|CBSA [121500]|551.48||||551.48|386.04|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|551.48||||551.48|275.74|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|GUARDIAN [1465]|GUARDIAN [146500]|551.48||||551.48|386.04|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|551.48||||551.48|386.04|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|551.48||||551.48|37.87|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|551.48||||551.48|413.61|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|TDH BCCS [2341]|TDH BCCS [234100]|551.48||||551.48|63.53|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|551.48||||551.48|386.04|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|551.48||||551.48|314.34|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|551.48||||551.48|63.53|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|551.48||||551.48|468.76|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|PHCS [1780]|PHCS MULTIPLAN [178000]|551.48||||551.48|386.04|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|551.48||||551.48|386.04|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|551.48||||551.48|400.37|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|CELTIC LIFE [1220]|CELTIC LIFE [122000]|551.48||||551.48|386.04|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|EQUITABLE [1355]|EQUITABLE INS [135500]|551.48||||551.48|386.04|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|551.48||||551.48|386.04|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|551.48||||551.48|63.53|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|551.48||||551.48|275.74|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|551.48||||551.48|386.04|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|551.48||||551.48|413.61|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|551.48||||551.48|193.02|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|551.48||||551.48|231.62|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|551.48||||551.48|259.2|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|551.48||||551.48|386.04|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|551.48||||551.48|281.25|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|551.48||||551.48|330.89|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|551.48||||551.48|63.75|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|551.48||||551.48|468.76|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|551.48||||551.48|386.04|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|551.48||||551.48|386.04|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|551.48||||551.48|413.61|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|551.48||||551.48|106.71|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|551.48||||551.48|183.81|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|551.48||||551.48|231.62|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|551.48||||551.48|413.61|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|||551.48||||551.48|413.61|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|551.48||||551.48|386.04|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|551.48||||551.48|400.37|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|551.48||||551.48|26.27|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|551.48||||551.48|468.76|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA PANTEX [126003]|551.48||||551.48|259.2|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|PHCS [1780]|FREEDOM LIFE [178009]|551.48||||551.48|468.76|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|551.48||||551.48|275.74|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|551.48||||551.48|386.04|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|551.48||||551.48|400.37|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|TML [1980]|TML [198000]|551.48||||551.48|338.06|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|551.48||||551.48|413.61|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|551.48||||551.48|413.61|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|551.48||||551.48|468.76|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|LEWER AGENCY [1565]|LEWER AGENCY [156500]|551.48||||551.48|386.04|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|MEDICA [2910]|MEDICA HARMONY [291000]|551.48||||551.48|386.04|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|WEB TPA [2115]|WEB TPA [211501]|551.48||||551.48|386.04|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|WEB TPA [2115]|WEB TPA [211500]|551.48||||551.48|413.61|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|551.48||||551.48|386.04|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|551.48||||551.48|275.74|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|UMR [2035]|UMR CORE [203505]|551.48||||551.48|236.03|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|551.48||||551.48|413.61|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|551.48||||551.48|400.93|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|UMR [2035]|UMR CHOICE [203500]|551.48||||551.48|338.06|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|551.48||||551.48|63.53|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|551.48||||551.48|338.06|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|551.48||||551.48|468.76|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|GILSBAR [1425]|GILSBAR [142500]|551.48||||551.48|413.61|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|551.48||||551.48|236.03|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|551.48||||551.48|468.76|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|551.48||||551.48|338.06|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|551.48||||551.48|386.04|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|551.48||||551.48|400.93|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|551.48||||551.48|386.04|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|551.48||||551.48|170.96|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|551.48||||551.48|386.04|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|551.48||||551.48|413.61|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|551.48||||551.48|413.61|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|551.48||||551.48|386.04|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|551.48||||551.48|74.93|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|551.48||||551.48|468.76|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|AETNA [1015]|AMERICAN CONTINENTAL [101507]|551.48||||551.48|413.61|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|AETNA [1015]|AETNA TRS [101506]|551.48||||551.48|358.46|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|551.48||||551.48|386.04|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|551.48||||551.48|231.62|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|551.48||||551.48|468.76|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|551.48||||551.48|413.61|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|551.48||||551.48|106.71|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|NRECA [1735]|NRECA [173500]|551.48||||551.48|338.06|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|GROUP HEALTH [2165]|GROUP HEALTH [216500]|551.48||||551.48|468.76|468.76|26.27 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|551.48||||551.48||| 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|551.48||||551.48||| 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|551.48||||551.48||| 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|551.48||||551.48||| 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|551.48||||551.48||| 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|551.48||||551.48||| 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|551.48||||551.48||| 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|551.48||||551.48||| 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|551.48||||551.48||| 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|551.48||||551.48||| 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|551.48||||551.48||| 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|551.48||||551.48||| 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|551.48||||551.48||| 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|551.48||||551.48||| 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|551.48||||551.48||| 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|551.48||||551.48||| 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|551.48||||551.48||| 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|551.48||||551.48||| 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|551.48||||551.48||| 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|551.48||||551.48||| 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|551.48||||551.48||| 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|551.48||||551.48||| 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|UMR [2035]|UMR CHEROKEE MLR [203504]|551.48||||551.48||| 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|551.48||||551.48||| 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|551.48||||551.48||| 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|551.48||||551.48||| 10248|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IFOSFAMIDE 1 GRAM INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|551.48||||551.48||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|423.80||||423.80|82.01|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|2.98||||2.98|2.53|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|423.80||||423.80|360.23|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|AETNA [1015]|AMERICAN CONTINENTAL [101507]|2.98||||2.98|2.24|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|NRECA [1735]|NRECA [173500]|2.98||||2.98|1.83|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|423.80||||423.80|296.66|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|423.80||||423.80|317.85|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|2.98||||2.98|2.24|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|423.80||||423.80|317.85|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|423.80||||423.80|296.66|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|2.98||||2.98|2.09|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|423.80||||423.80|296.66|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|2.98||||2.98|2.53|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|GILSBAR [1425]|GILSBAR [142500]|423.80||||423.80|317.85|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|423.80||||423.80|360.23|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|2.98||||2.98|2.53|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|423.80||||423.80|259.79|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2.98||||2.98|0.34|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|423.80||||423.80|48.82|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|UMR [2035]|UMR CORE [203505]|2.98||||2.98|1.28|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|UMR [2035]|UMR CHOICE [203500]|2.98||||2.98|1.83|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|UMR [2035]|UMR OPTIONS [203501]|2.98||||2.98|2.17|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|UMR [2035]|UMR OPTIONS [203501]|423.80||||423.80|308.1|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|AETNA [1015]|AETNA TRS [101506]|423.80||||423.80|275.47|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|AETNA [1015]|AMERICAN CONTINENTAL [101507]|423.80||||423.80|317.85|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|2.98||||2.98|1.49|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|WEB TPA [2115]|WEB TPA [211501]|423.80||||423.80|296.66|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|WEB TPA [2115]|WEB TPA [211500]|2.98||||2.98|2.24|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|WEB TPA [2115]|WEB TPA [211501]|2.98||||2.98|2.09|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|MEDICA [2910]|MEDICA HARMONY [291000]|2.98||||2.98|2.09|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|MEDICA [2910]|MEDICA HARMONY [291000]|423.80||||423.80|296.66|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|LEWER AGENCY [1565]|LEWER AGENCY [156500]|423.80||||423.80|296.66|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|NRECA [1735]|NRECA [173500]|423.80||||423.80|259.79|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|2.98||||2.98|2.53|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|423.80||||423.80|360.23|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|423.80||||423.80|317.85|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|2.98||||2.98|1.49|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2.98||||2.98|0.99|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|2.98||||2.98|2.24|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|423.80||||423.80|317.85|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|2.98||||2.98|2.09|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|2.98||||2.98|0.58|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|423.80||||423.80|82.01|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|2.98||||2.98|2.24|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|2.98||||2.98|2.09|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|423.80||||423.80|296.66|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|2.98||||2.98|2.09|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|2.98||||2.98|2.17|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|423.80||||423.80|181.39|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|423.80||||423.80|259.79|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|2.98||||2.98|1.28|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|423.80||||423.80|296.66|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|2.98||||2.98|2.53|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|423.80||||423.80|360.23|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|423.80||||423.80|13.8|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|423.80||||423.80|15.93|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|423.80||||423.80|254.28|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|2.98||||2.98|1.52|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|2.98||||2.98|0.23|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|423.80||||423.80|216.14|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|423.80||||423.80|141.25|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|423.80||||423.80|360.23|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2.98||||2.98|1.25|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|2.98||||2.98|1.4|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|423.80||||423.80|199.19|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|2.98||||2.98|2.09|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|GROUP HEALTH [2165]|GROUP HEALTH [216500]|2.98||||2.98|2.53|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|GROUP HEALTH [2165]|GROUP HEALTH [216500]|423.80||||423.80|360.23|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|2.98||||2.98|1.04|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|423.80||||423.80|178|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|2.98||||2.98|1.25|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|2.98||||2.98|2.09|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|423.80||||423.80|57|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|2.98||||2.98|0.95|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2.98||||2.98|2.09|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|423.80||||423.80|307.68|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|EQUITABLE [1355]|EQUITABLE INS [135500]|423.80||||423.80|296.66|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|CELTIC LIFE [1220]|CELTIC LIFE [122000]|423.80||||423.80|296.66|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|423.80||||423.80|307.68|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2.98||||2.98|2.16|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|2.98||||2.98|2.09|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|423.80||||423.80|296.66|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|CELTIC LIFE [1220]|CELTIC LIFE [122000]|2.98||||2.98|2.09|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|PHCS [1780]|FREEDOM LIFE [178009]|423.80||||423.80|360.23|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|PHCS [1780]|FREEDOM LIFE [178009]|2.98||||2.98|2.53|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|423.80||||423.80|296.66|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|423.80||||423.80|296.66|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|423.80||||423.80|211.9|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|423.80||||423.80|178|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|PHCS [1780]|PHCS MULTIPLAN [178000]|2.98||||2.98|2.09|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|PHCS [1780]|PHCS MULTIPLAN [178000]|423.80||||423.80|296.66|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2.98||||2.98||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2.98||||2.98||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|423.80||||423.80||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|2.98||||2.98||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|423.80||||423.80||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|UMR [2035]|UMR CHEROKEE MLR [203504]|423.80||||423.80||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|UMR [2035]|UMR CHEROKEE MLR [203504]|2.98||||2.98||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|2.98||||2.98||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|423.80||||423.80||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|423.80||||423.80||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2.98||||2.98||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|2.98||||2.98||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|2.98||||2.98||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|423.80||||423.80||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|423.80||||423.80||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|423.80||||423.80||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|2.98||||2.98||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|2.98||||2.98||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|2.98||||2.98||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2.98||||2.98||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|423.80||||423.80||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|2.98||||2.98||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|423.80||||423.80||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|423.80||||423.80||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|2.98||||2.98||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|2.98||||2.98||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|423.80||||423.80||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|2.98||||2.98||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|423.80||||423.80||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|423.80||||423.80||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|423.80||||423.80||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|2.98||||2.98||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2.98||||2.98||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|2.98||||2.98||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|423.80||||423.80||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|2.98||||2.98|2.53|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|2.98||||2.98|2.16|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|2.98||||2.98|2.53|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|423.80||||423.80|360.23|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|2.98||||2.98|0.27|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|2.98||||2.98|0.34|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|2.98||||2.98|1.79|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|423.80||||423.80|296.66|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|423.80||||423.80|48.82|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|423.80||||423.80|317.85|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|423.80||||423.80|296.66|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|2.98||||2.98|2.09|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|EQUITABLE [1355]|EQUITABLE INS [135500]|2.98||||2.98|2.09|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|423.80||||423.80|296.66|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|||423.80||||423.80|317.85|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|2.98||||2.98|2.09|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2.98||||2.98|2.09|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|423.80||||423.80|308.1|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|2.98||||2.98|1.83|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|423.80||||423.80|307.68|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|423.80||||423.80|296.66|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|2.98||||2.98|2.16|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|423.80||||423.80|317.85|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|423.80||||423.80|57|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|2.98||||2.98|0.95|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|2.98||||2.98|2.24|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|2.98||||2.98|1.25|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|||2.98||||2.98|2.23|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|423.80||||423.80|317.85|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2.98||||2.98|2.24|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2.98||||2.98|2.24|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|423.80||||423.80|148.33|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|423.80||||423.80|317.85|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|423.80||||423.80|178|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|423.80||||423.80|296.66|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|2.98||||2.98|2.09|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|2.98||||2.98|1.7|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|423.80||||423.80|241.57|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|GUARDIAN [1465]|GUARDIAN [146500]|423.80||||423.80|296.66|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|TDH BCCS [2341]|TDH BCCS [234100]|423.80||||423.80|48.82|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|TDH BCCS [2341]|TDH BCCS [234100]|2.98||||2.98|0.34|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|2.98||||2.98|1.49|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|423.80||||423.80|296.66|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|CBSA [1215]|CBSA [121500]|423.80||||423.80|296.66|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|423.80||||423.80|296.66|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|2.98||||2.98|0.34|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|423.80||||423.80|296.66|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|CIGNA [1260]|CIGNA PANTEX [126003]|423.80||||423.80|199.19|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|CIGNA [1260]|CIGNA [126008]|423.80||||423.80|307.68|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|2.98||||2.98|2.24|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|2.98||||2.98|0.58|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|LEWER AGENCY [1565]|LEWER AGENCY [156500]|2.98||||2.98|2.09|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|2.98||||2.98|2.24|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|423.80||||423.80|317.85|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|WEB TPA [2115]|WEB TPA [211500]|423.80||||423.80|317.85|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|423.80||||423.80|211.9|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|AETNA [1015]|AETNA TRS [101506]|2.98||||2.98|1.94|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|2.98||||2.98|2.53|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|CIGNA [1260]|CIGNA [126008]|2.98||||2.98|2.16|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|423.80||||423.80|360.23|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|UMR [2035]|UMR CHOICE [203500]|423.80||||423.80|259.79|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|2.98||||2.98|0.94|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|423.80||||423.80|56.4|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|2.98||||2.98|2.24|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|UMR [2035]|UMR CORE [203505]|423.80||||423.80|181.39|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|423.80||||423.80|131.38|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|2.98||||2.98|0.92|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|2.98||||2.98|1.83|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2.98||||2.98|2.53|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|423.80||||423.80|360.23|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|GILSBAR [1425]|GILSBAR [142500]|2.98||||2.98|2.24|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|423.80||||423.80|360.23|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|423.80||||423.80|360.23|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|2.98||||2.98|2.53|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|2.98||||2.98|2.09|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|423.80||||423.80|296.66|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|2.98||||2.98|2.09|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|423.80||||423.80|307.68|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|2.98||||2.98|2.16|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|2.98||||2.98|2.09|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|2.98||||2.98|2.24|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|423.80||||423.80|317.85|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|423.80||||423.80|296.66|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|423.80||||423.80|48.82|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|2.98||||2.98|2.09|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|2.98||||2.98|2.09|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|2.98||||2.98|1.49|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|CBSA [1215]|CBSA [121500]|2.98||||2.98|2.09|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|423.80||||423.80|211.9|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|423.80||||423.80|317.85|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|423.80||||423.80|211.9|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|2.98||||2.98|2.24|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|423.80||||423.80|360.23|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|TML [1980]|TML [198000]|2.98||||2.98|1.83|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2.98||||2.98|2.53|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|2.98||||2.98|2.09|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|423.80||||423.80|317.85|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|2.98||||2.98|2.24|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|2.98||||2.98|2.09|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|GUARDIAN [1465]|GUARDIAN [146500]|2.98||||2.98|2.09|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|423.80||||423.80|296.66|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|423.80||||423.80|211.9|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|2.98||||2.98|1.49|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|MAILHANDLERS [1595]|MAILHANDLERS [159500]|423.80||||423.80|317.85|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|MAILHANDLERS [1595]|MAILHANDLERS [159500]|2.98||||2.98|2.24|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|TML [1980]|TML [198000]|423.80||||423.80|259.79|360.23|0.23 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|423.80||||423.80||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|423.80||||423.80||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|2.98||||2.98||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|423.80||||423.80||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|2.98||||2.98||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|423.80||||423.80||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|423.80||||423.80||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2.98||||2.98||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|423.80||||423.80||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|423.80||||423.80||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2.98||||2.98||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|2.98||||2.98||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|423.80||||423.80||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|423.80||||423.80||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|2.98||||2.98||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2.98||||2.98||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|423.80||||423.80||| 10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|CIGNA [1260]|CIGNA PANTEX [126003]|2.98||||2.98||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|MAILHANDLERS [1595]|MAILHANDLERS [159500]|2.69||||2.69|2.02|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|2.69||||2.69|2.02|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2.69||||2.69|2.29|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|2.69||||2.69|1.35|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|2.69||||2.69|2.02|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2.69||||2.69|2.29|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|2.69||||2.69|0.59|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|2.69||||2.69|2.29|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|CIGNA [1260]|CIGNA PANTEX [126003]|2.69||||2.69|1.26|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|2.69||||2.69|1.88|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|2.69||||2.69|1.35|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|2.69||||2.69|1.88|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|TML [1980]|TML [198000]|2.69||||2.69|1.65|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|2.69||||2.69|1.53|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|2.69||||2.69|1.88|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|2.69||||2.69|1.95|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|2.69||||2.69|0.31|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131500]|2.69||||2.69|1.95|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|2.69||||2.69|1.88|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|PHCS [1780]|PHCS MULTIPLAN [178000]|2.69||||2.69|1.88|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|CELTIC LIFE [1220]|CELTIC LIFE [122000]|2.69||||2.69|1.88|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|2.69||||2.69|1.88|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|2.69||||2.69|1.13|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|2.69||||2.69|1.13|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|GROUP HEALTH [2165]|GROUP HEALTH [216500]|2.69||||2.69|2.29|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|2.69||||2.69|1.88|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|2.69||||2.69|1.26|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2.69||||2.69|1.13|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|2.69||||2.69|2.29|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|2.69||||2.69|1.37|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|2.69||||2.69|1.53|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|2.69||||2.69|1.29|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|2.69||||2.69|2.29|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|2.69||||2.69|2.02|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|2.69||||2.69|1.88|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|2.69||||2.69|1.61|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|2.69||||2.69|1.65|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|2.69||||2.69|1.96|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|||2.69||||2.69|2.02|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|2.69||||2.69|1.15|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|2.69||||2.69|0.94|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|2.69||||2.69|1.88|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|EQUITABLE [1355]|EQUITABLE INS [135500]|2.69||||2.69|1.88|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|2.69||||2.69|1.88|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|2.69||||2.69|2.02|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|2.69||||2.69|0.52|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|2.69||||2.69|2.02|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|PHCS [1780]|FREEDOM LIFE [178009]|2.69||||2.69|2.29|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2.69||||2.69|1.95|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|2.69||||2.69|2.29|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2.69||||2.69|0.9|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|2.69||||2.69|1.88|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|2.69||||2.69|1.88|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|2.69||||2.69|1.35|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2.69||||2.69|2.02|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|2.69||||2.69|2.02|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2.69||||2.69|2.02|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|2.69||||2.69|2.29|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|LEWER AGENCY [1565]|LEWER AGENCY [156500]|2.69||||2.69|1.88|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|MEDICA [2910]|MEDICA HARMONY [291000]|2.69||||2.69|1.88|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|WEB TPA [2115]|WEB TPA [211501]|2.69||||2.69|1.88|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|WEB TPA [2115]|WEB TPA [211500]|2.69||||2.69|2.02|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|GUARDIAN [1465]|GUARDIAN [146500]|2.69||||2.69|1.88|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|TDH BCCS [2341]|TDH BCCS [234100]|2.69||||2.69|0.31|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|2.69||||2.69|1.35|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|UMR [2035]|UMR CORE [203505]|2.69||||2.69|1.15|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|UMR [2035]|UMR OPTIONS [203501]|2.69||||2.69|1.96|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|UMR [2035]|UMR CHOICE [203500]|2.69||||2.69|1.65|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|CBSA [1215]|CBSA [121500]|2.69||||2.69|1.88|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|2.69||||2.69|0.31|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|CIGNA [1260]|CIGNA [126008]|2.69||||2.69|1.95|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2.69||||2.69|0.31|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|2.69||||2.69|1.65|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|2.69||||2.69|2.29|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|2.69||||2.69|2.29|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|GILSBAR [1425]|GILSBAR [142500]|2.69||||2.69|2.02|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|2.69||||2.69|2.29|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|2.69||||2.69|1.88|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|2.69||||2.69|1.88|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|2.69||||2.69|1.88|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|2.69||||2.69|0.83|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|2.69||||2.69|1.88|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|2.69||||2.69|2.02|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|2.69||||2.69|2.02|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|2.69||||2.69|1.95|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|2.69||||2.69|1.88|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2.69||||2.69|1.88|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|AETNA [1015]|AMERICAN CONTINENTAL [101507]|2.69||||2.69|2.02|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|2.69||||2.69|2.02|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|AETNA [1015]|AETNA TRS [101506]|2.69||||2.69|1.75|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|2.69||||2.69|1.88|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|2.69||||2.69|2.29|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|2.69||||2.69|2.02|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|2.69||||2.69|0.52|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|NRECA [1735]|NRECA [173500]|2.69||||2.69|1.65|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|2.69||||2.69|1.35|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2.69||||2.69|1.88|2.29|0.31 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2.69||||2.69||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2.69||||2.69||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|2.69||||2.69||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2.69||||2.69||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|2.69||||2.69||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|2.69||||2.69||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2.69||||2.69||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|2.69||||2.69||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|2.69||||2.69||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|2.69||||2.69||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2.69||||2.69||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|2.69||||2.69||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|2.69||||2.69||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|2.69||||2.69||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|2.69||||2.69||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|2.69||||2.69||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|2.69||||2.69||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|2.69||||2.69||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2.69||||2.69||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|2.69||||2.69||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|2.69||||2.69||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|2.69||||2.69||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|2.69||||2.69||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|UMR [2035]|UMR CHEROKEE MLR [203504]|2.69||||2.69||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|2.69||||2.69||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2.69||||2.69||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|2.69||||2.69||| 103890|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|TAMSULOSIN 0.4 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2.69||||2.69||| 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|1911.91||||1911.91|220.25|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|1911.91||||1911.91|220.25|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|1911.91||||1911.91|1338.34|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|CIGNA [1260]|CIGNA [126008]|1911.91||||1911.91|1388.05|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|1911.91||||1911.91|497.1|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|CIGNA [1260]|CIGNA [126008]|1911.91||||1911.91|1388.05|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|CIGNA [1260]|CIGNA PANTEX [126003]|1911.91||||1911.91|898.6|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|1911.91||||1911.91|497.1|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|1911.91||||1911.91|1625.12|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|1911.91||||1911.91|1625.12|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|1911.91||||1911.91|1625.12|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|1911.91||||1911.91|1625.12|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|1911.91||||1911.91|205.11|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1911.91||||1911.91|1625.12|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1911.91||||1911.91|1625.12|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|1911.91||||1911.91|1338.34|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|1911.91||||1911.91|1338.34|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1911.91||||1911.91|497.1|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1911.91||||1911.91|497.1|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|CHAMPVA [1240]|CHAMP VA [124000]|1911.91||||1911.91|487.15|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|1911.91||||1911.91|205.11|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|CHAMPVA [1240]|CHAMP VA [124000]|1911.91||||1911.91|487.15|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1911.91||||1911.91|1388.05|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1911.91||||1911.91|1388.05|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|1911.91||||1911.91|1433.93|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1911.91||||1911.91|497.1|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|1911.91||||1911.91|1338.34|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|1911.91||||1911.91|1433.93|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|CIGNA [1260]|CIGNA PANTEX [126003]|1911.91||||1911.91|898.6|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|1911.91||||1911.91|1433.93|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|1911.91||||1911.91|955.96|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1911.91||||1911.91|1625.12|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|1911.91||||1911.91|1338.34|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1911.91||||1911.91|1625.12|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|1911.91||||1911.91|955.96|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|HEALTHNET [1495]|HEALTHNET [149500]|1911.91||||1911.91|1433.93|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|1911.91||||1911.91|1338.34|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|HEALTHNET [1495]|HEALTHNET [149500]|1911.91||||1911.91|1433.93|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1911.91||||1911.91|497.1|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|1911.91||||1911.91|1338.34|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|1911.91||||1911.91|1433.93|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|1911.91||||1911.91|1338.34|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|1911.91||||1911.91|955.96|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|1911.91||||1911.91|955.96|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|MAILHANDLERS [1595]|MAILHANDLERS [159500]|1911.91||||1911.91|1433.93|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|1911.91||||1911.91|1338.34|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|MAILHANDLERS [1595]|MAILHANDLERS [159500]|1911.91||||1911.91|1433.93|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|NRECA [1735]|NRECA [173500]|1911.91||||1911.91|1172|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|NRECA [1735]|NRECA [173500]|1911.91||||1911.91|1172|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|1911.91||||1911.91|369.95|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|1911.91||||1911.91|1433.93|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|1911.91||||1911.91|1433.93|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|1911.91||||1911.91|1625.12|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|1911.91||||1911.91|1625.12|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1911.91||||1911.91|497.1|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1911.91||||1911.91|497.1|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|AETNA [1015]|AETNA TRS [101506]|1911.91||||1911.91|1242.74|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1911.91||||1911.91|507.04|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|AETNA [1015]|AMERICAN CONTINENTAL [101507]|1911.91||||1911.91|1433.93|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|AETNA [1015]|AMERICAN CONTINENTAL [101507]|1911.91||||1911.91|1433.93|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1911.91||||1911.91|1338.34|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1911.91||||1911.91|1338.34|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|1911.91||||1911.91|1433.93|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|1911.91||||1911.91|1433.93|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|1911.91||||1911.91|1433.93|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|1911.91||||1911.91|1338.34|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|1911.91||||1911.91|1338.34|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|1911.91||||1911.91|592.69|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|1911.91||||1911.91|592.69|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|1911.91||||1911.91|1338.34|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|1911.91||||1911.91|497.1|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|1911.91||||1911.91|497.1|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|1911.91||||1911.91|1625.12|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|GILSBAR [1425]|GILSBAR [142500]|1911.91||||1911.91|1433.93|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|GILSBAR [1425]|GILSBAR [142500]|1911.91||||1911.91|1433.93|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|1911.91||||1911.91|1625.12|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|1911.91||||1911.91|1172|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|1911.91||||1911.91|1172|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1911.91||||1911.91|220.25|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1911.91||||1911.91|220.25|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|UMR [2035]|UMR CHEROKEE MLR [203504]|1911.91||||1911.91|497.1|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|UMR [2035]|UMR CORE [203505]|1911.91||||1911.91|818.3|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|UMR [2035]|UMR OPTIONS [203501]|1911.91||||1911.91|1389.96|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|UMR [2035]|UMR CHOICE [203500]|1911.91||||1911.91|1172|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|UMR [2035]|UMR CORE [203505]|1911.91||||1911.91|818.3|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|UMR [2035]|UMR OPTIONS [203501]|1911.91||||1911.91|1389.96|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|1911.91||||1911.91|955.96|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|1911.91||||1911.91|955.96|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|WEB TPA [2115]|WEB TPA [211501]|1911.91||||1911.91|1338.34|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|WEB TPA [2115]|WEB TPA [211500]|1911.91||||1911.91|1433.93|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|WEB TPA [2115]|WEB TPA [211501]|1911.91||||1911.91|1338.34|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|MEDICA [2910]|MEDICA HARMONY [291000]|1911.91||||1911.91|1338.34|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|MEDICA [2910]|MEDICA HARMONY [291000]|1911.91||||1911.91|1338.34|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|LEWER AGENCY [1565]|LEWER AGENCY [156500]|1911.91||||1911.91|1338.34|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|LEWER AGENCY [1565]|LEWER AGENCY [156500]|1911.91||||1911.91|1338.34|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|1911.91||||1911.91|1625.12|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1911.91||||1911.91|1433.93|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1911.91||||1911.91|1433.93|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|1911.91||||1911.91|497.1|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1911.91||||1911.91|955.96|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|1911.91||||1911.91|497.1|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1911.91||||1911.91|955.96|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|1911.91||||1911.91|1338.34|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|1911.91||||1911.91|1338.34|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1911.91||||1911.91|497.1|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1911.91||||1911.91|497.1|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1911.91||||1911.91|637.24|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1911.91||||1911.91|637.24|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|1911.91||||1911.91|497.1|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|1911.91||||1911.91|497.1|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|1911.91||||1911.91|1433.93|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|1911.91||||1911.91|369.95|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|1911.91||||1911.91|369.95|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|TRUSTMARK [2030]|STARMARK [203000]|1911.91||||1911.91|1433.93|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|1911.91||||1911.91|1338.34|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|TRUSTMARK [2030]|STARMARK [203000]|1911.91||||1911.91|1433.93|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|1911.91||||1911.91|1338.34|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|1911.91||||1911.91|1338.34|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|1911.91||||1911.91|497.1|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|1911.91||||1911.91|497.1|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|1911.91||||1911.91|497.1|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|1911.91||||1911.91|1389.96|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1911.91||||1911.91|1172|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1911.91||||1911.91|1172|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|1911.91||||1911.91|497.1|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|1911.91||||1911.91||| 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|1911.91||||1911.91|497.1|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|1911.91||||1911.91|818.3|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|1911.91||||1911.91|1338.34|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|1911.91||||1911.91|1338.34|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|1911.91||||1911.91|1625.12|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|1911.91||||1911.91|1625.12|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|1911.91||||1911.91|975.07|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|1911.91||||1911.91|975.07|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|1911.91||||1911.91|1147.15|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|1911.91||||1911.91|550.77|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|1911.91||||1911.91|550.77|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|1911.91||||1911.91|468.62|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|1911.91||||1911.91|468.62|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|1911.91||||1911.91|818.3|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|1911.91||||1911.91|1147.15|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|1911.91||||1911.91|1625.12|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|1911.91||||1911.91|1625.12|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1911.91||||1911.91|497.1|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|1911.91||||1911.91|1389.96|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1911.91||||1911.91|497.1|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1911.91||||1911.91|803|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|1911.91||||1911.91|497.1|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1911.91||||1911.91|803|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|1911.91||||1911.91|898.6|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|1911.91||||1911.91|898.6|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|1911.91||||1911.91|1338.34|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|1911.91||||1911.91|1338.34|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|GROUP HEALTH [2165]|GROUP HEALTH [216500]|1911.91||||1911.91|1625.12|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|1911.91||||1911.91|1338.34|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|GROUP HEALTH [2165]|GROUP HEALTH [216500]|1911.91||||1911.91|1625.12|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|1911.91||||1911.91|497.1|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|1911.91||||1911.91|497.1|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|1911.91||||1911.91|803|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|1911.91||||1911.91|1433.93|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|1911.91||||1911.91|1118.47|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|1911.91||||1911.91|1118.47|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|1911.91||||1911.91|803|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|1911.91||||1911.91|803|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|1911.91||||1911.91|669.17|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|1911.91||||1911.91|803|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|1911.91||||1911.91|669.17|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|1911.91||||1911.91|1433.93|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|1911.91||||1911.91|1433.93|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|1911.91||||1911.91|1338.34|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|1911.91||||1911.91|1338.34|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|1911.91||||1911.91|262.36|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|1911.91||||1911.91|497.1|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|1911.91||||1911.91|497.1|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|1911.91||||1911.91|262.36|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|||1911.91||||1911.91|1433.93|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|||1911.91||||1911.91|1433.93|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1911.91||||1911.91|1338.34|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|1911.91||||1911.91|1625.12|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1911.91||||1911.91|1338.34|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|1911.91||||1911.91|497.1|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|1911.91||||1911.91|497.1|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|1911.91||||1911.91|497.1|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|1911.91||||1911.91|497.1|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|CORESOURCE [1315]|CORESOURCE [131500]|1911.91||||1911.91|1388.05|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|CORESOURCE [1315]|CORESOURCE [131500]|1911.91||||1911.91|1388.05|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|EQUITABLE [1355]|EQUITABLE INS [135500]|1911.91||||1911.91|1338.34|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|WEB TPA [2115]|WEB TPA [211500]|1911.91||||1911.91|1433.93|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|EQUITABLE [1355]|EQUITABLE INS [135500]|1911.91||||1911.91|1338.34|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1911.91||||1911.91|497.1|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1911.91||||1911.91|497.1|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|CELTIC LIFE [1220]|CELTIC LIFE [122000]|1911.91||||1911.91|1338.34|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|UMR [2035]|UMR CHEROKEE MLR [203504]|1911.91||||1911.91|497.1|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|UMR [2035]|UMR CHOICE [203500]|1911.91||||1911.91|1172|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|CELTIC LIFE [1220]|CELTIC LIFE [122000]|1911.91||||1911.91|1338.34|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|1911.91||||1911.91|507.04|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|1911.91||||1911.91|507.04|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1911.91||||1911.91|1388.05|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1911.91||||1911.91|1388.05|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|1911.91||||1911.91|1338.34|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|1911.91||||1911.91|1338.34|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|PHCS [1780]|PHCS MULTIPLAN [178000]|1911.91||||1911.91|1338.34|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|1911.91||||1911.91|1625.12|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|PHCS [1780]|FREEDOM LIFE [178009]|1911.91||||1911.91|1625.12|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|PHCS [1780]|PHCS MULTIPLAN [178000]|1911.91||||1911.91|1338.34|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|PHCS [1780]|FREEDOM LIFE [178009]|1911.91||||1911.91|1625.12|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|1911.91||||1911.91|1625.12|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|1911.91||||1911.91|1625.12|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|1911.91||||1911.91|1625.12|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|1911.91||||1911.91|220.25|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|1911.91||||1911.91|220.25|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|1911.91||||1911.91|1338.34|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|1911.91||||1911.91|1338.34|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|1911.91||||1911.91|1338.34|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1911.91||||1911.91|1388.05|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1911.91||||1911.91|1388.05|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|1911.91||||1911.91|262.36|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|1911.91||||1911.91|1433.93|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|1911.91||||1911.91|262.36|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|1911.91||||1911.91|516.22|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|1911.91||||1911.91|516.22|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1911.91||||1911.91|1433.93|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1911.91||||1911.91|507.04|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1911.91||||1911.91|1433.93|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1911.91||||1911.91|1433.93|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1911.91||||1911.91|1433.93|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|1911.91||||1911.91|224.91|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|AETNA [1015]|AETNA TRS [101506]|1911.91||||1911.91|1242.74|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|1911.91||||1911.91|224.91|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|1911.91||||1911.91|1338.34|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|1911.91||||1911.91|1338.34|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|1911.91||||1911.91|1089.79|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|1911.91||||1911.91|1089.79|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|GUARDIAN [1465]|GUARDIAN [146500]|1911.91||||1911.91|1338.34|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|1911.91||||1911.91|369.95|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|GUARDIAN [1465]|GUARDIAN [146500]|1911.91||||1911.91|1338.34|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1911.91||||1911.91|497.1|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1911.91||||1911.91|497.1|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|TML [1980]|TML [198000]|1911.91||||1911.91|1172|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|TML [1980]|TML [198000]|1911.91||||1911.91|1172|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|TDH BCCS [2341]|TDH BCCS [234100]|1911.91||||1911.91|220.25|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|TDH BCCS [2341]|TDH BCCS [234100]|1911.91||||1911.91|220.25|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|1911.91||||1911.91|955.96|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|1911.91||||1911.91|955.96|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|CBSA [1215]|CBSA [121500]|1911.91||||1911.91|1338.34|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|CBSA [1215]|CBSA [121500]|1911.91||||1911.91|1338.34|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|1911.91||||1911.91|1338.34|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|1911.91||||1911.91|1338.34|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|1911.91||||1911.91|1338.34|1625.12|205.11 103895|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PNEUMOCOCCAL 13-VAL CONJ VACCINE-DIP CRM (PF) 0.5 ML IM SYRINGE|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|1911.91||||1911.91||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|MAILHANDLERS [1595]|MAILHANDLERS [159500]|33.60||||33.60|25.2|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|MAILHANDLERS [1595]|MAILHANDLERS [159500]|33.60||||33.60|25.2|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|33.60||||33.60|16.8|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|33.60||||33.60|16.8|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|33.60||||33.60|23.52|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|33.60||||33.60|25.2|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|33.60||||33.60|25.2|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|33.60||||33.60|28.56|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|33.60||||33.60|25.2|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|33.60||||33.60|25.2|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|33.60||||33.60|16.8|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|33.60||||33.60|23.52|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|33.60||||33.60|23.52|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|33.60||||33.60|25.2|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|33.60||||33.60|25.2|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|33.60||||33.60|24.39|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|33.60||||33.60|23.52|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|33.60||||33.60|23.52|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|33.60||||33.60|28.56|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|33.60||||33.60|0.76|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|33.60||||33.60|0.76|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|33.60||||33.60|28.56|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|33.60||||33.60|28.56|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|33.60||||33.60|28.56|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|33.60||||33.60|28.56|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|CIGNA [1260]|CIGNA [126008]|33.60||||33.60|24.39|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|CIGNA [1260]|CIGNA [126008]|33.60||||33.60|24.39|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|33.60||||33.60|23.52|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|33.60||||33.60|23.52|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|33.60||||33.60|3.87|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|33.60||||33.60|23.52|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|33.60||||33.60|23.52|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|33.60||||33.60|23.52|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|33.60||||33.60|23.52|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|CBSA [1215]|CBSA [121500]|33.60||||33.60|23.52|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|CBSA [1215]|CBSA [121500]|33.60||||33.60|23.52|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|33.60||||33.60|16.8|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|TDH BCCS [2341]|TDH BCCS [234100]|33.60||||33.60|3.87|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|TDH BCCS [2341]|TDH BCCS [234100]|33.60||||33.60|3.87|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|TML [1980]|TML [198000]|33.60||||33.60|20.6|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|GUARDIAN [1465]|GUARDIAN [146500]|33.60||||33.60|23.52|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|33.60||||33.60|19.15|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|33.60||||33.60|19.15|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|33.60||||33.60|23.52|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|33.60||||33.60|23.52|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|33.60||||33.60|25.2|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|33.60||||33.60|25.2|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|33.60||||33.60|25.2|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|33.60||||33.60|0.79|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|33.60||||33.60|0.79|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|33.60||||33.60|24.39|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|33.60||||33.60|23.52|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|33.60||||33.60|23.52|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|33.60||||33.60|3.87|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|33.60||||33.60|3.87|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|33.60||||33.60|28.56|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|33.60||||33.60|28.56|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|PHCS [1780]|PHCS MULTIPLAN [178000]|33.60||||33.60|23.52|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|PHCS [1780]|FREEDOM LIFE [178009]|33.60||||33.60|28.56|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|PHCS [1780]|PHCS MULTIPLAN [178000]|33.60||||33.60|23.52|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|33.60||||33.60|23.52|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|33.60||||33.60|24.39|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|33.60||||33.60|24.39|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|CELTIC LIFE [1220]|CELTIC LIFE [122000]|33.60||||33.60|23.52|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|CELTIC LIFE [1220]|CELTIC LIFE [122000]|33.60||||33.60|23.52|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|EQUITABLE [1355]|EQUITABLE INS [135500]|33.60||||33.60|23.52|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|EQUITABLE [1355]|EQUITABLE INS [135500]|33.60||||33.60|23.52|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|33.60||||33.60|24.39|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|33.60||||33.60|23.52|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|33.60||||33.60|23.52|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|||33.60||||33.60|25.2|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|33.60||||33.60|0.79|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|33.60||||33.60|0.79|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|33.60||||33.60|25.2|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|33.60||||33.60|23.52|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|33.60||||33.60|25.2|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|33.60||||33.60|23.52|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|33.60||||33.60|14.11|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|33.60||||33.60|14.11|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|33.60||||33.60|11.76|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|33.60||||33.60|11.76|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|GROUP HEALTH [2165]|GROUP HEALTH [216500]|33.60||||33.60|28.56|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|GROUP HEALTH [2165]|GROUP HEALTH [216500]|33.60||||33.60|28.56|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|33.60||||33.60|23.52|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|33.60||||33.60|23.52|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|33.60||||33.60|15.79|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|33.60||||33.60|15.79|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|33.60||||33.60|14.11|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|33.60||||33.60|14.11|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|33.60||||33.60|28.56|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|33.60||||33.60|28.56|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|33.60||||33.60|17.14|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|33.60||||33.60|0.8|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|33.60||||33.60|0.94|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|33.60||||33.60|14.11|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|33.60||||33.60|20.16|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|33.60||||33.60|20.16|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|33.60||||33.60|14.11|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|33.60||||33.60|0.8|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|33.60||||33.60|17.14|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|33.60||||33.60|0.94|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|33.60||||33.60|28.56|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|33.60||||33.60||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|33.60||||33.60||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|33.60||||33.60||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|33.60||||33.60||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|33.60||||33.60||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|33.60||||33.60||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|CIGNA [1260]|CIGNA PANTEX [126003]|33.60||||33.60||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|33.60||||33.60||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|33.60||||33.60||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|33.60||||33.60||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|33.60||||33.60||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|33.60||||33.60||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|33.60||||33.60||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|33.60||||33.60||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|33.60||||33.60||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|33.60||||33.60||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|33.60||||33.60||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|33.60||||33.60||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|33.60||||33.60||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|33.60||||33.60||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|33.60||||33.60||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|33.60||||33.60||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|33.60||||33.60||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|33.60||||33.60||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|33.60||||33.60|28.56|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|33.60||||33.60|23.52|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|||33.60||||33.60|25.2|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|33.60||||33.60|23.52|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|33.60||||33.60|20.6|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|33.60||||33.60|20.6|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|33.60||||33.60|14.38|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|33.60||||33.60|14.38|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|33.60||||33.60|24.43|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|33.60||||33.60|24.39|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|33.60||||33.60|24.43|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|33.60||||33.60|23.52|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|33.60||||33.60|23.52|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|33.60||||33.60|23.52|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|33.60||||33.60|23.52|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|33.60||||33.60|25.2|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|33.60||||33.60|25.2|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|33.60||||33.60|23.52|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|33.60||||33.60|6.5|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|PHCS [1780]|FREEDOM LIFE [178009]|33.60||||33.60|28.56|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|33.60||||33.60|6.5|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|33.60||||33.60|25.2|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|33.60||||33.60|25.2|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|33.60||||33.60|11.2|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|33.60||||33.60|24.39|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|33.60||||33.60|11.2|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|33.60||||33.60|23.52|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|33.60||||33.60|25.2|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|33.60||||33.60|23.52|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|33.60||||33.60|16.8|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|33.60||||33.60|16.8|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|33.60||||33.60|25.2|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|GUARDIAN [1465]|GUARDIAN [146500]|33.60||||33.60|23.52|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|33.60||||33.60|25.2|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|33.60||||33.60|28.56|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|33.60||||33.60|28.56|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|LEWER AGENCY [1565]|LEWER AGENCY [156500]|33.60||||33.60|23.52|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|LEWER AGENCY [1565]|LEWER AGENCY [156500]|33.60||||33.60|23.52|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|MEDICA [2910]|MEDICA HARMONY [291000]|33.60||||33.60|23.52|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|MEDICA [2910]|MEDICA HARMONY [291000]|33.60||||33.60|23.52|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|WEB TPA [2115]|WEB TPA [211501]|33.60||||33.60|23.52|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|TML [1980]|TML [198000]|33.60||||33.60|20.6|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|33.60||||33.60|16.8|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|WEB TPA [2115]|WEB TPA [211500]|33.60||||33.60|25.2|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|WEB TPA [2115]|WEB TPA [211501]|33.60||||33.60|23.52|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|WEB TPA [2115]|WEB TPA [211500]|33.60||||33.60|25.2|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|33.60||||33.60|16.8|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|33.60||||33.60|3.87|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|33.60||||33.60|16.8|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|UMR [2035]|UMR OPTIONS [203501]|33.60||||33.60|24.43|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|UMR [2035]|UMR CORE [203505]|33.60||||33.60|14.38|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|UMR [2035]|UMR OPTIONS [203501]|33.60||||33.60|24.43|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|UMR [2035]|UMR CHOICE [203500]|33.60||||33.60|20.6|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|UMR [2035]|UMR CHOICE [203500]|33.60||||33.60|20.6|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|UMR [2035]|UMR CORE [203505]|33.60||||33.60|14.38|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|33.60||||33.60|3.87|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|33.60||||33.60|3.87|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|33.60||||33.60|20.6|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|33.60||||33.60|20.6|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|33.60||||33.60|28.56|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|33.60||||33.60|28.56|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|33.60||||33.60|28.56|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|GILSBAR [1425]|GILSBAR [142500]|33.60||||33.60|25.2|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|GILSBAR [1425]|GILSBAR [142500]|33.60||||33.60|25.2|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|33.60||||33.60|28.56|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|33.60||||33.60|28.56|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|33.60||||33.60|24.39|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|33.60||||33.60|23.52|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|33.60||||33.60|23.52|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|33.60||||33.60|10.42|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|33.60||||33.60|10.42|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|33.60||||33.60|23.52|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|33.60||||33.60|23.52|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|33.60||||33.60|25.2|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|33.60||||33.60|16.8|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|33.60||||33.60|25.2|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|33.60||||33.60|25.2|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|33.60||||33.60|28.56|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|33.60||||33.60|25.2|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|33.60||||33.60|23.52|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|33.60||||33.60|23.52|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|33.60||||33.60|23.52|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|AETNA [1015]|AMERICAN CONTINENTAL [101507]|33.60||||33.60|25.2|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|AETNA [1015]|AMERICAN CONTINENTAL [101507]|33.60||||33.60|25.2|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|AETNA [1015]|AETNA TRS [101506]|33.60||||33.60|21.84|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|AETNA [1015]|AETNA TRS [101506]|33.60||||33.60|21.84|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|33.60||||33.60|28.56|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|33.60||||33.60|28.56|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|33.60||||33.60|25.2|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|33.60||||33.60|25.2|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|33.60||||33.60|6.5|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|33.60||||33.60|6.5|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|NRECA [1735]|NRECA [173500]|33.60||||33.60|20.6|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|NRECA [1735]|NRECA [173500]|33.60||||33.60|20.6|28.56|0.76 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|33.60||||33.60||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|33.60||||33.60||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|33.60||||33.60||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|33.60||||33.60||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|33.60||||33.60||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|33.60||||33.60||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|33.60||||33.60||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|33.60||||33.60||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|33.60||||33.60||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|33.60||||33.60||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|33.60||||33.60||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|33.60||||33.60||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|33.60||||33.60||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|33.60||||33.60||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|33.60||||33.60||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|33.60||||33.60||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|33.60||||33.60||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|33.60||||33.60||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|33.60||||33.60||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|33.60||||33.60||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|UMR [2035]|UMR CHEROKEE MLR [203504]|33.60||||33.60||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|UMR [2035]|UMR CHEROKEE MLR [203504]|33.60||||33.60||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|CIGNA [1260]|CIGNA PANTEX [126003]|33.60||||33.60||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|33.60||||33.60||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|33.60||||33.60||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|33.60||||33.60||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|33.60||||33.60||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|33.60||||33.60||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|33.60||||33.60||| 10467|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|LORAZEPAM 2 MG/ML INJECTION SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|33.60||||33.60||| 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|NRECA [1735]|NRECA [173500]|629.85||||629.85|386.1|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|629.85||||629.85|121.88|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|629.85||||629.85|535.37|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA TRS [101506]|629.85||||629.85|409.4|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|AETNA [1015]|AMERICAN CONTINENTAL [101507]|629.85||||629.85|472.39|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|629.85||||629.85|440.9|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|629.85||||629.85|472.39|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|629.85||||629.85|440.9|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|629.85||||629.85|195.25|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|629.85||||629.85|440.9|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|629.85||||629.85|535.37|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|GILSBAR [1425]|GILSBAR [142500]|629.85||||629.85|472.39|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|629.85||||629.85|535.37|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|629.85||||629.85|72.56|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|UMR [2035]|UMR CHOICE [203500]|629.85||||629.85|386.1|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|629.85||||629.85|457.9|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|629.85||||629.85|314.93|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|WEB TPA [2115]|WEB TPA [211501]|629.85||||629.85|440.9|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|MEDICA [2910]|MEDICA HARMONY [291000]|629.85||||629.85|440.9|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|LEWER AGENCY [1565]|LEWER AGENCY [156500]|629.85||||629.85|440.9|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|629.85||||629.85|535.37|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|629.85||||629.85|472.39|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|629.85||||629.85|314.93|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|629.85||||629.85|209.93|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|629.85||||629.85|472.39|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|629.85||||629.85|121.88|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|629.85||||629.85|440.9|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|629.85||||629.85|440.9|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|629.85||||629.85|269.58|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|629.85||||629.85|457.9|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|629.85||||629.85|386.1|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|629.85||||629.85|535.37|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|629.85||||629.85|40.71|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|629.85||||629.85|34.65|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|629.85||||629.85|377.91|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|629.85||||629.85|535.37|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|629.85||||629.85|264.54|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|629.85||||629.85|296.03|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|629.85||||629.85|440.9|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|GROUP HEALTH [2165]|GROUP HEALTH [216500]|629.85||||629.85|535.37|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|629.85||||629.85|264.54|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|629.85||||629.85|220.45|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|629.85||||629.85|264.54|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|629.85||||629.85|440.9|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|629.85||||629.85|472.39|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|629.85||||629.85|3.5|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|629.85||||629.85|321.22|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|||629.85||||629.85|472.39|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|629.85||||629.85|440.9|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|629.85||||629.85|440.9|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|629.85||||629.85|457.27|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|EQUITABLE [1355]|EQUITABLE INS [135500]|629.85||||629.85|440.9|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|CELTIC LIFE [1220]|CELTIC LIFE [122000]|629.85||||629.85|440.9|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|629.85||||629.85|457.27|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|629.85||||629.85|440.9|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|PHCS [1780]|PHCS MULTIPLAN [178000]|629.85||||629.85|440.9|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|629.85||||629.85|472.39|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|PHCS [1780]|FREEDOM LIFE [178009]|629.85||||629.85|535.37|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|629.85||||629.85|535.37|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|629.85||||629.85|72.56|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|629.85||||629.85|440.9|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|629.85||||629.85|440.9|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|629.85||||629.85|457.27|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|629.85||||629.85|3.5|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|629.85||||629.85|472.39|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|629.85||||629.85|472.39|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|629.85||||629.85|440.9|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|629.85||||629.85|359.01|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|WEB TPA [2115]|WEB TPA [211500]|629.85||||629.85|472.39|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|GUARDIAN [1465]|GUARDIAN [146500]|629.85||||629.85|440.9|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|TML [1980]|TML [198000]|629.85||||629.85|386.1|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|TDH BCCS [2341]|TDH BCCS [234100]|629.85||||629.85|72.56|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|UMR [2035]|UMR CORE [203505]|629.85||||629.85|269.58|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|629.85||||629.85|386.1|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|629.85||||629.85|314.93|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|CBSA [1215]|CBSA [121500]|629.85||||629.85|440.9|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|629.85||||629.85|440.9|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|629.85||||629.85|440.9|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|629.85||||629.85|72.56|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|629.85||||629.85|440.9|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA [126008]|629.85||||629.85|457.27|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|629.85||||629.85|472.39|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA PANTEX [126003]|629.85||||629.85|296.03|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|629.85||||629.85|535.37|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|629.85||||629.85|535.37|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|629.85||||629.85|12.35|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|629.85||||629.85|535.37|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|629.85||||629.85|440.9|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|629.85||||629.85|472.39|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|629.85||||629.85|457.27|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|629.85||||629.85|472.39|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|629.85||||629.85|440.9|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|629.85||||629.85|314.93|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|629.85||||629.85|472.39|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|629.85||||629.85|535.37|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|629.85||||629.85|472.39|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|629.85||||629.85|440.9|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|629.85||||629.85|314.93|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|MAILHANDLERS [1595]|MAILHANDLERS [159500]|629.85||||629.85|472.39|535.37|3.5 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|629.85||||629.85||| 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|629.85||||629.85||| 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|UMR [2035]|UMR CHEROKEE MLR [203504]|629.85||||629.85||| 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|629.85||||629.85||| 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|629.85||||629.85||| 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|629.85||||629.85||| 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|629.85||||629.85||| 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|629.85||||629.85||| 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|629.85||||629.85||| 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|629.85||||629.85||| 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|629.85||||629.85||| 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|629.85||||629.85||| 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|629.85||||629.85||| 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|629.85||||629.85||| 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|629.85||||629.85||| 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|629.85||||629.85||| 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|629.85||||629.85||| 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|629.85||||629.85||| 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|629.85||||629.85||| 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|629.85||||629.85||| 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|629.85||||629.85||| 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|629.85||||629.85||| 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|629.85||||629.85||| 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|629.85||||629.85||| 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|629.85||||629.85||| 10537|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MESNA 100 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|629.85||||629.85||| 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|MAILHANDLERS [1595]|MAILHANDLERS [159500]|5754.56||||5754.56|4315.92|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|5754.56||||5754.56|2877.28|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|5754.56||||5754.56|4028.19|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5754.56||||5754.56|4891.38|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|5754.56||||5754.56|4315.92|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|5754.56||||5754.56|2877.28|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5754.56||||5754.56|1207.38|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|5754.56||||5754.56|4315.92|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|5754.56||||5754.56|4177.81|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|CHAMPVA [1240]|CHAMP VA [124000]|5754.56||||5754.56|1183.23|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5754.56||||5754.56|1207.38|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|5754.56||||5754.56|4028.19|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5754.56||||5754.56|4891.38|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|5754.56||||5754.56|4891.38|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|5754.56||||5754.56|4891.38|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|5754.56||||5754.56|1207.38|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|CIGNA [1260]|CIGNA PANTEX [126003]|5754.56||||5754.56|2704.64|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|5754.56||||5754.56|4028.19|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|5754.56||||5754.56|662.93|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|5754.56||||5754.56|4028.19|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|CBSA [1215]|CBSA [121500]|5754.56||||5754.56|4028.19|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|5754.56||||5754.56|2877.28|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|TDH BCCS [2341]|TDH BCCS [234100]|5754.56||||5754.56|662.93|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|TML [1980]|TML [198000]|5754.56||||5754.56|3527.55|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5754.56||||5754.56|1207.38|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|GUARDIAN [1465]|GUARDIAN [146500]|5754.56||||5754.56|4028.19|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|5754.56||||5754.56|4028.19|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|5754.56||||5754.56|1030.8|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5754.56||||5754.56|4315.92|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|5754.56||||5754.56|1207.38|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|5754.56||||5754.56|1361.4|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|5754.56||||5754.56|4177.81|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|5754.56||||5754.56|662.93|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|5754.56||||5754.56|4891.38|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|PHCS [1780]|FREEDOM LIFE [178009]|5754.56||||5754.56|4891.38|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|PHCS [1780]|PHCS MULTIPLAN [178000]|5754.56||||5754.56|4028.19|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|5754.56||||5754.56|4028.19|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5754.56||||5754.56|4177.81|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|5754.56||||5754.56|1231.53|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5754.56||||5754.56|1207.38|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|EQUITABLE [1355]|EQUITABLE INS [135500]|5754.56||||5754.56|4028.19|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|CORESOURCE [1315]|CORESOURCE [131500]|5754.56||||5754.56|4177.81|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|5754.56||||5754.56|1207.38|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5754.56||||5754.56|4028.19|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|||5754.56||||5754.56|4315.92|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|5754.56||||5754.56|4028.19|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|5754.56||||5754.56|4315.92|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|5754.56||||5754.56|2416.92|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|5754.56||||5754.56|2716.61|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|5754.56||||5754.56|2014.1|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|5754.56||||5754.56|2416.92|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|5754.56||||5754.56|1207.38|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|GROUP HEALTH [2165]|GROUP HEALTH [216500]|5754.56||||5754.56|4891.38|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|5754.56||||5754.56|4028.19|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|5754.56||||5754.56|2704.64|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5754.56||||5754.56|2416.92|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5754.56||||5754.56|1207.38|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|5754.56||||5754.56|4891.38|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|5754.56||||5754.56|2748.81|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|5754.56||||5754.56|2338.8|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|5754.56||||5754.56|1361.4|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|5754.56||||5754.56|1207.38|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|5754.56||||5754.56|3452.74|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|5754.56||||5754.56|2934.83|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|5754.56||||5754.56|4891.38|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|5754.56||||5754.56|4028.19|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|CELTIC LIFE [1220]|CELTIC LIFE [122000]|5754.56||||5754.56|4028.19|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|5754.56||||5754.56|2462.95|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|5754.56||||5754.56|4183.57|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|5754.56||||5754.56|3527.55|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|5754.56||||5754.56|1207.38|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|5754.56||||5754.56|1207.38|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|5754.56||||5754.56|4028.19|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|5754.56||||5754.56|4028.19|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|5754.56||||5754.56|4028.19|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|TRUSTMARK [2030]|STARMARK [203000]|5754.56||||5754.56|4315.92|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|5754.56||||5754.56|1113.51|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|5754.56||||5754.56|4315.92|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|5754.56||||5754.56|1207.38|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5754.56||||5754.56|4315.92|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|5754.56||||5754.56|3280.1|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5754.56||||5754.56|1917.99|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5754.56||||5754.56|1207.38|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|5754.56||||5754.56|4028.19|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|5754.56||||5754.56|2877.28|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|5754.56||||5754.56|1207.38|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|5754.56||||5754.56|1207.38|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|5754.56||||5754.56|4315.92|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|5754.56||||5754.56|4028.19|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|5754.56||||5754.56|4891.38|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|LEWER AGENCY [1565]|LEWER AGENCY [156500]|5754.56||||5754.56|4028.19|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|MEDICA [2910]|MEDICA HARMONY [291000]|5754.56||||5754.56|4028.19|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|WEB TPA [2115]|WEB TPA [211501]|5754.56||||5754.56|4028.19|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|CIGNA [1260]|CIGNA [126008]|5754.56||||5754.56|4177.81|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|WEB TPA [2115]|WEB TPA [211500]|5754.56||||5754.56|4315.92|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|5754.56||||5754.56|2877.28|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|UMR [2035]|UMR CORE [203505]|5754.56||||5754.56|2462.95|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|UMR [2035]|UMR CHEROKEE MLR [203504]|5754.56||||5754.56|1207.38|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|5754.56||||5754.56|1102.8|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|UMR [2035]|UMR OPTIONS [203501]|5754.56||||5754.56|4183.57|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|UMR [2035]|UMR CHOICE [203500]|5754.56||||5754.56|3527.55|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|5754.56||||5754.56|662.93|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|5754.56||||5754.56|3527.55|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|5754.56||||5754.56|4891.38|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|GILSBAR [1425]|GILSBAR [142500]|5754.56||||5754.56|4315.92|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|5754.56||||5754.56|4891.38|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|5754.56||||5754.56|1207.38|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|5754.56||||5754.56|4028.19|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|HEALTHNET [1495]|HEALTHNET [149500]|5754.56||||5754.56|4315.92|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|5754.56||||5754.56|4028.19|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|5754.56||||5754.56|1783.91|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|5754.56||||5754.56|4028.19|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|5754.56||||5754.56|4315.92|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|5754.56||||5754.56|4315.92|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5754.56||||5754.56|4028.19|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|AETNA [1015]|AMERICAN CONTINENTAL [101507]|5754.56||||5754.56|4315.92|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|AETNA [1015]|AETNA TRS [101506]|5754.56||||5754.56|3740.46|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5754.56||||5754.56|1231.53|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5754.56||||5754.56|1207.38|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|5754.56||||5754.56|4891.38|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|5754.56||||5754.56|4315.92|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|5754.56||||5754.56|1113.51|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|NRECA [1735]|NRECA [173500]|5754.56||||5754.56|3527.55|4891.38|662.93 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|5754.56||||5754.56||| 105502|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|5754.56||||5754.56||| 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|NRECA [1735]|NRECA [173500]|34624.53||||34624.53|21224.84|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|34624.53||||34624.53|6699.85|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|34624.53||||34624.53|6699.85|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|34624.53||||34624.53|25968.4|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|34624.53||||34624.53|25968.4|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|34624.53||||34624.53|29430.85|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|34624.53||||34624.53|29430.85|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|34624.53||||34624.53|10890.54|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|AETNA [1015]|AETNA TRS [101506]|34624.53||||34624.53|22505.94|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|AETNA [1015]|AMERICAN CONTINENTAL [101507]|34624.53||||34624.53|25968.4|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|34624.53||||34624.53|11108.35|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|34624.53||||34624.53|11108.35|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|AETNA [1015]|AETNA TRS [101506]|34624.53||||34624.53|22505.94|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|34624.53||||34624.53|24237.17|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|34624.53||||34624.53|25968.4|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|34624.53||||34624.53|25968.4|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|34624.53||||34624.53|25968.4|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|34624.53||||34624.53|25968.4|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|34624.53||||34624.53|24237.17|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|34624.53||||34624.53|24237.17|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|34624.53||||34624.53|10733.6|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|34624.53||||34624.53|24237.17|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|34624.53||||34624.53|24237.17|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|34624.53||||34624.53|10890.54|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|34624.53||||34624.53|29430.85|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|34624.53||||34624.53|29430.85|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|GILSBAR [1425]|GILSBAR [142500]|34624.53||||34624.53|25968.4|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|34624.53||||34624.53|29430.85|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|34624.53||||34624.53|29430.85|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|34624.53||||34624.53|21224.84|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|34624.53||||34624.53|21224.84|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|34624.53||||34624.53|3988.75|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|34624.53||||34624.53|3988.75|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|UMR [2035]|UMR CHEROKEE MLR [203504]|34624.53||||34624.53|10890.54|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|34624.53||||34624.53|25172.03|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|UMR [2035]|UMR CHEROKEE MLR [203504]|34624.53||||34624.53|10890.54|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|UMR [2035]|UMR CHOICE [203500]|34624.53||||34624.53|21224.84|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|34624.53||||34624.53|25172.03|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|UMR [2035]|UMR CORE [203505]|34624.53||||34624.53|14819.3|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|34624.53||||34624.53|17312.27|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|WEB TPA [2115]|WEB TPA [211500]|34624.53||||34624.53|25968.4|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|WEB TPA [2115]|WEB TPA [211500]|34624.53||||34624.53|25968.4|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|WEB TPA [2115]|WEB TPA [211501]|34624.53||||34624.53|24237.17|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|WEB TPA [2115]|WEB TPA [211501]|34624.53||||34624.53|24237.17|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|MEDICA [2910]|MEDICA HARMONY [291000]|34624.53||||34624.53|24237.17|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|MEDICA [2910]|MEDICA HARMONY [291000]|34624.53||||34624.53|24237.17|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|LEWER AGENCY [1565]|LEWER AGENCY [156500]|34624.53||||34624.53|24237.17|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|34624.53||||34624.53|29430.85|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|34624.53||||34624.53|29430.85|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|34624.53||||34624.53|25968.4|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|34624.53||||34624.53|10890.54|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|34624.53||||34624.53|10890.54|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|34624.53||||34624.53|10890.54|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|34624.53||||34624.53|17312.27|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|34624.53||||34624.53|10890.54|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|34624.53||||34624.53|24237.17|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|34624.53||||34624.53|24237.17|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|34624.53||||34624.53|10890.54|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|34624.53||||34624.53|10890.54|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|34624.53||||34624.53|11540.36|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|34624.53||||34624.53|10890.54|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|34624.53||||34624.53|25968.4|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|34624.53||||34624.53|25968.4|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|34624.53||||34624.53|6699.85|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|34624.53||||34624.53|25968.4|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|34624.53||||34624.53|25968.4|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|34624.53||||34624.53|24237.17|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|34624.53||||34624.53|24237.17|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|34624.53||||34624.53|24237.17|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|34624.53||||34624.53|24237.17|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|34624.53||||34624.53|10890.54|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|34624.53||||34624.53|10890.54|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|34624.53||||34624.53|10890.54|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|34624.53||||34624.53|25172.03|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|34624.53||||34624.53|25172.03|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|34624.53||||34624.53|21224.84|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|34624.53||||34624.53|14819.3|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|34624.53||||34624.53|21224.84|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|34624.53||||34624.53|24237.17|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|34624.53||||34624.53|24237.17|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|34624.53||||34624.53|29430.85|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|34624.53||||34624.53|29430.85|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|34624.53||||34624.53|23728.8|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|34624.53||||34624.53|20774.72|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|34624.53||||34624.53|23728.8|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|34624.53||||34624.53|27888.12|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|34624.53||||34624.53|17658.51|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|34624.53||||34624.53|20774.72|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|34624.53||||34624.53|29430.85|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|34624.53||||34624.53|10890.54|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|34624.53||||34624.53|10890.54|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|34624.53||||34624.53|14542.3|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|34624.53||||34624.53|14542.3|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|34624.53||||34624.53|16273.53|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|34624.53||||34624.53|16273.53|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|34624.53||||34624.53|24237.17|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|GROUP HEALTH [2165]|GROUP HEALTH [216500]|34624.53||||34624.53|29430.85|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|GROUP HEALTH [2165]|GROUP HEALTH [216500]|34624.53||||34624.53|29430.85|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|34624.53||||34624.53|10890.54|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|34624.53||||34624.53|14542.3|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|34624.53||||34624.53|14542.3|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|34624.53||||34624.53|14542.3|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|34624.53||||34624.53|12118.59|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|34624.53||||34624.53|24503.72|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|34624.53||||34624.53|14542.3|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|34624.53||||34624.53|24503.72|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|34624.53||||34624.53|25968.4|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|34624.53||||34624.53|24237.17|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|34624.53||||34624.53|25968.4|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|34624.53||||34624.53|12118.59|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|34624.53||||34624.53|10890.54|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|34624.53||||34624.53|24237.17|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|34624.53||||34624.53|12412.8|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|34624.53||||34624.53|12412.8|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|||34624.53||||34624.53|25968.4|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|34624.53||||34624.53|24237.17|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|||34624.53||||34624.53|25968.4|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|34624.53||||34624.53|24237.17|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|34624.53||||34624.53|24237.17|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|34624.53||||34624.53|10890.54|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|34624.53||||34624.53|10890.54|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|34624.53||||34624.53|10890.54|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|34624.53||||34624.53|29430.85|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|34624.53||||34624.53||| 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|34624.53||||34624.53||| 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|34624.53||||34624.53||| 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|34624.53||||34624.53|10890.54|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|34624.53||||34624.53|25137.41|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|34624.53||||34624.53|25137.41|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|EQUITABLE [1355]|EQUITABLE INS [135500]|34624.53||||34624.53|24237.17|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|EQUITABLE [1355]|EQUITABLE INS [135500]|34624.53||||34624.53|24237.17|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|34624.53||||34624.53|10890.54|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|34624.53||||34624.53|27888.12|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|34624.53||||34624.53|17658.51|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|34624.53||||34624.53|10890.54|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|CELTIC LIFE [1220]|CELTIC LIFE [122000]|34624.53||||34624.53|24237.17|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|CELTIC LIFE [1220]|CELTIC LIFE [122000]|34624.53||||34624.53|24237.17|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|34624.53||||34624.53|11108.35|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|34624.53||||34624.53|11108.35|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|34624.53||||34624.53|25137.41|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|34624.53||||34624.53|25137.41|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|34624.53||||34624.53|24237.17|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|34624.53||||34624.53|14819.3|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|34624.53||||34624.53|24237.17|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|PHCS [1780]|FREEDOM LIFE [178009]|34624.53||||34624.53|29430.85|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|PHCS [1780]|PHCS MULTIPLAN [178000]|34624.53||||34624.53|24237.17|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|PHCS [1780]|PHCS MULTIPLAN [178000]|34624.53||||34624.53|24237.17|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|PHCS [1780]|FREEDOM LIFE [178009]|34624.53||||34624.53|29430.85|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|34624.53||||34624.53|29430.85|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|34624.53||||34624.53|29430.85|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|34624.53||||34624.53|3988.75|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|34624.53||||34624.53|10890.54|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|34624.53||||34624.53|3988.75|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|34624.53||||34624.53|24237.17|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|34624.53||||34624.53|24237.17|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|34624.53||||34624.53|25137.41|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|34624.53||||34624.53|6699.85|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|34624.53||||34624.53|25137.41|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|34624.53||||34624.53|12412.8|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|34624.53||||34624.53|12412.8|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|34624.53||||34624.53|10890.54|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|34624.53||||34624.53|10890.54|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|34624.53||||34624.53|10890.54|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|34624.53||||34624.53|25968.4|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|34624.53||||34624.53|25968.4|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|34624.53||||34624.53|25968.4|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|34624.53||||34624.53|25968.4|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|34624.53||||34624.53|10195.8|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|34624.53||||34624.53|10195.8|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|34624.53||||34624.53|24237.17|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|34624.53||||34624.53|11540.36|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|34624.53||||34624.53|17312.27|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|34624.53||||34624.53|24237.17|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|34624.53||||34624.53|19735.98|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|34624.53||||34624.53|19735.98|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|GUARDIAN [1465]|GUARDIAN [146500]|34624.53||||34624.53|24237.17|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|34624.53||||34624.53|25968.4|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|GUARDIAN [1465]|GUARDIAN [146500]|34624.53||||34624.53|24237.17|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|34624.53||||34624.53|10890.54|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|34624.53||||34624.53|10890.54|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|TML [1980]|TML [198000]|34624.53||||34624.53|21224.84|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|LEWER AGENCY [1565]|LEWER AGENCY [156500]|34624.53||||34624.53|24237.17|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|TML [1980]|TML [198000]|34624.53||||34624.53|21224.84|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|TDH BCCS [2341]|TDH BCCS [234100]|34624.53||||34624.53|3988.75|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|TDH BCCS [2341]|TDH BCCS [234100]|34624.53||||34624.53|3988.75|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|34624.53||||34624.53|17312.27|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|34624.53||||34624.53|17312.27|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|CBSA [1215]|CBSA [121500]|34624.53||||34624.53|24237.17|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|CBSA [1215]|CBSA [121500]|34624.53||||34624.53|24237.17|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|34624.53||||34624.53|24237.17|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|34624.53||||34624.53|17312.27|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|UMR [2035]|UMR CORE [203505]|34624.53||||34624.53|14819.3|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|34624.53||||34624.53|24237.17|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|34624.53||||34624.53|24237.17|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|34624.53||||34624.53|24237.17|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|34624.53||||34624.53|3988.75|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|UMR [2035]|UMR CHOICE [203500]|34624.53||||34624.53|21224.84|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|34624.53||||34624.53|3988.75|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|34624.53||||34624.53|24237.17|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|34624.53||||34624.53|24237.17|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA PANTEX [126003]|34624.53||||34624.53|16273.53|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA PANTEX [126003]|34624.53||||34624.53|16273.53|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA [126008]|34624.53||||34624.53|25137.41|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA [126008]|34624.53||||34624.53|25137.41|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|34624.53||||34624.53|10890.54|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|GILSBAR [1425]|GILSBAR [142500]|34624.53||||34624.53|25968.4|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|34624.53||||34624.53|10890.54|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|34624.53||||34624.53|29430.85|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|34624.53||||34624.53|29430.85|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|34624.53||||34624.53|29430.85|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|34624.53||||34624.53|10890.54|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|34624.53||||34624.53|10733.6|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|34624.53||||34624.53|29430.85|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|34624.53||||34624.53|9815.4|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|34624.53||||34624.53|9815.4|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|34624.53||||34624.53|29430.85|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|34624.53||||34624.53|29430.85|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|34624.53||||34624.53|24237.17|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|34624.53||||34624.53|24237.17|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|34624.53||||34624.53|10890.54|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|34624.53||||34624.53|24237.17|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|34624.53||||34624.53|10890.54|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|34624.53||||34624.53|10672.73|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|34624.53||||34624.53|10672.73|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|34624.53||||34624.53|25137.41|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|AETNA [1015]|AMERICAN CONTINENTAL [101507]|34624.53||||34624.53|25968.4|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|34624.53||||34624.53|25137.41|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|34624.53||||34624.53|25968.4|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|34624.53||||34624.53|25968.4|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|34624.53||||34624.53|10890.54|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|34624.53||||34624.53|10890.54|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|34624.53||||34624.53|10890.54|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|34624.53||||34624.53|24237.17|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|34624.53||||34624.53|24237.17|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|34624.53||||34624.53|17312.27|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|NRECA [1735]|NRECA [173500]|34624.53||||34624.53|21224.84|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|34624.53||||34624.53|17312.27|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|34624.53||||34624.53|25968.4|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|34624.53||||34624.53|25968.4|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|34624.53||||34624.53|29430.85|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|34624.53||||34624.53|29430.85|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|34624.53||||34624.53|25968.4|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|34624.53||||34624.53|25968.4|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|34624.53||||34624.53|24237.17|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|34624.53||||34624.53|24237.17|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|34624.53||||34624.53|17312.27|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|34624.53||||34624.53|17312.27|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|MAILHANDLERS [1595]|MAILHANDLERS [159500]|34624.53||||34624.53|25968.4|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|MAILHANDLERS [1595]|MAILHANDLERS [159500]|34624.53||||34624.53|25968.4|29430.85|3988.75 105644|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|CABAZITAXEL 10 MG/ML (FINAL CONC) INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|34624.53||||34624.53||| 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|MAILHANDLERS [1595]|MAILHANDLERS [159500]|233.00||||233.00|174.75|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|233.00||||233.00|116.5|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|233.00||||233.00|163.1|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|HEALTHNET [1495]|HEALTHNET [149500]|233.00||||233.00|174.75|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|233.00||||233.00|198.05|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|233.00||||233.00|174.75|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|233.00||||233.00|163.1|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|233.00||||233.00|174.75|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|233.00||||233.00|163.1|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|233.00||||233.00|6.97|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|233.00||||233.00|198.05|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|233.00||||233.00|198.05|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|CIGNA [1260]|CIGNA [126008]|233.00||||233.00|169.16|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|233.00||||233.00|163.1|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|233.00||||233.00|163.1|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|233.00||||233.00|163.1|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|CBSA [1215]|CBSA [121500]|233.00||||233.00|163.1|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|TDH BCCS [2341]|TDH BCCS [234100]|233.00||||233.00|26.84|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|TML [1980]|TML [198000]|233.00||||233.00|142.83|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|233.00||||233.00|132.81|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|233.00||||233.00|163.1|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|233.00||||233.00|174.75|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|233.00||||233.00|174.75|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|233.00||||233.00|7.66|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|233.00||||233.00|163.1|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|233.00||||233.00|26.84|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|233.00||||233.00|198.05|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|PHCS [1780]|PHCS MULTIPLAN [178000]|233.00||||233.00|163.1|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|233.00||||233.00|163.1|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|233.00||||233.00|169.16|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|CELTIC LIFE [1220]|CELTIC LIFE [122000]|233.00||||233.00|163.1|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|EQUITABLE [1355]|EQUITABLE INS [135500]|233.00||||233.00|163.1|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|CORESOURCE [1315]|CORESOURCE [131500]|233.00||||233.00|169.16|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|233.00||||233.00|163.1|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|233.00||||233.00|7.66|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|233.00||||233.00|163.1|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|233.00||||233.00|174.75|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|233.00||||233.00|81.55|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|233.00||||233.00|97.86|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|GROUP HEALTH [2165]|GROUP HEALTH [216500]|233.00||||233.00|198.05|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|233.00||||233.00|163.1|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|233.00||||233.00|109.51|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|233.00||||233.00|97.86|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|233.00||||233.00|97.86|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|233.00||||233.00|198.05|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|233.00||||233.00|118.83|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|||233.00||||233.00|174.75|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|233.00||||233.00|8.73|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|233.00||||233.00|139.8|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|233.00||||233.00|7.43|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|233.00||||233.00|198.05|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|233.00||||233.00|163.1|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|233.00||||233.00|142.83|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|233.00||||233.00|169.39|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|PHCS [1780]|FREEDOM LIFE [178009]|233.00||||233.00|198.05|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|233.00||||233.00|99.72|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|233.00||||233.00|163.1|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|TRUSTMARK [2030]|STARMARK [203000]|233.00||||233.00|174.75|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|233.00||||233.00|163.1|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|233.00||||233.00|45.09|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|233.00||||233.00|174.75|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|233.00||||233.00|169.16|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|233.00||||233.00|77.66|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|GUARDIAN [1465]|GUARDIAN [146500]|233.00||||233.00|163.1|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|233.00||||233.00|163.1|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|233.00||||233.00|116.5|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|233.00||||233.00|116.5|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|233.00||||233.00|26.84|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|233.00||||233.00|174.75|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|233.00||||233.00|198.05|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|LEWER AGENCY [1565]|LEWER AGENCY [156500]|233.00||||233.00|163.1|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|MEDICA [2910]|MEDICA HARMONY [291000]|233.00||||233.00|163.1|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|WEB TPA [2115]|WEB TPA [211500]|233.00||||233.00|174.75|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|WEB TPA [2115]|WEB TPA [211501]|233.00||||233.00|163.1|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|233.00||||233.00|116.5|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|UMR [2035]|UMR CHOICE [203500]|233.00||||233.00|142.83|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|233.00||||233.00|198.05|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|UMR [2035]|UMR OPTIONS [203501]|233.00||||233.00|169.39|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|UMR [2035]|UMR CORE [203505]|233.00||||233.00|99.72|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|233.00||||233.00|26.84|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|233.00||||233.00|169.16|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|233.00||||233.00|142.83|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|233.00||||233.00|198.05|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|GILSBAR [1425]|GILSBAR [142500]|233.00||||233.00|174.75|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|233.00||||233.00|198.05|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|233.00||||233.00|116.5|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|233.00||||233.00|163.1|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|233.00||||233.00|72.23|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|233.00||||233.00|163.1|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|233.00||||233.00|174.75|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|233.00||||233.00|174.75|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|233.00||||233.00|163.1|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|AETNA [1015]|AMERICAN CONTINENTAL [101507]|233.00||||233.00|174.75|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|AETNA [1015]|AETNA TRS [101506]|233.00||||233.00|151.45|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|233.00||||233.00|198.05|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|233.00||||233.00|174.75|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|233.00||||233.00|45.09|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|NRECA [1735]|NRECA [173500]|233.00||||233.00|142.83|198.05|6.97 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|233.00||||233.00||| 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|CHAMPVA [1240]|CHAMP VA [124000]|233.00||||233.00||| 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|233.00||||233.00||| 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|CIGNA [1260]|CIGNA PANTEX [126003]|233.00||||233.00||| 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|233.00||||233.00||| 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|233.00||||233.00||| 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|233.00||||233.00||| 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|233.00||||233.00||| 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|233.00||||233.00||| 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|233.00||||233.00||| 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|233.00||||233.00||| 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|233.00||||233.00||| 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|233.00||||233.00||| 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|233.00||||233.00||| 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|233.00||||233.00||| 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|233.00||||233.00||| 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|233.00||||233.00||| 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|233.00||||233.00||| 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|233.00||||233.00||| 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|233.00||||233.00||| 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|233.00||||233.00||| 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|233.00||||233.00||| 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|233.00||||233.00||| 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|UMR [2035]|UMR CHEROKEE MLR [203504]|233.00||||233.00||| 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|233.00||||233.00||| 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|233.00||||233.00||| 10578|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 125 MG SOLUTION FOR INJECTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|233.00||||233.00||| 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|NRECA [1735]|NRECA [173500]|462.40||||462.40|283.45|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|462.40||||462.40|89.47|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|462.40||||462.40|346.8|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|AETNA [1015]|AMERICAN CONTINENTAL [101507]|462.40||||462.40|346.8|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|462.40||||462.40|323.68|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|462.40||||462.40|346.8|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|462.40||||462.40|346.8|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|462.40||||462.40|143.34|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|462.40||||462.40|323.68|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|462.40||||462.40|393.04|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|GILSBAR [1425]|GILSBAR [142500]|462.40||||462.40|346.8|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|462.40||||462.40|393.04|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|462.40||||462.40|283.45|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|UMR [2035]|UMR CHOICE [203500]|462.40||||462.40|283.45|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|462.40||||462.40|336.16|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|UMR [2035]|UMR CORE [203505]|462.40||||462.40|197.91|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|462.40||||462.40|231.2|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|WEB TPA [2115]|WEB TPA [211500]|462.40||||462.40|346.8|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|WEB TPA [2115]|WEB TPA [211501]|462.40||||462.40|323.68|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|LEWER AGENCY [1565]|LEWER AGENCY [156500]|462.40||||462.40|323.68|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|462.40||||462.40|393.04|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|462.40||||462.40|346.8|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|462.40||||462.40|231.2|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|462.40||||462.40|323.68|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|462.40||||462.40|154.12|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|462.40||||462.40|89.47|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|462.40||||462.40|346.8|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|462.40||||462.40|323.68|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|462.40||||462.40|336.16|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|462.40||||462.40|197.91|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|462.40||||462.40|283.45|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|462.40||||462.40|323.68|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|462.40||||462.40|34.93|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|462.40||||462.40|277.44|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|462.40||||462.40|235.82|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|462.40||||462.40|393.04|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|462.40||||462.40|194.21|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|462.40||||462.40|323.68|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|GROUP HEALTH [2165]|GROUP HEALTH [216500]|462.40||||462.40|393.04|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|462.40||||462.40|194.21|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|462.40||||462.40|161.84|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|462.40||||462.40|194.21|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|462.40||||462.40|217.33|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|462.40||||462.40|346.8|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|462.40||||462.40|323.68|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|462.40||||462.40|29.72|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|462.40||||462.40|30.64|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|||462.40||||462.40|346.8|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|462.40||||462.40|393.04|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|462.40||||462.40|323.68|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|462.40||||462.40|335.7|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|EQUITABLE [1355]|EQUITABLE INS [135500]|462.40||||462.40|323.68|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|CELTIC LIFE [1220]|CELTIC LIFE [122000]|462.40||||462.40|323.68|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|462.40||||462.40|335.7|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|462.40||||462.40|323.68|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|PHCS [1780]|PHCS MULTIPLAN [178000]|462.40||||462.40|323.68|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|PHCS [1780]|FREEDOM LIFE [178009]|462.40||||462.40|393.04|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|462.40||||462.40|323.68|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|462.40||||462.40|346.8|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|462.40||||462.40|393.04|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|462.40||||462.40|53.27|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|462.40||||462.40|323.68|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|462.40||||462.40|335.7|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|462.40||||462.40|30.64|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|462.40||||462.40|346.8|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|462.40||||462.40|346.8|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|MEDICA [2910]|MEDICA HARMONY [291000]|462.40||||462.40|323.68|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|462.40||||462.40|323.68|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|462.40||||462.40|263.57|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|GUARDIAN [1465]|GUARDIAN [146500]|462.40||||462.40|323.68|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|TML [1980]|TML [198000]|462.40||||462.40|283.45|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|TDH BCCS [2341]|TDH BCCS [234100]|462.40||||462.40|53.27|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|462.40||||462.40|231.2|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|462.40||||462.40|53.27|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|CBSA [1215]|CBSA [121500]|462.40||||462.40|323.68|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|462.40||||462.40|323.68|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|462.40||||462.40|323.68|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|462.40||||462.40|53.27|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|462.40||||462.40|323.68|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA [126008]|462.40||||462.40|335.7|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA PANTEX [126003]|462.40||||462.40|217.33|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|462.40||||462.40|323.68|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|AETNA [1015]|AETNA TRS [101506]|462.40||||462.40|300.56|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|462.40||||462.40|393.04|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|462.40||||462.40|393.04|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|462.40||||462.40|27.88|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|462.40||||462.40|393.04|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|462.40||||462.40|323.68|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|462.40||||462.40|335.7|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|462.40||||462.40|393.04|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|462.40||||462.40|346.8|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|462.40||||462.40|323.68|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|462.40||||462.40|231.2|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|462.40||||462.40|346.8|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|462.40||||462.40|393.04|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|462.40||||462.40|346.8|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|462.40||||462.40|323.68|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|462.40||||462.40|231.2|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|MAILHANDLERS [1595]|MAILHANDLERS [159500]|462.40||||462.40|346.8|393.04|27.88 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|462.40||||462.40||| 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|462.40||||462.40||| 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|462.40||||462.40||| 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|462.40||||462.40||| 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|462.40||||462.40||| 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|462.40||||462.40||| 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|462.40||||462.40||| 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|462.40||||462.40||| 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|462.40||||462.40||| 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|462.40||||462.40||| 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|462.40||||462.40||| 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|462.40||||462.40||| 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|462.40||||462.40||| 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|462.40||||462.40||| 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|462.40||||462.40||| 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|462.40||||462.40||| 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|462.40||||462.40||| 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|462.40||||462.40||| 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|462.40||||462.40||| 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|462.40||||462.40||| 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|UMR [2035]|UMR CHEROKEE MLR [203504]|462.40||||462.40||| 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|462.40||||462.40||| 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|462.40||||462.40||| 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|462.40||||462.40||| 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|462.40||||462.40||| 10581|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|METHYLPREDNISOLONE SODIUM SUCCINATE 500 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|462.40||||462.40||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|629.20||||629.20|314.6|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|629.20||||629.20|440.44|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|HEALTHNET [1495]|HEALTHNET [149500]|629.20||||629.20|471.9|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|629.20||||629.20|471.9|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|629.20||||629.20|314.6|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|629.20||||629.20|440.44|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|629.20||||629.20|471.9|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|629.20||||629.20|456.8|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|629.20||||629.20|440.44|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|629.20||||629.20|534.82|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|629.20||||629.20|6.96|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|629.20||||629.20|534.82|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|CIGNA [1260]|CIGNA [126008]|629.20||||629.20|456.8|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|629.20||||629.20|440.44|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|629.20||||629.20|72.48|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|629.20||||629.20|440.44|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|CBSA [1215]|CBSA [121500]|629.20||||629.20|440.44|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|629.20||||629.20|314.6|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|TDH BCCS [2341]|TDH BCCS [234100]|629.20||||629.20|72.48|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|TML [1980]|TML [198000]|629.20||||629.20|385.7|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|GUARDIAN [1465]|GUARDIAN [146500]|629.20||||629.20|440.44|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|629.20||||629.20|358.64|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|629.20||||629.20|471.9|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|629.20||||629.20|471.9|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|629.20||||629.20|6.32|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|629.20||||629.20|456.8|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|629.20||||629.20|440.44|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|629.20||||629.20|72.48|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|629.20||||629.20|534.82|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|PHCS [1780]|PHCS MULTIPLAN [178000]|629.20||||629.20|440.44|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|PHCS [1780]|FREEDOM LIFE [178009]|629.20||||629.20|534.82|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|629.20||||629.20|440.44|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|629.20||||629.20|456.8|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|CELTIC LIFE [1220]|CELTIC LIFE [122000]|629.20||||629.20|440.44|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|EQUITABLE [1355]|EQUITABLE INS [135500]|629.20||||629.20|440.44|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|CORESOURCE [1315]|CORESOURCE [131500]|629.20||||629.20|456.8|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|629.20||||629.20|440.44|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|||629.20||||629.20|471.9|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|629.20||||629.20|6.32|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|629.20||||629.20|440.44|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|629.20||||629.20|220.22|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|629.20||||629.20|264.26|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|629.20||||629.20|264.26|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|GROUP HEALTH [2165]|GROUP HEALTH [216500]|629.20||||629.20|534.82|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|629.20||||629.20|440.44|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|629.20||||629.20|295.72|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|629.20||||629.20|264.26|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|629.20||||629.20|471.9|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|629.20||||629.20|534.82|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|629.20||||629.20|320.89|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|629.20||||629.20|377.52|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|629.20||||629.20|14.88|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|629.20||||629.20|17.46|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|629.20||||629.20|534.82|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|629.20||||629.20|440.44|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|629.20||||629.20|269.3|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|629.20||||629.20|457.43|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|629.20||||629.20|385.7|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|629.20||||629.20|440.44|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|629.20||||629.20|440.44|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|TRUSTMARK [2030]|STARMARK [203000]|629.20||||629.20|471.9|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|629.20||||629.20|121.75|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|629.20||||629.20|471.9|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|629.20||||629.20|440.44|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|629.20||||629.20|209.71|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|629.20||||629.20|440.44|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|629.20||||629.20|314.6|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|629.20||||629.20|471.9|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|629.20||||629.20|534.82|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|629.20||||629.20|440.44|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|LEWER AGENCY [1565]|LEWER AGENCY [156500]|629.20||||629.20|440.44|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|MEDICA [2910]|MEDICA HARMONY [291000]|629.20||||629.20|440.44|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|CIGNA [1260]|CIGNA PANTEX [126003]|629.20||||629.20|295.72|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|WEB TPA [2115]|WEB TPA [211500]|629.20||||629.20|471.9|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|WEB TPA [2115]|WEB TPA [211501]|629.20||||629.20|440.44|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|629.20||||629.20|534.82|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|629.20||||629.20|314.6|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|UMR [2035]|UMR OPTIONS [203501]|629.20||||629.20|457.43|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|UMR [2035]|UMR CORE [203505]|629.20||||629.20|269.3|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|UMR [2035]|UMR CHOICE [203500]|629.20||||629.20|385.7|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|629.20||||629.20|72.48|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|629.20||||629.20|385.7|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|629.20||||629.20|534.82|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|GILSBAR [1425]|GILSBAR [142500]|629.20||||629.20|471.9|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|629.20||||629.20|534.82|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|629.20||||629.20|440.44|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|629.20||||629.20|534.82|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|629.20||||629.20|195.05|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|629.20||||629.20|440.44|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|MAILHANDLERS [1595]|MAILHANDLERS [159500]|629.20||||629.20|471.9|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|629.20||||629.20|471.9|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|629.20||||629.20|471.9|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|629.20||||629.20|440.44|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|AETNA TRS [101506]|629.20||||629.20|408.98|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|AMERICAN CONTINENTAL [101507]|629.20||||629.20|471.9|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|629.20||||629.20|534.82|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|629.20||||629.20|471.9|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|629.20||||629.20|121.75|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|NRECA [1735]|NRECA [173500]|629.20||||629.20|385.7|534.82|6.32 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|CHAMPVA [1240]|CHAMP VA [124000]|629.20||||629.20||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|629.20||||629.20||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|629.20||||629.20||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|629.20||||629.20||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|629.20||||629.20||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|629.20||||629.20||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|629.20||||629.20||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|629.20||||629.20||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|629.20||||629.20||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|629.20||||629.20||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|629.20||||629.20||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|629.20||||629.20||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|629.20||||629.20||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|629.20||||629.20||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|629.20||||629.20||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|629.20||||629.20||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|629.20||||629.20||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|629.20||||629.20||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|629.20||||629.20||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|629.20||||629.20||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|629.20||||629.20||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|UMR [2035]|UMR CHEROKEE MLR [203504]|629.20||||629.20||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|629.20||||629.20||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|629.20||||629.20||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|629.20||||629.20||| 105902|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|629.20||||629.20||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|NRECA [1735]|NRECA [173500]|944.08||||944.08|578.72|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|944.08||||944.08|708.06|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|944.08||||944.08|802.47|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|AMERICAN CONTINENTAL [101507]|944.08||||944.08|708.06|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|944.08||||944.08|660.86|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|944.08||||944.08|708.06|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|944.08||||944.08|708.06|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|944.08||||944.08|660.86|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|944.08||||944.08|292.66|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|944.08||||944.08|802.47|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|GILSBAR [1425]|GILSBAR [142500]|944.08||||944.08|708.06|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|944.08||||944.08|578.72|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|944.08||||944.08|108.76|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|UMR [2035]|UMR CORE [203505]|944.08||||944.08|404.07|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|UMR [2035]|UMR CHOICE [203500]|944.08||||944.08|578.72|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|944.08||||944.08|472.04|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|WEB TPA [2115]|WEB TPA [211501]|944.08||||944.08|660.86|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|WEB TPA [2115]|WEB TPA [211500]|944.08||||944.08|708.06|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|MEDICA [2910]|MEDICA HARMONY [291000]|944.08||||944.08|660.86|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|LEWER AGENCY [1565]|LEWER AGENCY [156500]|944.08||||944.08|660.86|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|944.08||||944.08|708.06|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|944.08||||944.08|472.04|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|944.08||||944.08|660.86|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|944.08||||944.08|314.66|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|944.08||||944.08|708.06|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|944.08||||944.08|182.68|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|944.08||||944.08|660.86|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|TRUSTMARK [2030]|STARMARK [203000]|944.08||||944.08|708.06|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|944.08||||944.08|660.86|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|944.08||||944.08|686.35|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|944.08||||944.08|578.72|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|944.08||||944.08|660.86|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|944.08||||944.08|802.47|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|944.08||||944.08|26.2|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|944.08||||944.08|22.32|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|944.08||||944.08|566.45|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|944.08||||944.08|802.47|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|944.08||||944.08|396.51|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|944.08||||944.08|443.72|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|944.08||||944.08|660.86|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|944.08||||944.08|330.43|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|GROUP HEALTH [2165]|GROUP HEALTH [216500]|944.08||||944.08|802.47|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|944.08||||944.08|396.51|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|944.08||||944.08|396.51|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|944.08||||944.08|708.06|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|944.08||||944.08|660.86|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|944.08||||944.08|9.48|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|||944.08||||944.08|708.06|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|944.08||||944.08|481.48|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|944.08||||944.08|660.86|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|CORESOURCE [1315]|CORESOURCE [131500]|944.08||||944.08|685.4|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|EQUITABLE [1355]|EQUITABLE INS [135500]|944.08||||944.08|660.86|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|944.08||||944.08|404.07|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|CELTIC LIFE [1220]|CELTIC LIFE [122000]|944.08||||944.08|660.86|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|944.08||||944.08|685.4|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|944.08||||944.08|660.86|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|PHCS [1780]|FREEDOM LIFE [178009]|944.08||||944.08|802.47|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|PHCS [1780]|PHCS MULTIPLAN [178000]|944.08||||944.08|660.86|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|944.08||||944.08|802.47|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|944.08||||944.08|108.76|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|944.08||||944.08|660.86|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|944.08||||944.08|685.4|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|944.08||||944.08|9.48|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|944.08||||944.08|708.06|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|944.08||||944.08|708.06|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|944.08||||944.08|660.86|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|944.08||||944.08|802.47|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|944.08||||944.08|538.13|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|GUARDIAN [1465]|GUARDIAN [146500]|944.08||||944.08|660.86|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|TML [1980]|TML [198000]|944.08||||944.08|578.72|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|UMR [2035]|UMR OPTIONS [203501]|944.08||||944.08|686.35|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|TDH BCCS [2341]|TDH BCCS [234100]|944.08||||944.08|108.76|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|944.08||||944.08|472.04|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|CBSA [1215]|CBSA [121500]|944.08||||944.08|660.86|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|944.08||||944.08|660.86|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|944.08||||944.08|802.47|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|944.08||||944.08|660.86|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|944.08||||944.08|108.76|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|944.08||||944.08|660.86|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|944.08||||944.08|660.86|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|CIGNA [1260]|CIGNA PANTEX [126003]|944.08||||944.08|443.72|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|CIGNA [1260]|CIGNA [126008]|944.08||||944.08|685.4|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|944.08||||944.08|802.47|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|944.08||||944.08|802.47|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|AETNA TRS [101506]|944.08||||944.08|613.65|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|944.08||||944.08|10.44|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|944.08||||944.08|802.47|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|944.08||||944.08|660.86|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|944.08||||944.08|182.68|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|944.08||||944.08|685.4|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|944.08||||944.08|708.06|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|944.08||||944.08|660.86|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|944.08||||944.08|472.04|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|944.08||||944.08|708.06|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|944.08||||944.08|802.47|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|HEALTHNET [1495]|HEALTHNET [149500]|944.08||||944.08|708.06|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|944.08||||944.08|660.86|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|944.08||||944.08|472.04|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|MAILHANDLERS [1595]|MAILHANDLERS [159500]|944.08||||944.08|708.06|802.47|9.48 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|944.08||||944.08||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|944.08||||944.08||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|944.08||||944.08||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|UMR [2035]|UMR CHEROKEE MLR [203504]|944.08||||944.08||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|944.08||||944.08||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|944.08||||944.08||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|944.08||||944.08||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|944.08||||944.08||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|944.08||||944.08||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|944.08||||944.08||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|944.08||||944.08||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|944.08||||944.08||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|944.08||||944.08||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|944.08||||944.08||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|944.08||||944.08||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|944.08||||944.08||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|944.08||||944.08||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|944.08||||944.08||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|944.08||||944.08||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|944.08||||944.08||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|944.08||||944.08||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|944.08||||944.08||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|944.08||||944.08||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|944.08||||944.08||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|CHAMPVA [1240]|CHAMP VA [124000]|944.08||||944.08||| 105904|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYRINGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|944.08||||944.08||| 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|MAILHANDLERS [1595]|MAILHANDLERS [159500]|6004.00||||6004.00|4503|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|6004.00||||6004.00|3002|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|6004.00||||6004.00|4503|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|6004.00||||6004.00|5103.4|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|6004.00||||6004.00|4503|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|6004.00||||6004.00|3002|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|6004.00||||6004.00|4202.8|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6004.00||||6004.00|199.52|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|6004.00||||6004.00|4503|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|6004.00||||6004.00|195.53|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6004.00||||6004.00|199.52|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|6004.00||||6004.00|4202.8|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|6004.00||||6004.00|576.32|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|6004.00||||6004.00|5103.4|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|6004.00||||6004.00|5103.4|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|6004.00||||6004.00|199.52|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA PANTEX [126003]|6004.00||||6004.00|2821.88|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|6004.00||||6004.00|4202.8|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|6004.00||||6004.00|691.66|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|6004.00||||6004.00|4202.8|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|6004.00||||6004.00|4202.8|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|CBSA [1215]|CBSA [121500]|6004.00||||6004.00|4202.8|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|TDH BCCS [2341]|TDH BCCS [234100]|6004.00||||6004.00|691.66|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|TML [1980]|TML [198000]|6004.00||||6004.00|3680.45|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6004.00||||6004.00|199.52|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|6004.00||||6004.00|3422.28|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|6004.00||||6004.00|4202.8|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|6004.00||||6004.00|307.52|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|6004.00||||6004.00|4503|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6004.00||||6004.00|4503|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|6004.00||||6004.00|199.52|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|6004.00||||6004.00|260.88|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|6004.00||||6004.00|4358.9|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|6004.00||||6004.00|4202.8|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|6004.00||||6004.00|691.66|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|6004.00||||6004.00|5103.4|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|PHCS [1780]|PHCS MULTIPLAN [178000]|6004.00||||6004.00|4202.8|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|6004.00||||6004.00|4202.8|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6004.00||||6004.00|4358.9|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|CELTIC LIFE [1220]|CELTIC LIFE [122000]|6004.00||||6004.00|4202.8|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6004.00||||6004.00|199.52|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|EQUITABLE [1355]|EQUITABLE INS [135500]|6004.00||||6004.00|4202.8|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|6004.00||||6004.00|199.52|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|6004.00||||6004.00|199.52|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|6004.00||||6004.00|4202.8|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|||6004.00||||6004.00|4503|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|6004.00||||6004.00|260.88|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|6004.00||||6004.00|4503|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|6004.00||||6004.00|4202.8|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|6004.00||||6004.00|448.91|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|6004.00||||6004.00|2521.68|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|6004.00||||6004.00|2521.68|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|6004.00||||6004.00|199.52|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|GROUP HEALTH [2165]|GROUP HEALTH [216500]|6004.00||||6004.00|5103.4|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|6004.00||||6004.00|4202.8|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|6004.00||||6004.00|2821.88|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|6004.00||||6004.00|2101.4|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|6004.00||||6004.00|2521.68|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6004.00||||6004.00|199.52|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|6004.00||||6004.00|5103.4|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|6004.00||||6004.00|3062.04|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|6004.00||||6004.00|3602.4|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|6004.00||||6004.00|1023.36|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|6004.00||||6004.00|1202.77|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|6004.00||||6004.00|5103.4|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|6004.00||||6004.00|4358.9|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|6004.00||||6004.00|203.51|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|6004.00||||6004.00|4202.8|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|6004.00||||6004.00|4364.91|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|6004.00||||6004.00|3680.45|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|PHCS [1780]|FREEDOM LIFE [178009]|6004.00||||6004.00|5103.4|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|6004.00||||6004.00|2569.71|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|6004.00||||6004.00|199.52|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|6004.00||||6004.00|199.52|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|6004.00||||6004.00|4202.8|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|6004.00||||6004.00|4202.8|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|6004.00||||6004.00|4503|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|6004.00||||6004.00|1161.77|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|6004.00||||6004.00|4503|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|6004.00||||6004.00|199.52|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6004.00||||6004.00|2001.13|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6004.00||||6004.00|199.52|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|GUARDIAN [1465]|GUARDIAN [146500]|6004.00||||6004.00|4202.8|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|6004.00||||6004.00|4202.8|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|6004.00||||6004.00|3002|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|6004.00||||6004.00|3002|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|6004.00||||6004.00|199.52|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|6004.00||||6004.00|199.52|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|6004.00||||6004.00|4503|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|6004.00||||6004.00|5103.4|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|LEWER AGENCY [1565]|LEWER AGENCY [156500]|6004.00||||6004.00|4202.8|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|MEDICA [2910]|MEDICA HARMONY [291000]|6004.00||||6004.00|4202.8|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA [126008]|6004.00||||6004.00|4358.9|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|WEB TPA [2115]|WEB TPA [211501]|6004.00||||6004.00|4202.8|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|WEB TPA [2115]|WEB TPA [211500]|6004.00||||6004.00|4503|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|6004.00||||6004.00|3002|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|6004.00||||6004.00|4364.91|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|UMR [2035]|UMR CHEROKEE MLR [203504]|6004.00||||6004.00|199.52|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|UMR [2035]|UMR CHOICE [203500]|6004.00||||6004.00|3680.45|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|UMR [2035]|UMR CORE [203505]|6004.00||||6004.00|2569.71|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|6004.00||||6004.00|691.66|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|6004.00||||6004.00|5103.4|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|6004.00||||6004.00|4358.9|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|6004.00||||6004.00|3680.45|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|6004.00||||6004.00|5103.4|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|GILSBAR [1425]|GILSBAR [142500]|6004.00||||6004.00|4503|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|6004.00||||6004.00|5103.4|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|6004.00||||6004.00|199.52|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|6004.00||||6004.00|4202.8|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|6004.00||||6004.00|1861.24|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|6004.00||||6004.00|4202.8|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|6004.00||||6004.00|4202.8|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|6004.00||||6004.00|4503|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|6004.00||||6004.00|4503|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|6004.00||||6004.00|4202.8|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|AETNA [1015]|AETNA TRS [101506]|6004.00||||6004.00|3902.6|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|6004.00||||6004.00|203.51|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|AETNA [1015]|AMERICAN CONTINENTAL [101507]|6004.00||||6004.00|4503|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6004.00||||6004.00|199.52|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|6004.00||||6004.00|5103.4|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|6004.00||||6004.00|4503|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|6004.00||||6004.00|1161.77|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|NRECA [1735]|NRECA [173500]|6004.00||||6004.00|3680.45|5103.4|195.53 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|6004.00||||6004.00||| 10630|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 20 MG INTRAVENOUS SOLUTION|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|6004.00||||6004.00||| 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|NRECA [1735]|NRECA [173500]|2311.07||||2311.07|1416.69|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|2311.07||||2311.07|447.19|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|2311.07||||2311.07|1733.3|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|2311.07||||2311.07|1964.41|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2311.07||||2311.07|49.88|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|AETNA [1015]|AETNA TRS [101506]|2311.07||||2311.07|1502.2|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2311.07||||2311.07|50.88|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2311.07||||2311.07|1617.75|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|2311.07||||2311.07|1733.3|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|2311.07||||2311.07|1733.3|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|2311.07||||2311.07|716.43|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|2311.07||||2311.07|1617.75|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|2311.07||||2311.07|49.88|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|GILSBAR [1425]|GILSBAR [142500]|2311.07||||2311.07|1733.3|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|2311.07||||2311.07|1964.41|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|2311.07||||2311.07|1416.69|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2311.07||||2311.07|266.24|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|UMR [2035]|UMR CHEROKEE MLR [203504]|2311.07||||2311.07|49.88|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|UMR [2035]|UMR CORE [203505]|2311.07||||2311.07|989.14|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|UMR [2035]|UMR CHOICE [203500]|2311.07||||2311.07|1416.69|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|2311.07||||2311.07|1155.54|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|WEB TPA [2115]|WEB TPA [211501]|2311.07||||2311.07|1617.75|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|WEB TPA [2115]|WEB TPA [211500]|2311.07||||2311.07|1733.3|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|LEWER AGENCY [1565]|LEWER AGENCY [156500]|2311.07||||2311.07|1617.75|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|2311.07||||2311.07|1964.41|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|2311.07||||2311.07|1733.3|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|2311.07||||2311.07|1155.54|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|2311.07||||2311.07|49.88|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|2311.07||||2311.07|1617.75|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2311.07||||2311.07|49.88|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2311.07||||2311.07|770.28|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|2311.07||||2311.07|49.88|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|2311.07||||2311.07|447.19|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|2311.07||||2311.07|1617.75|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|2311.07||||2311.07|1733.3|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|2311.07||||2311.07|49.88|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|2311.07||||2311.07|49.88|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|2311.07||||2311.07|1416.69|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|2311.07||||2311.07|1680.15|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|2311.07||||2311.07|1617.75|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|2311.07||||2311.07|1964.41|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|2311.07||||2311.07|1178.65|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|2311.07||||2311.07|255.84|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|2311.07||||2311.07|300.69|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|2311.07||||2311.07|1964.41|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2311.07||||2311.07|49.88|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2311.07||||2311.07|970.65|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|2311.07||||2311.07|1617.75|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|GROUP HEALTH [2165]|GROUP HEALTH [216500]|2311.07||||2311.07|1964.41|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|2311.07||||2311.07|49.88|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|2311.07||||2311.07|112.23|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|2311.07||||2311.07|808.87|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|2311.07||||2311.07|1086.2|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|2311.07||||2311.07|970.65|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|2311.07||||2311.07|970.65|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|2311.07||||2311.07|1617.75|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|2311.07||||2311.07|1733.3|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|2311.07||||2311.07|65.22|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|||2311.07||||2311.07|1733.3|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|2311.07||||2311.07|1386.64|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2311.07||||2311.07|1617.75|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|2311.07||||2311.07|49.88|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|2311.07||||2311.07|49.88|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|2311.07||||2311.07|1677.84|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|2311.07||||2311.07|989.14|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|EQUITABLE [1355]|EQUITABLE INS [135500]|2311.07||||2311.07|1617.75|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2311.07||||2311.07|49.88|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|CELTIC LIFE [1220]|CELTIC LIFE [122000]|2311.07||||2311.07|1617.75|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|2311.07||||2311.07|50.88|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|2311.07||||2311.07|1617.75|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2311.07||||2311.07|1677.84|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|2311.07||||2311.07|1617.75|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|2311.07||||2311.07|1733.3|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|PHCS [1780]|PHCS MULTIPLAN [178000]|2311.07||||2311.07|1617.75|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|PHCS [1780]|FREEDOM LIFE [178009]|2311.07||||2311.07|1964.41|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|2311.07||||2311.07|1964.41|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|2311.07||||2311.07|266.24|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|2311.07||||2311.07|1617.75|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|2311.07||||2311.07|1677.84|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|2311.07||||2311.07|49.88|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|2311.07||||2311.07|65.22|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|2311.07||||2311.07|49.88|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2311.07||||2311.07|1733.3|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2311.07||||2311.07|1733.3|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|MEDICA [2910]|MEDICA HARMONY [291000]|2311.07||||2311.07|1617.75|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|2311.07||||2311.07|76.88|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|2311.07||||2311.07|1617.75|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|2311.07||||2311.07|1317.31|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|GUARDIAN [1465]|GUARDIAN [146500]|2311.07||||2311.07|1617.75|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|2311.07||||2311.07|1680.15|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2311.07||||2311.07|49.88|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|TML [1980]|TML [198000]|2311.07||||2311.07|1416.69|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|TDH BCCS [2341]|TDH BCCS [234100]|2311.07||||2311.07|266.24|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|2311.07||||2311.07|1155.54|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|CBSA [1215]|CBSA [121500]|2311.07||||2311.07|1617.75|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|2311.07||||2311.07|1617.75|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|2311.07||||2311.07|1617.75|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|2311.07||||2311.07|266.24|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|2311.07||||2311.07|1964.41|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|2311.07||||2311.07|1617.75|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|2311.07||||2311.07|1617.75|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|2311.07||||2311.07|49.88|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA [126008]|2311.07||||2311.07|1677.84|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA PANTEX [126003]|2311.07||||2311.07|1086.2|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|AETNA [1015]|AMERICAN CONTINENTAL [101507]|2311.07||||2311.07|1733.3|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|2311.07||||2311.07|1964.41|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|2311.07||||2311.07|1964.41|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|2311.07||||2311.07|144.08|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2311.07||||2311.07|1964.41|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|2311.07||||2311.07|1617.75|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2311.07||||2311.07|49.88|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|2311.07||||2311.07|48.88|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|2311.07||||2311.07|1677.84|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|2311.07||||2311.07|1733.3|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2311.07||||2311.07|49.88|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|2311.07||||2311.07|1617.75|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|2311.07||||2311.07|1155.54|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|2311.07||||2311.07|1733.3|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2311.07||||2311.07|1964.41|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|2311.07||||2311.07|1733.3|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|2311.07||||2311.07|1617.75|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|2311.07||||2311.07|1155.54|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|MAILHANDLERS [1595]|MAILHANDLERS [159500]|2311.07||||2311.07|1733.3|1964.41|48.88 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|2311.07||||2311.07||| 10632|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|MITOMYCIN 5 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|2311.07||||2311.07||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|MAILHANDLERS [1595]|MAILHANDLERS [159500]|23.00||||23.00|17.25|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|23.00||||23.00|11.5|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|23.00||||23.00|11.5|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|23.00||||23.00|16.1|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|HEALTHNET [1495]|HEALTHNET [149500]|23.00||||23.00|17.25|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|HEALTHNET [1495]|HEALTHNET [149500]|23.00||||23.00|17.25|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|23.00||||23.00|19.55|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|23.00||||23.00|17.25|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|23.00||||23.00|17.25|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|23.00||||23.00|11.5|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|23.00||||23.00|11.5|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|23.00||||23.00|16.1|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|23.00||||23.00|16.1|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|23.00||||23.00|17.25|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|23.00||||23.00|17.25|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|23.00||||23.00|16.7|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|23.00||||23.00|16.1|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|23.00||||23.00|16.1|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|23.00||||23.00|19.55|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|23.00||||23.00|19.55|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|23.00||||23.00|0.32|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|23.00||||23.00|0.32|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|23.00||||23.00|19.55|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|23.00||||23.00|19.55|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|23.00||||23.00|19.55|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|CIGNA [1260]|CIGNA [126008]|23.00||||23.00|16.7|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|CIGNA [1260]|CIGNA [126008]|23.00||||23.00|16.7|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|23.00||||23.00|16.1|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|23.00||||23.00|16.1|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|23.00||||23.00|2.65|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|23.00||||23.00|2.65|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|23.00||||23.00|16.1|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|23.00||||23.00|16.1|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|23.00||||23.00|16.1|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|CBSA [1215]|CBSA [121500]|23.00||||23.00|16.1|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|CBSA [1215]|CBSA [121500]|23.00||||23.00|16.1|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|23.00||||23.00|11.5|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|TDH BCCS [2341]|TDH BCCS [234100]|23.00||||23.00|2.65|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|TDH BCCS [2341]|TDH BCCS [234100]|23.00||||23.00|2.65|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|TML [1980]|TML [198000]|23.00||||23.00|14.1|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|GUARDIAN [1465]|GUARDIAN [146500]|23.00||||23.00|16.1|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|GUARDIAN [1465]|GUARDIAN [146500]|23.00||||23.00|16.1|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|23.00||||23.00|13.11|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|23.00||||23.00|13.11|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|23.00||||23.00|16.1|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|23.00||||23.00|17.25|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|23.00||||23.00|17.25|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|23.00||||23.00|17.25|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|23.00||||23.00|0.44|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|23.00||||23.00|0.44|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|23.00||||23.00|16.7|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|23.00||||23.00|16.7|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|23.00||||23.00|16.1|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|23.00||||23.00|16.1|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|23.00||||23.00|2.65|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|23.00||||23.00|19.55|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|23.00||||23.00|19.55|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|PHCS [1780]|FREEDOM LIFE [178009]|23.00||||23.00|19.55|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|PHCS [1780]|PHCS MULTIPLAN [178000]|23.00||||23.00|16.1|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|PHCS [1780]|FREEDOM LIFE [178009]|23.00||||23.00|19.55|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|23.00||||23.00|16.1|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|23.00||||23.00|16.7|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|23.00||||23.00|16.7|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|CELTIC LIFE [1220]|CELTIC LIFE [122000]|23.00||||23.00|16.1|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|CELTIC LIFE [1220]|CELTIC LIFE [122000]|23.00||||23.00|16.1|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|EQUITABLE [1355]|EQUITABLE INS [135500]|23.00||||23.00|16.1|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|EQUITABLE [1355]|EQUITABLE INS [135500]|23.00||||23.00|16.1|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|CORESOURCE [1315]|CORESOURCE [131500]|23.00||||23.00|16.7|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|23.00||||23.00|16.1|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|23.00||||23.00|16.1|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|||23.00||||23.00|17.25|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|||23.00||||23.00|17.25|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|23.00||||23.00|0.44|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|23.00||||23.00|0.44|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|23.00||||23.00|17.25|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|23.00||||23.00|17.25|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|23.00||||23.00|16.1|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|23.00||||23.00|8.05|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|23.00||||23.00|9.66|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|23.00||||23.00|9.66|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|23.00||||23.00|9.66|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|GROUP HEALTH [2165]|GROUP HEALTH [216500]|23.00||||23.00|19.55|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|GROUP HEALTH [2165]|GROUP HEALTH [216500]|23.00||||23.00|19.55|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|23.00||||23.00|16.1|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|23.00||||23.00|10.81|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|23.00||||23.00|10.81|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|23.00||||23.00|9.66|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|23.00||||23.00|16.1|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|23.00||||23.00|9.66|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|23.00||||23.00|19.55|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|23.00||||23.00|19.55|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|23.00||||23.00|11.73|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|23.00||||23.00|11.73|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|23.00||||23.00|6.96|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|23.00||||23.00|9.66|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|23.00||||23.00|13.8|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|23.00||||23.00|6.96|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|23.00||||23.00|5.92|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|23.00||||23.00|5.92|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|23.00||||23.00|8.05|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|23.00||||23.00|13.8|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|23.00||||23.00|19.55|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|23.00||||23.00|16.1|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|23.00||||23.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|CHAMPVA [1240]|CHAMP VA [124000]|23.00||||23.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|CHAMPVA [1240]|CHAMP VA [124000]|23.00||||23.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|23.00||||23.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|CIGNA [1260]|CIGNA PANTEX [126003]|23.00||||23.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|23.00||||23.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|23.00||||23.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|23.00||||23.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|23.00||||23.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|23.00||||23.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|23.00||||23.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|23.00||||23.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|23.00||||23.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|23.00||||23.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|23.00||||23.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|23.00||||23.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|23.00||||23.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|23.00||||23.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|23.00||||23.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|23.00||||23.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|23.00||||23.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|23.00||||23.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|23.00||||23.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|23.00||||23.00|19.55|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|23.00||||23.00|16.1|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|23.00||||23.00|16.1|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|23.00||||23.00|9.84|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|23.00||||23.00|14.1|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|23.00||||23.00|16.72|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|23.00||||23.00|16.72|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|23.00||||23.00|14.1|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|23.00||||23.00|9.84|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|CORESOURCE [1315]|CORESOURCE [131500]|23.00||||23.00|16.7|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|23.00||||23.00|16.1|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|23.00||||23.00|16.1|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|TRUSTMARK [2030]|STARMARK [203000]|23.00||||23.00|17.25|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|23.00||||23.00|16.1|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|TRUSTMARK [2030]|STARMARK [203000]|23.00||||23.00|17.25|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|23.00||||23.00|16.1|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|23.00||||23.00|4.45|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|23.00||||23.00|16.1|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|PHCS [1780]|PHCS MULTIPLAN [178000]|23.00||||23.00|16.1|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|23.00||||23.00|4.45|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|23.00||||23.00|17.25|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|23.00||||23.00|17.25|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|23.00||||23.00|2.65|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|23.00||||23.00|7.67|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|23.00||||23.00|7.67|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|23.00||||23.00|16.1|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|23.00||||23.00|16.1|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|23.00||||23.00|11.5|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|23.00||||23.00|17.25|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|23.00||||23.00|16.1|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|23.00||||23.00|11.5|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|23.00||||23.00|17.25|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|23.00||||23.00|17.25|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|23.00||||23.00|19.55|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|23.00||||23.00|19.55|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|LEWER AGENCY [1565]|LEWER AGENCY [156500]|23.00||||23.00|16.1|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|TML [1980]|TML [198000]|23.00||||23.00|14.1|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|LEWER AGENCY [1565]|LEWER AGENCY [156500]|23.00||||23.00|16.1|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|MEDICA [2910]|MEDICA HARMONY [291000]|23.00||||23.00|16.1|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|MEDICA [2910]|MEDICA HARMONY [291000]|23.00||||23.00|16.1|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|WEB TPA [2115]|WEB TPA [211500]|23.00||||23.00|17.25|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|23.00||||23.00|11.5|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|WEB TPA [2115]|WEB TPA [211500]|23.00||||23.00|17.25|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|WEB TPA [2115]|WEB TPA [211501]|23.00||||23.00|16.1|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|WEB TPA [2115]|WEB TPA [211501]|23.00||||23.00|16.1|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|23.00||||23.00|11.5|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|23.00||||23.00|16.1|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|23.00||||23.00|11.5|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|UMR [2035]|UMR CORE [203505]|23.00||||23.00|9.84|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|UMR [2035]|UMR OPTIONS [203501]|23.00||||23.00|16.72|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|UMR [2035]|UMR CORE [203505]|23.00||||23.00|9.84|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|UMR [2035]|UMR OPTIONS [203501]|23.00||||23.00|16.72|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|UMR [2035]|UMR CHOICE [203500]|23.00||||23.00|14.1|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|UMR [2035]|UMR CHOICE [203500]|23.00||||23.00|14.1|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|23.00||||23.00|2.65|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|23.00||||23.00|2.65|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|23.00||||23.00|14.1|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|23.00||||23.00|19.55|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|23.00||||23.00|14.1|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|23.00||||23.00|19.55|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|23.00||||23.00|19.55|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|GILSBAR [1425]|GILSBAR [142500]|23.00||||23.00|17.25|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|GILSBAR [1425]|GILSBAR [142500]|23.00||||23.00|17.25|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|23.00||||23.00|19.55|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|23.00||||23.00|19.55|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|23.00||||23.00|16.1|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|23.00||||23.00|16.1|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|23.00||||23.00|7.13|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|23.00||||23.00|16.7|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|23.00||||23.00|7.13|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|23.00||||23.00|16.1|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|23.00||||23.00|16.1|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|23.00||||23.00|17.25|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|23.00||||23.00|17.25|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|23.00||||23.00|17.25|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|23.00||||23.00|17.25|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|23.00||||23.00|16.1|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|23.00||||23.00|19.55|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|23.00||||23.00|16.1|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|AETNA [1015]|AETNA TRS [101506]|23.00||||23.00|14.95|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|23.00||||23.00|16.1|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|AETNA [1015]|AMERICAN CONTINENTAL [101507]|23.00||||23.00|17.25|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|AETNA [1015]|AMERICAN CONTINENTAL [101507]|23.00||||23.00|17.25|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|AETNA [1015]|AETNA TRS [101506]|23.00||||23.00|14.95|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|MAILHANDLERS [1595]|MAILHANDLERS [159500]|23.00||||23.00|17.25|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|23.00||||23.00|19.55|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|23.00||||23.00|19.55|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|FMH BENEFIT SERVICES [1390]|FMH [139000]|23.00||||23.00|17.25|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|FMH BENEFIT SERVICES [1390]|FMH [139000]|23.00||||23.00|17.25|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|23.00||||23.00|4.45|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|23.00||||23.00|4.45|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|NRECA [1735]|NRECA [173500]|23.00||||23.00|14.1|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|NRECA [1735]|NRECA [173500]|23.00||||23.00|14.1|19.55|0.32 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|23.00||||23.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|23.00||||23.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|23.00||||23.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|23.00||||23.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|23.00||||23.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|23.00||||23.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|23.00||||23.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|23.00||||23.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|23.00||||23.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|23.00||||23.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|23.00||||23.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|23.00||||23.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|23.00||||23.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|23.00||||23.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|23.00||||23.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|23.00||||23.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|23.00||||23.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|23.00||||23.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|23.00||||23.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|UMR [2035]|UMR CHEROKEE MLR [203504]|23.00||||23.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|UMR [2035]|UMR CHEROKEE MLR [203504]|23.00||||23.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|23.00||||23.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|CIGNA [1260]|CIGNA PANTEX [126003]|23.00||||23.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|23.00||||23.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|23.00||||23.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|23.00||||23.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|23.00||||23.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|23.00||||23.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|23.00||||23.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|23.00||||23.00||| 106348|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION *2 ML VIAL*|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|23.00||||23.00||| 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|5.00||||5.00|0.22|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5.00||||5.00|3.75|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5.00||||5.00|3.75|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|5.00||||5.00|3.5|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|5.00||||5.00|2.85|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|TML [1980]|TML [198000]|5.00||||5.00|3.07|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|TDH BCCS [2341]|TDH BCCS [234100]|5.00||||5.00|0.58|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|CBSA [1215]|CBSA [121500]|5.00||||5.00|3.5|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|5.00||||5.00|3.5|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|5.00||||5.00|3.5|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|5.00||||5.00|0.58|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|5.00||||5.00|3.5|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|5.00||||5.00|2.5|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|CIGNA [1260]|CIGNA [126008]|5.00||||5.00|3.63|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|5.00||||5.00|4.25|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|5.00||||5.00|4.25|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|5.00||||5.00|0.16|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|GUARDIAN [1465]|GUARDIAN [146500]|5.00||||5.00|3.5|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5.00||||5.00|4.25|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|5.00||||5.00|3.5|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|5.00||||5.00|3.63|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|5.00||||5.00|3.63|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|5.00||||5.00|3.75|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|5.00||||5.00|3.5|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|5.00||||5.00|2.5|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|5.00||||5.00|3.75|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5.00||||5.00|4.25|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|HEALTHNET [1495]|HEALTHNET [149500]|5.00||||5.00|3.75|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|5.00||||5.00|3.5|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|5.00||||5.00|2.5|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|MAILHANDLERS [1595]|MAILHANDLERS [159500]|5.00||||5.00|3.75|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|WEB TPA [2115]|WEB TPA [211501]|5.00||||5.00|3.5|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|FMH BENEFIT SERVICES [1390]|FMH [139000]|5.00||||5.00|3.75|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5.00||||5.00|3.5|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|5.00||||5.00|3|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|5.00||||5.00|3.75|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|5.00||||5.00|4.25|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|5.00||||5.00|3.75|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5.00||||5.00|1.67|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|TRUSTMARK [2030]|STARMARK [203000]|5.00||||5.00|3.75|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|5.00||||5.00|2.96|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|GILSBAR [1425]|GILSBAR [142500]|5.00||||5.00|3.75|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|5.00||||5.00|3.5|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|5.00||||5.00|3.5|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|PHCS [1780]|FREEDOM LIFE [178009]|5.00||||5.00|4.25|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|5.00||||5.00|3.5|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|5.00||||5.00|3.48|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|5.00||||5.00|4.25|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|5.00||||5.00|0.58|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|5.00||||5.00|4.25|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|NRECA [1735]|NRECA [173500]|5.00||||5.00|3.07|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|5.00||||5.00|2.1|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5.00||||5.00|3.63|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|5.00||||5.00|3.75|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|5.00||||5.00|3.75|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|5.00||||5.00|2.55|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|5.00||||5.00|0.58|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|5.00||||5.00|2.5|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|5.00||||5.00|4.25|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|5.00||||5.00|4.25|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|5.00||||5.00|4.25|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|UMR [2035]|UMR OPTIONS [203501]|5.00||||5.00|3.64|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|GROUP HEALTH [2165]|GROUP HEALTH [216500]|5.00||||5.00|4.25|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|5.00||||5.00|3.75|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|5.00||||5.00|0.97|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|EQUITABLE [1355]|EQUITABLE INS [135500]|5.00||||5.00|3.5|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|5.00||||5.00|3.5|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|5.00||||5.00|3.5|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|5.00||||5.00|3.5|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|WEB TPA [2115]|WEB TPA [211500]|5.00||||5.00|3.75|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|5.00||||5.00|3.64|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|||5.00||||5.00|3.75|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|5.00||||5.00|3.5|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|PHCS [1780]|PHCS MULTIPLAN [178000]|5.00||||5.00|3.5|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|5.00||||5.00|3.5|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|5.00||||5.00|3.5|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|5.00||||5.00|2.1|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|5.00||||5.00|2.5|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|5.00||||5.00|2.35|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|LEWER AGENCY [1565]|LEWER AGENCY [156500]|5.00||||5.00|3.5|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5.00||||5.00|2.1|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|5.00||||5.00|3.5|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|UMR [2035]|UMR CHOICE [203500]|5.00||||5.00|3.07|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|5.00||||5.00|3.07|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|5.00||||5.00|1.55|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|5.00||||5.00|3.07|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|AETNA [1015]|AMERICAN CONTINENTAL [101507]|5.00||||5.00|3.75|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|5.00||||5.00|1.75|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5.00||||5.00|3.5|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|UMR [2035]|UMR CORE [203505]|5.00||||5.00|2.14|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|MEDICA [2910]|MEDICA HARMONY [291000]|5.00||||5.00|3.5|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|5.00||||5.00|4.25|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|CELTIC LIFE [1220]|CELTIC LIFE [122000]|5.00||||5.00|3.5|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|AETNA [1015]|AETNA TRS [101506]|5.00||||5.00|3.25|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|5.00||||5.00|0.22|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|CORESOURCE [1315]|CORESOURCE [131500]|5.00||||5.00|3.63|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|5.00||||5.00|2.14|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|5.00||||5.00|0.97|4.25|0.16 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|5.00||||5.00||| 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|5.00||||5.00||| 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5.00||||5.00||| 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|CIGNA [1260]|CIGNA PANTEX [126003]|5.00||||5.00||| 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|5.00||||5.00||| 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5.00||||5.00||| 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|CHAMPVA [1240]|CHAMP VA [124000]|5.00||||5.00||| 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5.00||||5.00||| 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|5.00||||5.00||| 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|5.00||||5.00||| 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5.00||||5.00||| 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5.00||||5.00||| 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|5.00||||5.00||| 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|5.00||||5.00||| 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|5.00||||5.00||| 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|5.00||||5.00||| 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|5.00||||5.00||| 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|5.00||||5.00||| 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|5.00||||5.00||| 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5.00||||5.00||| 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5.00||||5.00||| 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5.00||||5.00||| 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|5.00||||5.00||| 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|5.00||||5.00||| 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|5.00||||5.00||| 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|UMR [2035]|UMR CHEROKEE MLR [203504]|5.00||||5.00||| 106349|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION REPACK|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|5.00||||5.00||| 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|5310.00||||5310.00|3982.5|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|5310.00||||5310.00|1176.63|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|5310.00||||5310.00|4513.5|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|5310.00||||5310.00|1172.4|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|LEWER AGENCY [1565]|LEWER AGENCY [156500]|5310.00||||5310.00|3717|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5310.00||||5310.00|1176.63|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5310.00||||5310.00|3982.5|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|5310.00||||5310.00|1176.63|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|5310.00||||5310.00|3717|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|5310.00||||5310.00|611.71|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|NRECA [1735]|NRECA [173500]|5310.00||||5310.00|3255.03|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|5310.00||||5310.00|3255.03|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|5310.00||||5310.00|1338.6|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|5310.00||||5310.00|2655|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|GUARDIAN [1465]|GUARDIAN [146500]|5310.00||||5310.00|3717|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|MAILHANDLERS [1595]|MAILHANDLERS [159500]|5310.00||||5310.00|3982.5|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|AETNA [1015]|AMERICAN CONTINENTAL [101507]|5310.00||||5310.00|3982.5|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|5310.00||||5310.00|4513.5|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|5310.00||||5310.00|3982.5|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|5310.00||||5310.00|3717|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|MEDICA [2910]|MEDICA HARMONY [291000]|5310.00||||5310.00|3717|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|5310.00||||5310.00|2655|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|TDH BCCS [2341]|TDH BCCS [234100]|5310.00||||5310.00|611.71|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|5310.00||||5310.00|4513.5|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|5310.00||||5310.00|3717|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|5310.00||||5310.00|611.71|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|PHCS [1780]|PHCS MULTIPLAN [178000]|5310.00||||5310.00|3717|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|5310.00||||5310.00|3717|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|5310.00||||5310.00|2655|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5310.00||||5310.00|1200.16|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|5310.00||||5310.00|611.71|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5310.00||||5310.00|1176.63|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|5310.00||||5310.00|2655|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|UMR [2035]|UMR CHEROKEE MLR [203504]|5310.00||||5310.00|1176.63|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|5310.00||||5310.00|4513.5|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|5310.00||||5310.00|3717|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|5310.00||||5310.00|3717|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|5310.00||||5310.00|3855.06|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|5310.00||||5310.00|3855.06|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|TML [1980]|TML [198000]|5310.00||||5310.00|3255.03|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|5310.00||||5310.00|2230.2|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|5310.00||||5310.00|3860.37|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5310.00||||5310.00|4513.5|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|UMR [2035]|UMR CORE [203505]|5310.00||||5310.00|2272.68|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|5310.00||||5310.00|1176.63|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|5310.00||||5310.00|3717|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|5310.00||||5310.00|3982.5|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|5310.00||||5310.00|3026.7|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|5310.00||||5310.00|1338.6|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|5310.00||||5310.00|3717|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|5310.00||||5310.00|2655|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|UMR [2035]|UMR CHOICE [203500]|5310.00||||5310.00|3255.03|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|5310.00||||5310.00|1176.63|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|5310.00||||5310.00|3717|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|5310.00||||5310.00|1176.63|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|5310.00||||5310.00|1176.63|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5310.00||||5310.00|2230.2|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA PANTEX [126003]|5310.00||||5310.00|2495.7|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|5310.00||||5310.00|2230.2|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|WEB TPA [2115]|WEB TPA [211500]|5310.00||||5310.00|3982.5|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|5310.00||||5310.00|1129.9|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|5310.00||||5310.00|1176.63|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|5310.00||||5310.00|1176.63|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|5310.00||||5310.00|1176.63|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|5310.00||||5310.00|1200.16|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|5310.00||||5310.00|4513.5|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5310.00||||5310.00|1176.63|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|5310.00||||5310.00|3186|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|CBSA [1215]|CBSA [121500]|5310.00||||5310.00|3717|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|5310.00||||5310.00|2647.42|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5310.00||||5310.00|4513.5|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|EQUITABLE [1355]|EQUITABLE INS [135500]|5310.00||||5310.00|3717|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|5310.00||||5310.00|3982.5|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|5310.00||||5310.00|1646.1|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|5310.00||||5310.00|3255.03|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|5310.00||||5310.00|2495.7|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|5310.00||||5310.00|3035.55|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|5310.00||||5310.00|1176.63|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5310.00||||5310.00|1769.82|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|5310.00||||5310.00|4513.5|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|5310.00||||5310.00|3717|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|5310.00||||5310.00|3717|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|5310.00||||5310.00|1858.5|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|5310.00||||5310.00|4513.5|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|5310.00||||5310.00|3717|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|5310.00||||5310.00|3717|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|5310.00||||5310.00|2272.68|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|5310.00||||5310.00|2708.1|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|5310.00||||5310.00|3717|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|5310.00||||5310.00|4513.5|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5310.00||||5310.00|3717|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|GILSBAR [1425]|GILSBAR [142500]|5310.00||||5310.00|3982.5|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5310.00||||5310.00|3982.5|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|5310.00||||5310.00|3717|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA [126008]|5310.00||||5310.00|3855.06|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|5310.00||||5310.00|3982.5|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|5310.00||||5310.00|2582.8|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|5310.00||||5310.00|3982.5|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|5310.00||||5310.00|4513.5|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|AETNA [1015]|AETNA TRS [101506]|5310.00||||5310.00|3451.5|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|CELTIC LIFE [1220]|CELTIC LIFE [122000]|5310.00||||5310.00|3717|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|||5310.00||||5310.00|3982.5|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5310.00||||5310.00|1176.63|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|5310.00||||5310.00|3982.5|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5310.00||||5310.00|1176.63|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|5310.00||||5310.00|1153.1|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5310.00||||5310.00|3855.06|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5310.00||||5310.00|3717|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|5310.00||||5310.00|1027.49|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|5310.00||||5310.00|3860.37|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5310.00||||5310.00|1176.63|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|PHCS [1780]|FREEDOM LIFE [178009]|5310.00||||5310.00|4513.5|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|5310.00||||5310.00|3982.5|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|5310.00||||5310.00|3982.5|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|5310.00||||5310.00|1176.63|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5310.00||||5310.00|1176.63|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|WEB TPA [2115]|WEB TPA [211501]|5310.00||||5310.00|3717|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|GROUP HEALTH [2165]|GROUP HEALTH [216500]|5310.00||||5310.00|4513.5|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|5310.00||||5310.00|3717|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|5310.00||||5310.00|3855.06|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|5310.00||||5310.00|1027.49|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|5310.00||||5310.00|3982.5|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|5310.00||||5310.00|3717|4513.5|611.71 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|5310.00||||5310.00||| 106773|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|5310.00||||5310.00||| 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|780.71||||780.71|151.07|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|780.71||||780.71|585.53|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|780.71||||780.71|585.53|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA PANTEX [126003]|780.71||||780.71|366.93|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|780.71||||780.71|546.5|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|780.71||||780.71|585.53|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|780.71||||780.71|117.75|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|780.71||||780.71|546.5|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|GILSBAR [1425]|GILSBAR [142500]|780.71||||780.71|585.53|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|780.71||||780.71|117.75|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|AETNA [1015]|AMERICAN CONTINENTAL [101507]|780.71||||780.71|585.53|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA PANTEX [126003]|780.71||||780.71|366.93|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|780.71||||780.71|117.75|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|UMR [2035]|UMR CORE [203505]|780.71||||780.71|334.14|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|780.71||||780.71|117.75|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|780.71||||780.71|663.6|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|780.71||||780.71|546.5|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|780.71||||780.71|546.5|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|UMR [2035]|UMR CORE [203505]|780.71||||780.71|334.14|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|780.71||||780.71|546.5|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|AETNA [1015]|AMERICAN CONTINENTAL [101507]|780.71||||780.71|585.53|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|780.71||||780.71|585.53|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|780.71||||780.71|663.6|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|780.71||||780.71|117.75|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|780.71||||780.71|585.53|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|780.71||||780.71|585.53|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|780.71||||780.71|546.5|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|780.71||||780.71|120.11|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|AETNA [1015]|AETNA TRS [101506]|780.71||||780.71|507.46|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|780.71||||780.71|151.07|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|780.71||||780.71|585.53|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|780.71||||780.71|648|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|780.71||||780.71|117.75|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|780.71||||780.71|546.5|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|780.71||||780.71|566.8|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|780.71||||780.71|663.6|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|780.71||||780.71|585.53|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|780.71||||780.71|585.53|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|780.71||||780.71|117.75|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|780.71||||780.71|117.75|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|780.71||||780.71|260.21|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|780.71||||780.71|117.75|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|780.71||||780.71|663.6|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|780.71||||780.71|663.6|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|780.71||||780.71|663.6|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|780.71||||780.71|567.58|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|780.71||||780.71|260.21|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|780.71||||780.71|478.58|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|780.71||||780.71|585.53|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|780.71||||780.71|390.36|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|780.71||||780.71|390.36|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA [126008]|780.71||||780.71|566.8|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|780.71||||780.71|663.6|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|UMR [2035]|UMR CHOICE [203500]|780.71||||780.71|478.58|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|780.71||||780.71|117.75|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|MEDICA [2910]|MEDICA HARMONY [291000]|780.71||||780.71|546.5|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|WEB TPA [2115]|WEB TPA [211501]|780.71||||780.71|546.5|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|MEDICA [2910]|MEDICA HARMONY [291000]|780.71||||780.71|546.5|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|WEB TPA [2115]|WEB TPA [211501]|780.71||||780.71|546.5|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|WEB TPA [2115]|WEB TPA [211500]|780.71||||780.71|585.53|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|780.71||||780.71|117.75|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|780.71||||780.71|390.36|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|LEWER AGENCY [1565]|LEWER AGENCY [156500]|780.71||||780.71|546.5|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|UMR [2035]|UMR CHEROKEE MLR [203504]|780.71||||780.71|117.75|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|UMR [2035]|UMR CHEROKEE MLR [203504]|780.71||||780.71|117.75|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|MAILHANDLERS [1595]|MAILHANDLERS [159500]|780.71||||780.71|585.53|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|780.71||||780.71|117.75|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|780.71||||780.71|567.58|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|780.71||||780.71|117.75|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|780.71||||780.71|663.6|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|GILSBAR [1425]|GILSBAR [142500]|780.71||||780.71|585.53|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|780.71||||780.71|546.5|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|UMR [2035]|UMR CHOICE [203500]|780.71||||780.71|478.58|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|GROUP HEALTH [2165]|GROUP HEALTH [216500]|780.71||||780.71|663.6|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|780.71||||780.71|117.75|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|780.71||||780.71|663.6|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|780.71||||780.71|117.75|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|780.71||||780.71|663.6|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|780.71||||780.71|89.94|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|780.71||||780.71|89.94|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|780.71||||780.71|546.5|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|780.71||||780.71|663.6|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|780.71||||780.71|585.53|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|780.71||||780.71|663.6|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|780.71||||780.71|327.9|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|780.71||||780.71|117.75|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|780.71||||780.71|585.53|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|780.71||||780.71|151.07|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|780.71||||780.71|663.6|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|780.71||||780.71|585.53|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|780.71||||780.71|398.16|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|780.71||||780.71|242.02|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|780.71||||780.71|398.16|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|780.71||||780.71|468.43|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|780.71||||780.71|390.36|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|780.71||||780.71|585.53|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|780.71||||780.71|151.07|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|780.71||||780.71|117.75|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|780.71||||780.71|648|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|780.71||||780.71|567.58|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|780.71||||780.71|567.58|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|780.71||||780.71|663.6|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|NRECA [1735]|NRECA [173500]|780.71||||780.71|478.58|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|780.71||||780.71|663.6|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|780.71||||780.71|546.5|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|780.71||||780.71|334.14|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|AETNA [1015]|AETNA TRS [101506]|780.71||||780.71|507.46|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|780.71||||780.71|117.75|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|780.71||||780.71|663.6|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|780.71||||780.71|546.5|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|780.71||||780.71|546.5|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|780.71||||780.71|761.1|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|780.71||||780.71|117.75|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|780.71||||780.71|327.9|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|780.71||||780.71|663.6|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|EQUITABLE [1355]|EQUITABLE INS [135500]|780.71||||780.71|546.5|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|780.71||||780.71|546.5|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|780.71||||780.71|115.4|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|780.71||||780.71|566.8|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|PHCS [1780]|PHCS MULTIPLAN [178000]|780.71||||780.71|546.5|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|780.71||||780.71|115.4|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|780.71||||780.71|546.5|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|780.71||||780.71|117.75|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|780.71||||780.71||| 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|780.71||||780.71||| 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|780.71||||780.71||| 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|780.71||||780.71|585.53|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|780.71||||780.71|390.36|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|780.71||||780.71|566.8|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|780.71||||780.71|264.94|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|780.71||||780.71|663.6|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|780.71||||780.71|264.94|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|780.71||||780.71|89.94|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|780.71||||780.71|546.5|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|780.71||||780.71|242.02|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|780.71||||780.71|117.75|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|780.71||||780.71|117.75|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|||780.71||||780.71|585.53|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|780.71||||780.71|184.5|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|780.71||||780.71|390.36|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|780.71||||780.71|334.14|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|780.71||||780.71|478.58|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|780.71||||780.71|585.53|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|NRECA [1735]|NRECA [173500]|780.71||||780.71|478.58|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|780.71||||780.71|117.75|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|780.71||||780.71|478.58|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|780.71||||780.71|120.11|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|780.71||||780.71|478.58|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|780.71||||780.71|546.5|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|780.71||||780.71|663.6|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|780.71||||780.71|390.36|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|CELTIC LIFE [1220]|CELTIC LIFE [122000]|780.71||||780.71|546.5|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|780.71||||780.71|468.43|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|780.71||||780.71|761.1|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|780.71||||780.71|445|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|780.71||||780.71|566.8|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|780.71||||780.71|663.6|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|780.71||||780.71|585.53|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|780.71||||780.71|546.5|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|780.71||||780.71|184.5|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|780.71||||780.71|327.9|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|780.71||||780.71|546.5|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|780.71||||780.71|546.5|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|780.71||||780.71|566.8|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|780.71||||780.71|566.8|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|780.71||||780.71|303|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|TML [1980]|TML [198000]|780.71||||780.71|478.58|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|780.71||||780.71|546.5|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|780.71||||780.71|366.93|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|780.71||||780.71|585.53|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|MAILHANDLERS [1595]|MAILHANDLERS [159500]|780.71||||780.71|585.53|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|780.71||||780.71|312|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|780.71||||780.71|117.75|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|780.71||||780.71|546.5|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|EQUITABLE [1355]|EQUITABLE INS [135500]|780.71||||780.71|546.5|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|780.71||||780.71|117.75|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|780.71||||780.71|585.53|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|780.71||||780.71|117.75|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|TDH BCCS [2341]|TDH BCCS [234100]|780.71||||780.71|89.94|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|TDH BCCS [2341]|TDH BCCS [234100]|780.71||||780.71|89.94|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|780.71||||780.71|390.36|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|780.71||||780.71|663.6|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|780.71||||780.71|312|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|780.71||||780.71|546.5|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|WEB TPA [2115]|WEB TPA [211500]|780.71||||780.71|585.53|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|LEWER AGENCY [1565]|LEWER AGENCY [156500]|780.71||||780.71|546.5|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|780.71||||780.71|585.53|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|780.71||||780.71|89.94|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|||780.71||||780.71|585.53|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|780.71||||780.71|117.75|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|780.71||||780.71|546.5|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|780.71||||780.71|585.53|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|780.71||||780.71|566.8|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|CBSA [1215]|CBSA [121500]|780.71||||780.71|546.5|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|780.71||||780.71|184.5|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|CBSA [1215]|CBSA [121500]|780.71||||780.71|546.5|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|780.71||||780.71|273.25|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|GUARDIAN [1465]|GUARDIAN [146500]|780.71||||780.71|546.5|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|780.71||||780.71|117.75|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|780.71||||780.71|390.36|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|780.71||||780.71|117.75|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|780.71||||780.71|585.53|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|780.71||||780.71|327.9|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|TML [1980]|TML [198000]|780.71||||780.71|478.58|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|780.71||||780.71|303|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|780.71||||780.71|546.5|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|780.71||||780.71|273.25|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|780.71||||780.71|663.6|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|780.71||||780.71|546.5|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|CELTIC LIFE [1220]|CELTIC LIFE [122000]|780.71||||780.71|546.5|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|780.71||||780.71|117.75|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|GUARDIAN [1465]|GUARDIAN [146500]|780.71||||780.71|546.5|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|780.71||||780.71|445|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|780.71||||780.71|117.75|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|780.71||||780.71|120.11|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|780.71||||780.71|546.5|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|GROUP HEALTH [2165]|GROUP HEALTH [216500]|780.71||||780.71|663.6|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|780.71||||780.71|546.5|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|780.71||||780.71|546.5|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|PHCS [1780]|PHCS MULTIPLAN [178000]|780.71||||780.71|546.5|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|780.71||||780.71|546.5|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|PHCS [1780]|FREEDOM LIFE [178009]|780.71||||780.71|663.6|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|780.71||||780.71|546.5|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|780.71||||780.71|120.11|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|780.71||||780.71|585.53|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|780.71||||780.71|546.5|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|780.71||||780.71|546.5|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|780.71||||780.71|546.5|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|780.71||||780.71|546.5|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|780.71||||780.71|117.75|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|780.71||||780.71|89.94|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|780.71||||780.71|566.8|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|780.71||||780.71|117.75|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|780.71||||780.71|117.75|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|780.71||||780.71|327.9|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|780.71||||780.71|117.75|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|780.71||||780.71|366.93|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|780.71||||780.71|546.5|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|PHCS [1780]|FREEDOM LIFE [178009]|780.71||||780.71|663.6|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|780.71||||780.71|390.36|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|780.71||||780.71|546.5|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA [126008]|780.71||||780.71|566.8|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|780.71||||780.71|585.53|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|780.71||||780.71|184.5|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|780.71||||780.71|546.5|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|780.71||||780.71|117.75|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|780.71||||780.71|546.5|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|780.71||||780.71|327.9|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|780.71||||780.71|89.94|761.1|89.94 106783|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FOSAPREPITANT 150 MG INTRAVENOUS SOLUTION|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|780.71||||780.71||| 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|10585.13||||10585.13|8997.36|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|10585.13||||10585.13|7938.85|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|10585.13||||10585.13|7938.85|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|UMR [2035]|UMR CHEROKEE MLR [203504]|10585.13||||10585.13|2414.76|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|UMR [2035]|UMR CHEROKEE MLR [203504]|10585.13||||10585.13|2414.76|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|10585.13||||10585.13|8997.36|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|10585.13||||10585.13|6488.68|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10585.13||||10585.13|1219.41|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|10585.13||||10585.13|7695.39|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|10585.13||||10585.13|6488.68|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|10585.13||||10585.13|8997.36|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|10585.13||||10585.13|7695.39|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|10585.13||||10585.13|7938.85|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|10585.13||||10585.13|2414.76|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|10585.13||||10585.13|8997.36|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|10585.13||||10585.13|7409.59|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|10585.13||||10585.13|7409.59|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|10585.13||||10585.13|5292.57|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|10585.13||||10585.13|5292.57|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|10585.13||||10585.13|7938.85|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|10585.13||||10585.13|1219.41|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|UMR [2035]|UMR CHOICE [203500]|10585.13||||10585.13|6488.68|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|10585.13||||10585.13|7938.85|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|AETNA [1015]|AETNA TRS [101506]|10585.13||||10585.13|6880.33|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|GILSBAR [1425]|GILSBAR [142500]|10585.13||||10585.13|7938.85|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|UMR [2035]|UMR CORE [203505]|10585.13||||10585.13|4530.44|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|UMR [2035]|UMR CHOICE [203500]|10585.13||||10585.13|6488.68|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|AETNA [1015]|AMERICAN CONTINENTAL [101507]|10585.13||||10585.13|7938.85|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10585.13||||10585.13|2414.76|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|10585.13||||10585.13|2048.22|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|10585.13||||10585.13|2048.22|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|NRECA [1735]|NRECA [173500]|10585.13||||10585.13|6488.68|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|AETNA [1015]|AMERICAN CONTINENTAL [101507]|10585.13||||10585.13|7938.85|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|10585.13||||10585.13|2414.76|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|10585.13||||10585.13|7409.59|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|UMR [2035]|UMR CORE [203505]|10585.13||||10585.13|4530.44|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|10585.13||||10585.13|3281.39|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|10585.13||||10585.13|3281.39|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|10585.13||||10585.13|7409.59|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|CIGNA [1260]|CIGNA PANTEX [126003]|10585.13||||10585.13|4975.01|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|10585.13||||10585.13|2414.76|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10585.13||||10585.13|8997.36|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10585.13||||10585.13|8997.36|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|10585.13||||10585.13|7409.59|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10585.13||||10585.13|7409.59|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|10585.13||||10585.13|7938.85|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|10585.13||||10585.13|7938.85|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10585.13||||10585.13|2414.76|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10585.13||||10585.13|2414.76|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|10585.13||||10585.13|7409.59|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10585.13||||10585.13|2414.76|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|MAILHANDLERS [1595]|MAILHANDLERS [159500]|10585.13||||10585.13|7938.85|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|MAILHANDLERS [1595]|MAILHANDLERS [159500]|10585.13||||10585.13|7938.85|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|NRECA [1735]|NRECA [173500]|10585.13||||10585.13|6488.68|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|10585.13||||10585.13|5292.57|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|10585.13||||10585.13|8997.36|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|10585.13||||10585.13|2205.6|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|10585.13||||10585.13|7409.59|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|10585.13||||10585.13|7409.59|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|10585.13||||10585.13|7938.85|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|10585.13||||10585.13|8997.36|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|10585.13||||10585.13|7938.85|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10585.13||||10585.13|2414.76|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|10585.13||||10585.13|2366.46|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|10585.13||||10585.13|5292.57|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|10585.13||||10585.13|7684.8|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10585.13||||10585.13|2463.06|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|10585.13||||10585.13|7938.85|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|10585.13||||10585.13|7409.59|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|10585.13||||10585.13|7684.8|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|10585.13||||10585.13|2366.46|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10585.13||||10585.13|2414.76|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|10585.13||||10585.13|7409.59|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|10585.13||||10585.13|8997.36|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|10585.13||||10585.13|5292.57|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|10585.13||||10585.13|2205.6|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|10585.13||||10585.13|8997.36|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|10585.13||||10585.13|8997.36|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|10585.13||||10585.13|5292.57|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|10585.13||||10585.13|2463.06|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|CIGNA [1260]|CIGNA [126008]|10585.13||||10585.13|7684.8|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|10585.13||||10585.13|2463.06|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10585.13||||10585.13|7684.8|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|10585.13||||10585.13|8997.36|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|10585.13||||10585.13|2414.76|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|PHCS [1780]|FREEDOM LIFE [178009]|10585.13||||10585.13|8997.36|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|10585.13||||10585.13|1219.41|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|CIGNA [1260]|CIGNA [126008]|10585.13||||10585.13|7684.8|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|10585.13||||10585.13|7409.59|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|CBSA [1215]|CBSA [121500]|10585.13||||10585.13|7409.59|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|10585.13||||10585.13|1219.41|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|||10585.13||||10585.13|7938.85|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|10585.13||||10585.13|7409.59|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|TML [1980]|TML [198000]|10585.13||||10585.13|6488.68|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|TDH BCCS [2341]|TDH BCCS [234100]|10585.13||||10585.13|1219.41|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|TML [1980]|TML [198000]|10585.13||||10585.13|6488.68|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|10585.13||||10585.13|2722.8|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|GUARDIAN [1465]|GUARDIAN [146500]|10585.13||||10585.13|7409.59|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10585.13||||10585.13|2414.76|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|10585.13||||10585.13|6033.52|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|GILSBAR [1425]|GILSBAR [142500]|10585.13||||10585.13|7938.85|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|10585.13||||10585.13|7409.59|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|10585.13||||10585.13|2061.6|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10585.13||||10585.13|7938.85|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10585.13||||10585.13|7938.85|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10585.13||||10585.13|7938.85|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|10585.13||||10585.13|7938.85|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|10585.13||||10585.13|7684.8|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|10585.13||||10585.13|2722.8|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|10585.13||||10585.13|2414.76|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|10585.13||||10585.13|7409.59|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|10585.13||||10585.13|1219.41|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|10585.13||||10585.13|7409.59|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|10585.13||||10585.13|8997.36|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|10585.13||||10585.13|2414.76|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|10585.13||||10585.13|7684.8|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|10585.13||||10585.13|6033.52|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|PHCS [1780]|FREEDOM LIFE [178009]|10585.13||||10585.13|8997.36|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|10585.13||||10585.13|7409.59|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10585.13||||10585.13|7684.8|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|10585.13||||10585.13|5292.57|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|10585.13||||10585.13|5292.57|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|10585.13||||10585.13|7409.59|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|CELTIC LIFE [1220]|CELTIC LIFE [122000]|10585.13||||10585.13|7409.59|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|EQUITABLE [1355]|EQUITABLE INS [135500]|10585.13||||10585.13|7409.59|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10585.13||||10585.13|2414.76|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|10585.13||||10585.13|2414.76|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|10585.13||||10585.13|4445.75|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|10585.13||||10585.13|5433.21|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10585.13||||10585.13|2414.76|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|EQUITABLE [1355]|EQUITABLE INS [135500]|10585.13||||10585.13|7409.59|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|10585.13||||10585.13|7684.8|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|10585.13||||10585.13|2414.76|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|10585.13||||10585.13|4445.75|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|10585.13||||10585.13|8997.36|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|PHCS [1780]|PHCS MULTIPLAN [178000]|10585.13||||10585.13|7409.59|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|10585.13||||10585.13|2722.8|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|10585.13||||10585.13|4445.75|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|10585.13||||10585.13|2414.76|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|10585.13||||10585.13|2414.76|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|10585.13||||10585.13|3704.8|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|10585.13||||10585.13|8997.36|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|10585.13||||10585.13|7684.8|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|10585.13||||10585.13|7409.59|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|10585.13||||10585.13|2414.76|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|CELTIC LIFE [1220]|CELTIC LIFE [122000]|10585.13||||10585.13|7409.59|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10585.13||||10585.13|3528.02|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|10585.13||||10585.13|4530.44|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|10585.13||||10585.13|8997.36|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|10585.13||||10585.13|3704.8|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|10585.13||||10585.13|2414.76|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|10585.13||||10585.13|7409.59|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10585.13||||10585.13|2414.76|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|10585.13||||10585.13|5497.62|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10585.13||||10585.13|4445.75|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|10585.13||||10585.13|7409.59|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|GUARDIAN [1465]|GUARDIAN [146500]|10585.13||||10585.13|7409.59|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|10585.13||||10585.13|1219.41|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|LEWER AGENCY [1565]|LEWER AGENCY [156500]|10585.13||||10585.13|7409.59|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|10585.13||||10585.13|7409.59|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|10585.13||||10585.13|4445.75|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|LEWER AGENCY [1565]|LEWER AGENCY [156500]|10585.13||||10585.13|7409.59|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|MEDICA [2910]|MEDICA HARMONY [291000]|10585.13||||10585.13|7409.59|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|10585.13||||10585.13|2061.6|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|TDH BCCS [2341]|TDH BCCS [234100]|10585.13||||10585.13|1219.41|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|10585.13||||10585.13|7938.85|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|10585.13||||10585.13|8997.36|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|10585.13||||10585.13|6351.08|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|10585.13||||10585.13|7938.85|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|10585.13||||10585.13|4677.6|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|10585.13||||10585.13|5398.42|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|10585.13||||10585.13|5398.42|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|10585.13||||10585.13|5497.62|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|10585.13||||10585.13|4677.6|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|10585.13||||10585.13|8997.36|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|10585.13||||10585.13|2414.76|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|10585.13||||10585.13|5292.57|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|10585.13||||10585.13|7409.59|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10585.13||||10585.13|2414.76|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|10585.13||||10585.13|8997.36|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|10585.13||||10585.13|7409.59|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|10585.13||||10585.13|7695.39|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|10585.13||||10585.13|6488.68|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|10585.13||||10585.13|6351.08|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10585.13||||10585.13|3528.02|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|10585.13||||10585.13|7695.39|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|10585.13||||10585.13|2414.76|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|10585.13||||10585.13|2414.76|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|10585.13||||10585.13|4530.44|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|10585.13||||10585.13|6488.68|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|10585.13||||10585.13|2414.76|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|CBSA [1215]|CBSA [121500]|10585.13||||10585.13|7409.59|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|10585.13||||10585.13|7938.85|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|10585.13||||10585.13|2414.76|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|10585.13||||10585.13|7938.85|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|10585.13||||10585.13|2048.22|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|10585.13||||10585.13|7409.59|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|10585.13||||10585.13|2048.22|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|10585.13||||10585.13|7409.59|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10585.13||||10585.13|2414.76|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|10585.13||||10585.13|7938.85|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|10585.13||||10585.13|7409.59|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|10585.13||||10585.13|7409.59|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|CIGNA [1260]|CIGNA PANTEX [126003]|10585.13||||10585.13|4975.01|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|10585.13||||10585.13|2463.06|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|10585.13||||10585.13|8997.36|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|10585.13||||10585.13|4975.01|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|10585.13||||10585.13|7938.85|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|10585.13||||10585.13|2414.76|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|10585.13||||10585.13|8997.36|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10585.13||||10585.13|2414.76|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|10585.13||||10585.13|7409.59|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|10585.13||||10585.13|4445.75|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|10585.13||||10585.13|2414.76|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|10585.13||||10585.13|2414.76|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|10585.13||||10585.13|2414.76|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|10585.13||||10585.13|7409.59|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|10585.13||||10585.13|2414.76|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|AETNA [1015]|AETNA TRS [101506]|10585.13||||10585.13|6880.33|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|||10585.13||||10585.13|7938.85|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|10585.13||||10585.13|7938.85|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|10585.13||||10585.13|5292.57|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|10585.13||||10585.13|7938.85|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|10585.13||||10585.13|7409.59|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|10585.13||||10585.13|5433.21|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10585.13||||10585.13|7409.59|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|10585.13||||10585.13|7938.85|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|GROUP HEALTH [2165]|GROUP HEALTH [216500]|10585.13||||10585.13|8997.36|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|10585.13||||10585.13|7409.59|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|10585.13||||10585.13|7409.59|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|10585.13||||10585.13|7938.85|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|10585.13||||10585.13|2722.8|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|10585.13||||10585.13|7409.59|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|10585.13||||10585.13|8997.36|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|10585.13||||10585.13|4975.01|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|10585.13||||10585.13|7409.59|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|GROUP HEALTH [2165]|GROUP HEALTH [216500]|10585.13||||10585.13|8997.36|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|MEDICA [2910]|MEDICA HARMONY [291000]|10585.13||||10585.13|7409.59|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|WEB TPA [2115]|WEB TPA [211500]|10585.13||||10585.13|7938.85|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|10585.13||||10585.13|7409.59|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|WEB TPA [2115]|WEB TPA [211501]|10585.13||||10585.13|7409.59|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|PHCS [1780]|PHCS MULTIPLAN [178000]|10585.13||||10585.13|7409.59|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|10585.13||||10585.13|7409.59|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|WEB TPA [2115]|WEB TPA [211500]|10585.13||||10585.13|7938.85|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10585.13||||10585.13|2414.76|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|WEB TPA [2115]|WEB TPA [211501]|10585.13||||10585.13|7409.59|8997.36|1219.41 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|10585.13||||10585.13||| 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|10585.13||||10585.13||| 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|10585.13||||10585.13||| 106804|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|10585.13||||10585.13||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|NRECA [1735]|NRECA [173500]|977.44||||977.44|599.17|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|977.44||||977.44|684.21|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|977.44||||977.44|733.08|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|AETNA [1015]|AMERICAN CONTINENTAL [101507]|977.44||||977.44|733.08|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|977.44||||977.44|325.78|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|977.44||||977.44|733.08|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|NRECA [1735]|NRECA [173500]|977.44||||977.44|599.17|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|977.44||||977.44|189.13|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|977.44||||977.44|830.82|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|977.44||||977.44|830.82|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|977.44||||977.44|830.82|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|977.44||||977.44|684.21|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|AETNA [1015]|AETNA TRS [101506]|977.44||||977.44|635.34|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|977.44||||977.44|684.21|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|977.44||||977.44|684.21|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|977.44||||977.44|733.08|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|977.44||||977.44|684.21|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|977.44||||977.44|684.21|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|977.44||||977.44|733.08|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|AETNA [1015]|AMERICAN CONTINENTAL [101507]|977.44||||977.44|733.08|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|977.44||||977.44|488.72|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|GILSBAR [1425]|GILSBAR [142500]|977.44||||977.44|733.08|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|977.44||||977.44|830.82|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|977.44||||977.44|599.17|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|977.44||||977.44|733.08|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|977.44||||977.44|830.82|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|977.44||||977.44|112.6|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|UMR [2035]|UMR CORE [203505]|977.44||||977.44|418.34|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|WEB TPA [2115]|WEB TPA [211500]|977.44||||977.44|733.08|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|977.44||||977.44|488.72|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|977.44||||977.44|488.72|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|WEB TPA [2115]|WEB TPA [211500]|977.44||||977.44|733.08|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|UMR [2035]|UMR CORE [203505]|977.44||||977.44|418.34|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|WEB TPA [2115]|WEB TPA [211501]|977.44||||977.44|684.21|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|MEDICA [2910]|MEDICA HARMONY [291000]|977.44||||977.44|684.21|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|UMR [2035]|UMR CHOICE [203500]|977.44||||977.44|599.17|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|UMR [2035]|UMR OPTIONS [203501]|977.44||||977.44|710.6|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|LEWER AGENCY [1565]|LEWER AGENCY [156500]|977.44||||977.44|684.21|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|977.44||||977.44|830.82|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|977.44||||977.44|733.08|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|977.44||||977.44|684.21|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|977.44||||977.44|830.82|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|AETNA [1015]|AETNA TRS [101506]|977.44||||977.44|635.34|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|977.44||||977.44|488.72|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|977.44||||977.44|418.34|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|977.44||||977.44|733.08|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|977.44||||977.44|684.21|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|977.44||||977.44|684.21|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|977.44||||977.44|325.78|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|GILSBAR [1425]|GILSBAR [142500]|977.44||||977.44|733.08|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|TRUSTMARK [2030]|STARMARK [203000]|977.44||||977.44|733.08|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|977.44||||977.44|189.13|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|977.44||||977.44|684.21|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|977.44||||977.44|733.08|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|977.44||||977.44|189.13|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|977.44||||977.44|684.21|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|TRUSTMARK [2030]|STARMARK [203000]|977.44||||977.44|733.08|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|977.44||||977.44|684.21|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|977.44||||977.44|599.17|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|977.44||||977.44|599.17|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|977.44||||977.44|418.34|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|GROUP HEALTH [2165]|GROUP HEALTH [216500]|977.44||||977.44|830.82|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|977.44||||977.44|684.21|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|977.44||||977.44|163.73|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|977.44||||977.44|498.49|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|977.44||||977.44|830.82|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|977.44||||977.44|459.4|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|977.44||||977.44|410.52|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|977.44||||977.44|498.49|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|977.44||||977.44|139.35|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|977.44||||977.44|830.82|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|977.44||||977.44|830.82|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|977.44||||977.44|410.52|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|977.44||||977.44|684.21|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|977.44||||977.44|710.6|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|CELTIC LIFE [1220]|CELTIC LIFE [122000]|977.44||||977.44|684.21|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|977.44||||977.44|410.52|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|EQUITABLE [1355]|EQUITABLE INS [135500]|977.44||||977.44|684.21|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|977.44||||977.44|684.21|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|977.44||||977.44|684.21|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|977.44||||977.44|684.21|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|977.44||||977.44|684.21|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|||977.44||||977.44|733.08|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|977.44||||977.44|733.08|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|977.44||||977.44|342.1|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|CORESOURCE [1315]|CORESOURCE [131500]|977.44||||977.44|709.62|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|977.44||||977.44|410.52|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|CORESOURCE [1315]|CORESOURCE [131500]|977.44||||977.44|709.62|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|977.44||||977.44|733.08|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|EQUITABLE [1355]|EQUITABLE INS [135500]|977.44||||977.44|684.21|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|977.44||||977.44|410.52|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|977.44||||977.44|410.52|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|977.44||||977.44|459.4|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|CELTIC LIFE [1220]|CELTIC LIFE [122000]|977.44||||977.44|684.21|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|977.44||||977.44||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|977.44||||977.44||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|UMR [2035]|UMR CHEROKEE MLR [203504]|977.44||||977.44||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|UMR [2035]|UMR CHEROKEE MLR [203504]|977.44||||977.44||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|977.44||||977.44||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|977.44||||977.44||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|977.44||||977.44||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|977.44||||977.44||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|977.44||||977.44||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|977.44||||977.44||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|977.44||||977.44||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|977.44||||977.44||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|977.44||||977.44||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|977.44||||977.44||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|977.44||||977.44||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|977.44||||977.44||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|977.44||||977.44||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|977.44||||977.44||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|977.44||||977.44||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|977.44||||977.44||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|977.44||||977.44||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|977.44||||977.44||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|977.44||||977.44||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|977.44||||977.44||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|977.44||||977.44||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|977.44||||977.44||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|977.44||||977.44||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|977.44||||977.44||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|977.44||||977.44||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|977.44||||977.44||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|977.44||||977.44||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|977.44||||977.44||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|977.44||||977.44|709.62|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|||977.44||||977.44|733.08|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|977.44||||977.44|342.1|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|977.44||||977.44|709.62|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|977.44||||977.44|684.21|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|977.44||||977.44|684.21|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|PHCS [1780]|PHCS MULTIPLAN [178000]|977.44||||977.44|684.21|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|977.44||||977.44|586.46|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|977.44||||977.44|830.82|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|PHCS [1780]|FREEDOM LIFE [178009]|977.44||||977.44|830.82|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|PHCS [1780]|PHCS MULTIPLAN [178000]|977.44||||977.44|684.21|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|977.44||||977.44|830.82|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|977.44||||977.44|684.21|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|977.44||||977.44|710.6|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|GROUP HEALTH [2165]|GROUP HEALTH [216500]|977.44||||977.44|830.82|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|PHCS [1780]|FREEDOM LIFE [178009]|977.44||||977.44|830.82|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|977.44||||977.44|830.82|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|977.44||||977.44|112.6|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|977.44||||977.44|139.35|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|977.44||||977.44|684.21|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|977.44||||977.44|709.62|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|977.44||||977.44|733.08|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|977.44||||977.44|684.21|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|GUARDIAN [1465]|GUARDIAN [146500]|977.44||||977.44|684.21|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|977.44||||977.44|557.14|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|977.44||||977.44|830.82|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|977.44||||977.44|189.13|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|TDH BCCS [2341]|TDH BCCS [234100]|977.44||||977.44|112.6|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|977.44||||977.44|684.21|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|977.44||||977.44|733.08|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|977.44||||977.44|684.21|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|CBSA [1215]|CBSA [121500]|977.44||||977.44|684.21|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|CIGNA [1260]|CIGNA PANTEX [126003]|977.44||||977.44|459.4|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|977.44||||977.44|684.21|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|977.44||||977.44|303.01|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|977.44||||977.44|733.08|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|977.44||||977.44|684.21|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|977.44||||977.44|684.21|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|CIGNA [1260]|CIGNA PANTEX [126003]|977.44||||977.44|459.4|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|977.44||||977.44|830.82|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|977.44||||977.44|34.2|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|MAILHANDLERS [1595]|MAILHANDLERS [159500]|977.44||||977.44|733.08|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|977.44||||977.44|599.17|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|977.44||||977.44|112.6|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|UMR [2035]|UMR OPTIONS [203501]|977.44||||977.44|710.6|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|UMR [2035]|UMR CHOICE [203500]|977.44||||977.44|599.17|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|LEWER AGENCY [1565]|LEWER AGENCY [156500]|977.44||||977.44|684.21|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|MEDICA [2910]|MEDICA HARMONY [291000]|977.44||||977.44|684.21|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|977.44||||977.44|709.62|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|977.44||||977.44|684.21|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|WEB TPA [2115]|WEB TPA [211501]|977.44||||977.44|684.21|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|977.44||||977.44|733.08|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|HEALTHNET [1495]|HEALTHNET [149500]|977.44||||977.44|733.08|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|977.44||||977.44|684.21|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|977.44||||977.44|733.08|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|977.44||||977.44|488.72|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|977.44||||977.44|830.82|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|977.44||||977.44|488.72|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|977.44||||977.44|733.08|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|977.44||||977.44|684.21|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|977.44||||977.44|830.82|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|977.44||||977.44|733.08|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|HEALTHNET [1495]|HEALTHNET [149500]|977.44||||977.44|733.08|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|977.44||||977.44|709.62|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|977.44||||977.44|684.21|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|977.44||||977.44|488.72|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|977.44||||977.44|684.21|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|977.44||||977.44|488.72|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|MAILHANDLERS [1595]|MAILHANDLERS [159500]|977.44||||977.44|733.08|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|TML [1980]|TML [198000]|977.44||||977.44|599.17|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|977.44||||977.44|34.2|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|977.44||||977.44|830.82|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|977.44||||977.44|830.82|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|977.44||||977.44|830.82|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|977.44||||977.44|488.72|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|977.44||||977.44|684.21|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|TML [1980]|TML [198000]|977.44||||977.44|599.17|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|977.44||||977.44|112.6|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|CBSA [1215]|CBSA [121500]|977.44||||977.44|684.21|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|977.44||||977.44|709.62|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|CIGNA [1260]|CIGNA [126008]|977.44||||977.44|709.62|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|977.44||||977.44|684.21|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|977.44||||977.44|488.72|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|977.44||||977.44|830.82|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|TDH BCCS [2341]|TDH BCCS [234100]|977.44||||977.44|112.6|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|GUARDIAN [1465]|GUARDIAN [146500]|977.44||||977.44|684.21|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|977.44||||977.44|557.14|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|977.44||||977.44|684.21|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|977.44||||977.44|830.82|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|977.44||||977.44|303.01|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|977.44||||977.44|586.46|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|977.44||||977.44|163.73|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|977.44||||977.44|733.08|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|977.44||||977.44|112.6|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|977.44||||977.44|733.08|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|977.44||||977.44|112.6|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|977.44||||977.44|684.21|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|CIGNA [1260]|CIGNA [126008]|977.44||||977.44|709.62|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|977.44||||977.44|733.08|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|977.44||||977.44|684.21|830.82|34.2 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|977.44||||977.44||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|977.44||||977.44||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|977.44||||977.44||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|977.44||||977.44||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|977.44||||977.44||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|977.44||||977.44||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|977.44||||977.44||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|977.44||||977.44||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|977.44||||977.44||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|977.44||||977.44||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|977.44||||977.44||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|977.44||||977.44||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|977.44||||977.44||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|977.44||||977.44||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|977.44||||977.44||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|977.44||||977.44||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|977.44||||977.44||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|977.44||||977.44||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|CHAMPVA [1240]|CHAMP VA [124000]|977.44||||977.44||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|CHAMPVA [1240]|CHAMP VA [124000]|977.44||||977.44||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|977.44||||977.44||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|977.44||||977.44||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|977.44||||977.44||| 108028|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 7.5 MG/0.6 ML SUBCUTANEOUS SOLUTION SYRINGE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|977.44||||977.44||| 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|1032.08||||1032.08|185.8|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1032.08||||1032.08|433.47|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|1032.08||||1032.08|218.3|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|1032.08||||1032.08|722.46|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|1032.08||||1032.08|441.73|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1032.08||||1032.08|632.67|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1032.08||||1032.08|516.04|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|1032.08||||1032.08|199.71|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1032.08||||1032.08|343.99|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|1032.08||||1032.08|722.46|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|1032.08||||1032.08|722.46|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|1032.08||||1032.08|722.46|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1032.08||||1032.08|774.06|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|1032.08||||1032.08|526.36|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|1032.08||||1032.08|877.27|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|1032.08||||1032.08|774.06|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|WEB TPA [2115]|WEB TPA [211501]|1032.08||||1032.08|722.46|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|TRUSTMARK [2030]|STARMARK [203000]|1032.08||||1032.08|774.06|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|1032.08||||1032.08|877.27|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|1032.08||||1032.08|619.25|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|MEDICA [2910]|MEDICA HARMONY [291000]|1032.08||||1032.08|722.46|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|WEB TPA [2115]|WEB TPA [211500]|1032.08||||1032.08|774.06|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|1032.08||||1032.08|516.04|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|1032.08||||1032.08|877.27|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|UMR [2035]|UMR CHOICE [203500]|1032.08||||1032.08|632.67|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|1032.08||||1032.08|199.71|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|UMR [2035]|UMR CORE [203505]|1032.08||||1032.08|441.73|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|UMR [2035]|UMR OPTIONS [203501]|1032.08||||1032.08|750.32|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|AETNA [1015]|AMERICAN CONTINENTAL [101507]|1032.08||||1032.08|774.06|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|1032.08||||1032.08|774.06|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|1032.08||||1032.08|877.27|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|GILSBAR [1425]|GILSBAR [142500]|1032.08||||1032.08|774.06|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|1032.08||||1032.08|722.46|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|AETNA [1015]|AETNA TRS [101506]|1032.08||||1032.08|670.85|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|1032.08||||1032.08|774.06|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|NRECA [1735]|NRECA [173500]|1032.08||||1032.08|632.67|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|1032.08||||1032.08|750.32|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|LEWER AGENCY [1565]|LEWER AGENCY [156500]|1032.08||||1032.08|722.46|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|GROUP HEALTH [2165]|GROUP HEALTH [216500]|1032.08||||1032.08|877.27|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|1032.08||||1032.08|485.08|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|1032.08||||1032.08|632.67|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|1032.08||||1032.08|722.46|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1032.08||||1032.08|722.46|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|1032.08||||1032.08|774.06|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|1032.08||||1032.08|319.94|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|1032.08||||1032.08|722.46|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1032.08||||1032.08|118.9|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|1032.08||||1032.08|877.27|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|1032.08||||1032.08|877.27|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|EQUITABLE [1355]|EQUITABLE INS [135500]|1032.08||||1032.08|722.46|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|1032.08||||1032.08|722.46|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1032.08||||1032.08|774.06|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|1032.08||||1032.08|722.46|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|1032.08||||1032.08|722.46|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|1032.08||||1032.08|877.27|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|1032.08||||1032.08|722.46|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|1032.08||||1032.08|516.04|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|MAILHANDLERS [1595]|MAILHANDLERS [159500]|1032.08||||1032.08|774.06|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|1032.08||||1032.08|722.46|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1032.08||||1032.08|877.27|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|1032.08||||1032.08|774.06|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|1032.08||||1032.08|516.04|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|1032.08||||1032.08|774.06|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1032.08||||1032.08|749.29|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|1032.08||||1032.08|722.46|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1032.08||||1032.08|877.27|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|1032.08||||1032.08|45.6|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|1032.08||||1032.08|877.27|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|CIGNA [1260]|CIGNA [126008]|1032.08||||1032.08|749.29|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|1032.08||||1032.08|722.46|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|1032.08||||1032.08|118.9|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|CBSA [1215]|CBSA [121500]|1032.08||||1032.08|722.46|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|1032.08||||1032.08|516.04|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|TDH BCCS [2341]|TDH BCCS [234100]|1032.08||||1032.08|118.9|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|TML [1980]|TML [198000]|1032.08||||1032.08|632.67|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|GUARDIAN [1465]|GUARDIAN [146500]|1032.08||||1032.08|722.46|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|CIGNA [1260]|CIGNA PANTEX [126003]|1032.08||||1032.08|485.08|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|1032.08||||1032.08|588.29|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|1032.08||||1032.08|722.46|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1032.08||||1032.08|774.06|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1032.08||||1032.08|749.29|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|1032.08||||1032.08|118.9|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|1032.08||||1032.08|877.27|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|PHCS [1780]|PHCS MULTIPLAN [178000]|1032.08||||1032.08|722.46|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|PHCS [1780]|FREEDOM LIFE [178009]|1032.08||||1032.08|877.27|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|1032.08||||1032.08|722.46|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1032.08||||1032.08|749.29|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|CELTIC LIFE [1220]|CELTIC LIFE [122000]|1032.08||||1032.08|722.46|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|CORESOURCE [1315]|CORESOURCE [131500]|1032.08||||1032.08|749.29|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|HEALTHNET [1495]|HEALTHNET [149500]|1032.08||||1032.08|774.06|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1032.08||||1032.08|722.46|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|||1032.08||||1032.08|774.06|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|1032.08||||1032.08|774.06|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|1032.08||||1032.08|722.46|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|1032.08||||1032.08|433.47|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|1032.08||||1032.08|433.47|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|1032.08||||1032.08|361.23|877.27|45.6 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1032.08||||1032.08||| 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|1032.08||||1032.08||| 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|1032.08||||1032.08||| 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1032.08||||1032.08||| 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|1032.08||||1032.08||| 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|1032.08||||1032.08||| 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|1032.08||||1032.08||| 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|1032.08||||1032.08||| 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|UMR [2035]|UMR CHEROKEE MLR [203504]|1032.08||||1032.08||| 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|1032.08||||1032.08||| 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1032.08||||1032.08||| 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1032.08||||1032.08||| 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|1032.08||||1032.08||| 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1032.08||||1032.08||| 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|CHAMPVA [1240]|CHAMP VA [124000]|1032.08||||1032.08||| 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1032.08||||1032.08||| 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|1032.08||||1032.08||| 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1032.08||||1032.08||| 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|1032.08||||1032.08||| 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|1032.08||||1032.08||| 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|1032.08||||1032.08||| 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|1032.08||||1032.08||| 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1032.08||||1032.08||| 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|1032.08||||1032.08||| 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|1032.08||||1032.08||| 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|1032.08||||1032.08||| 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|1032.08||||1032.08||| 108029|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FONDAPARINUX 10 MG/0.8 ML SUBCUTANEOUS SOLUTION SYRINGE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|1032.08||||1032.08||| 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|NRECA [1735]|NRECA [173500]|5773.46||||5773.46|3539.13|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|5773.46||||5773.46|4907.44|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|5773.46||||5773.46|1260.24|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|5773.46||||5773.46|4330.1|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|AETNA [1015]|AMERICAN CONTINENTAL [101507]|5773.46||||5773.46|4330.1|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5773.46||||5773.46|4041.42|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|5773.46||||5773.46|4330.1|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|5773.46||||5773.46|4041.42|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|5773.46||||5773.46|4041.42|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|5773.46||||5773.46|1235.53|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|5773.46||||5773.46|4907.44|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|5773.46||||5773.46|4907.44|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|5773.46||||5773.46|4330.1|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|AETNA [1015]|AETNA TRS [101506]|5773.46||||5773.46|3752.75|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|5773.46||||5773.46|665.1|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|UMR [2035]|UMR CORE [203505]|5773.46||||5773.46|2471.04|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|5773.46||||5773.46|1117.16|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|5773.46||||5773.46|4197.31|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|5773.46||||5773.46|2886.73|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|WEB TPA [2115]|WEB TPA [211501]|5773.46||||5773.46|4041.42|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|WEB TPA [2115]|WEB TPA [211500]|5773.46||||5773.46|4330.1|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|MEDICA [2910]|MEDICA HARMONY [291000]|5773.46||||5773.46|4041.42|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|5773.46||||5773.46|4907.44|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|5773.46||||5773.46|4330.1|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|5773.46||||5773.46|1235.53|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|5773.46||||5773.46|1235.53|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|5773.46||||5773.46|4041.42|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5773.46||||5773.46|1235.53|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5773.46||||5773.46|1924.29|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|5773.46||||5773.46|1235.53|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|5773.46||||5773.46|4330.1|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|5773.46||||5773.46|1117.16|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|5773.46||||5773.46|4041.42|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|5773.46||||5773.46|4330.1|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|5773.46||||5773.46|4041.42|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|5773.46||||5773.46|4197.31|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|5773.46||||5773.46|4907.44|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|5773.46||||5773.46|3127.3|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5773.46||||5773.46|1235.53|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|5773.46||||5773.46|2424.85|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|5773.46||||5773.46|2713.53|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|5773.46||||5773.46|2424.85|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|5773.46||||5773.46|4041.42|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|5773.46||||5773.46|4041.42|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|5773.46||||5773.46|4191.53|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|EQUITABLE [1355]|EQUITABLE INS [135500]|5773.46||||5773.46|4041.42|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5773.46||||5773.46|4191.53|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|5773.46||||5773.46|4907.44|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|5773.46||||5773.46|1399.9|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|5773.46||||5773.46|4330.1|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|5773.46||||5773.46|1135.7|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5773.46||||5773.46|1235.53|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|CBSA [1215]|CBSA [121500]|5773.46||||5773.46|4041.42|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|5773.46||||5773.46|4041.42|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA PANTEX [126003]|5773.46||||5773.46|2713.53|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|5773.46||||5773.46|4907.44|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|5773.46||||5773.46|4041.42|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|5773.46||||5773.46|4330.1|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|5773.46||||5773.46|4330.1|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5773.46||||5773.46|4907.44|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|5773.46||||5773.46|4330.1|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|5773.46||||5773.46|4041.42|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|5773.46||||5773.46|2886.73|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|5773.46||||5773.46|4191.53|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|MAILHANDLERS [1595]|MAILHANDLERS [159500]|5773.46||||5773.46|4330.1|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5773.46||||5773.46|1235.53|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|5773.46||||5773.46|1210.82|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5773.46||||5773.46|1235.53|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5773.46||||5773.46|4907.44|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|5773.46||||5773.46|1140.4|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|5773.46||||5773.46|4907.44|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|5773.46||||5773.46|1235.53|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA [126008]|5773.46||||5773.46|4191.53|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|5773.46||||5773.46|665.1|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|5773.46||||5773.46|4041.42|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|5773.46||||5773.46|4041.42|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|5773.46||||5773.46|4041.42|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|5773.46||||5773.46|2886.73|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|TML [1980]|TML [198000]|5773.46||||5773.46|3539.13|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|GUARDIAN [1465]|GUARDIAN [146500]|5773.46||||5773.46|4041.42|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|5773.46||||5773.46|3290.87|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|5773.46||||5773.46|4041.42|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|5773.46||||5773.46|2886.73|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|TDH BCCS [2341]|TDH BCCS [234100]|5773.46||||5773.46|665.1|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5773.46||||5773.46|4330.1|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|5773.46||||5773.46|1235.53|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|5773.46||||5773.46|4041.42|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|5773.46||||5773.46|2886.73|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|5773.46||||5773.46|4191.53|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|5773.46||||5773.46|665.1|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|PHCS [1780]|PHCS MULTIPLAN [178000]|5773.46||||5773.46|4041.42|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|PHCS [1780]|FREEDOM LIFE [178009]|5773.46||||5773.46|4907.44|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|5773.46||||5773.46|4041.42|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5773.46||||5773.46|1235.53|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|UMR [2035]|UMR CHOICE [203500]|5773.46||||5773.46|3539.13|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|UMR [2035]|UMR CHEROKEE MLR [203504]|5773.46||||5773.46|1235.53|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|5773.46||||5773.46|3539.13|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|GILSBAR [1425]|GILSBAR [142500]|5773.46||||5773.46|4330.1|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5773.46||||5773.46|1235.53|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|5773.46||||5773.46|1235.53|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|5773.46||||5773.46|1789.77|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|||5773.46||||5773.46|4330.09|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|5773.46||||5773.46|1399.9|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|CELTIC LIFE [1220]|CELTIC LIFE [122000]|5773.46||||5773.46|4041.42|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|5773.46||||5773.46|1235.53|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|5773.46||||5773.46|4330.1|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|5773.46||||5773.46|2779.94|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|5773.46||||5773.46|2020.71|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|5773.46||||5773.46|2424.85|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|5773.46||||5773.46|1260.24|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|5773.46||||5773.46|1235.53|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|GROUP HEALTH [2165]|GROUP HEALTH [216500]|5773.46||||5773.46|4907.44|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|5773.46||||5773.46|4041.42|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|5773.46||||5773.46|4907.44|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|LEWER AGENCY [1565]|LEWER AGENCY [156500]|5773.46||||5773.46|4041.42|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|5773.46||||5773.46|2660.9|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|5773.46||||5773.46|3464.08|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|5773.46||||5773.46|2944.46|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|5773.46||||5773.46|4041.42|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|5773.46||||5773.46|2471.04|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|5773.46||||5773.46|3539.13|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|5773.46||||5773.46|1235.53|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|5773.46||||5773.46|1235.53|4907.44|665.1 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|5773.46||||5773.46||| 108055|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 100 MG/5 ML (20 MG/ML) INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|5773.46||||5773.46||| 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|WEB TPA [2115]|WEB TPA [211500]|23093.82||||23093.82|17320.37|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|23093.82||||23093.82|4942.12|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|MAILHANDLERS [1595]|MAILHANDLERS [159500]|23093.82||||23093.82|17320.37|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|23093.82||||23093.82|16165.67|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|23093.82||||23093.82|19629.75|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|23093.82||||23093.82|17320.37|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|23093.82||||23093.82|16165.67|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|23093.82||||23093.82|4942.12|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|23093.82||||23093.82|17320.37|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|23093.82||||23093.82|4942.12|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|23093.82||||23093.82|19629.75|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|23093.82||||23093.82|19629.75|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA [126008]|23093.82||||23093.82|16766.11|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|23093.82||||23093.82|4942.12|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|23093.82||||23093.82|16165.67|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|23093.82||||23093.82|16165.67|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|TML [1980]|TML [198000]|23093.82||||23093.82|14156.51|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|23093.82||||23093.82|4942.12|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|23093.82||||23093.82|16165.67|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|23093.82||||23093.82|17320.37|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|23093.82||||23093.82|4942.12|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|23093.82||||23093.82|16165.67|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|23093.82||||23093.82|2660.41|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|23093.82||||23093.82|19629.75|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|23093.82||||23093.82|16766.11|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|23093.82||||23093.82|16165.67|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|CELTIC LIFE [1220]|CELTIC LIFE [122000]|23093.82||||23093.82|16165.67|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|23093.82||||23093.82|4942.12|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131500]|23093.82||||23093.82|16766.11|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|23093.82||||23093.82|4942.12|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|PHCS [1780]|FREEDOM LIFE [178009]|23093.82||||23093.82|19629.75|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|23093.82||||23093.82|4942.12|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|23093.82||||23093.82|16165.67|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|||23093.82||||23093.82|17320.36|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|23093.82||||23093.82|5040.96|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|23093.82||||23093.82|5599.6|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|23093.82||||23093.82|16165.67|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|23093.82||||23093.82|11119.77|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|23093.82||||23093.82|9699.4|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|23093.82||||23093.82|8082.84|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|23093.82||||23093.82|4942.12|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|TDH BCCS [2341]|TDH BCCS [234100]|23093.82||||23093.82|2660.41|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|GROUP HEALTH [2165]|GROUP HEALTH [216500]|23093.82||||23093.82|19629.75|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|23093.82||||23093.82|16165.67|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|23093.82||||23093.82|9699.4|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|23093.82||||23093.82|4942.12|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|23093.82||||23093.82|19629.75|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|23093.82||||23093.82|2660.41|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|CBSA [1215]|CBSA [121500]|23093.82||||23093.82|16165.67|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|23093.82||||23093.82|10854.1|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|23093.82||||23093.82|12509.18|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|GUARDIAN [1465]|GUARDIAN [146500]|23093.82||||23093.82|16165.67|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|23093.82||||23093.82|9699.4|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA PANTEX [126003]|23093.82||||23093.82|10854.1|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|23093.82||||23093.82|13856.29|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|23093.82||||23093.82|13163.48|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|23093.82||||23093.82|4542.8|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|23093.82||||23093.82|17320.37|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|23093.82||||23093.82|5599.6|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|23093.82||||23093.82|11546.91|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|23093.82||||23093.82|16165.67|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|23093.82||||23093.82|11777.85|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|23093.82||||23093.82|10643.6|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|PHCS [1780]|PHCS MULTIPLAN [178000]|23093.82||||23093.82|16165.67|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|EQUITABLE [1355]|EQUITABLE INS [135500]|23093.82||||23093.82|16165.67|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|23093.82||||23093.82|19629.75|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|23093.82||||23093.82|4561.6|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|23093.82||||23093.82|16165.67|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|23093.82||||23093.82|16789.21|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|23093.82||||23093.82|16165.67|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|23093.82||||23093.82|14156.51|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|23093.82||||23093.82|16766.11|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|23093.82||||23093.82|9884.15|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|23093.82||||23093.82|4843.28|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|23093.82||||23093.82|4942.12|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|23093.82||||23093.82|4942.12|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|23093.82||||23093.82|16165.67|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|23093.82||||23093.82|16165.67|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|23093.82||||23093.82|17320.37|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|23093.82||||23093.82|17320.37|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|23093.82||||23093.82|11546.91|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|23093.82||||23093.82|17320.37|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|23093.82||||23093.82|4468.65|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|23093.82||||23093.82|17320.37|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|23093.82||||23093.82|11546.91|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|23093.82||||23093.82|4942.12|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|23093.82||||23093.82|19629.75|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|23093.82||||23093.82|7697.17|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|23093.82||||23093.82|16165.67|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|23093.82||||23093.82|4942.12|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|23093.82||||23093.82|11546.91|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|23093.82||||23093.82|4942.12|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|23093.82||||23093.82|17320.37|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|23093.82||||23093.82|19629.75|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|LEWER AGENCY [1565]|LEWER AGENCY [156500]|23093.82||||23093.82|16165.67|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|MEDICA [2910]|MEDICA HARMONY [291000]|23093.82||||23093.82|16165.67|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|WEB TPA [2115]|WEB TPA [211501]|23093.82||||23093.82|16165.67|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|23093.82||||23093.82|11546.91|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|UMR [2035]|UMR OPTIONS [203501]|23093.82||||23093.82|16789.21|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|UMR [2035]|UMR CHEROKEE MLR [203504]|23093.82||||23093.82|4942.12|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|UMR [2035]|UMR CHOICE [203500]|23093.82||||23093.82|14156.51|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|UMR [2035]|UMR CORE [203505]|23093.82||||23093.82|9884.15|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|23093.82||||23093.82|2660.41|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|GILSBAR [1425]|GILSBAR [142500]|23093.82||||23093.82|17320.37|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|23093.82||||23093.82|7159.08|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|23093.82||||23093.82|16165.67|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|AETNA [1015]|AETNA TRS [101506]|23093.82||||23093.82|15010.98|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|23093.82||||23093.82|5040.96|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|23093.82||||23093.82|4942.12|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|NRECA [1735]|NRECA [173500]|23093.82||||23093.82|14156.51|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|23093.82||||23093.82|4468.65|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|23093.82||||23093.82|17320.37|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|23093.82||||23093.82|16766.11|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|AETNA [1015]|AMERICAN CONTINENTAL [101507]|23093.82||||23093.82|17320.37|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|23093.82||||23093.82|17320.37|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|23093.82||||23093.82|16165.67|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|23093.82||||23093.82|17320.37|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|23093.82||||23093.82|16165.67|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|23093.82||||23093.82|19629.75|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|23093.82||||23093.82|19629.75|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|23093.82||||23093.82|14156.51|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|23093.82||||23093.82|4942.12|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|23093.82||||23093.82|19629.75|19629.75|2660.41 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|23093.82||||23093.82||| 108057|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|PANITUMUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|23093.82||||23093.82||| 108065|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|14344.92||||14344.92|12193.18|12193.18|413.13 108065|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|14344.92||||14344.92|3054.44|12193.18|413.13 108065|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION|NRECA [1735]|NRECA [173500]|3586.23||||3586.23|2198.36|12193.18|413.13 108065|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION|NRECA [1735]|NRECA [173500]|14344.92||||14344.92|8793.44|12193.18|413.13 108065|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|14344.92||||14344.92|2775.74|12193.18|413.13 108065|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|14344.92||||14344.92|10758.69|12193.18|413.13 108065|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|3586.23||||3586.23|3048.3|12193.18|413.13 108065|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3586.23||||3586.23|763.61|12193.18|413.13 108065|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3586.23||||3586.23|778.88|12193.18|413.13 108065|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA TRS [101506]|3586.23||||3586.23|2331.05|12193.18|413.13 108065|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|14344.92||||14344.92|3115.53|12193.18|413.13 108065|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION|AETNA [1015]|AMERICAN CONTINENTAL [101507]|3586.23||||3586.23|2689.67|12193.18|413.13 108065|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA TRS [101506]|14344.92||||14344.92|9324.2|12193.18|413.13 108065|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|14344.92||||14344.92|3054.44|12193.18|413.13 108065|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3586.23||||3586.23|2510.36|12193.18|413.13 108065|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|14344.92||||14344.92|10041.44|12193.18|413.13 108065|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|14344.92||||14344.92|10758.69|12193.18|413.13 108065|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|14344.92||||14344.92|10758.69|12193.18|413.13 108065|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|3586.23||||3586.23|2689.67|12193.18|413.13 108065|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|14344.92||||14344.92|10041.44|12193.18|413.13 108065|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|14344.92||||14344.92|4446.93|12193.18|413.13 108065|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|3586.23||||3586.23|1111.73|12193.18|413.13 108065|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|3586.23||||3586.23|2510.36|12193.18|413.13 108065|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|14344.92||||14344.92|10041.44|12193.18|413.13 108065|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|3586.23||||3586.23|763.61|12193.18|413.13 108065|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|3586.23||||3586.23|3048.3|12193.18|413.13 108065|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|BEVACIZUMAB 25 MG/ML INTRAVENOUS SOLUTION|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|14344.92||||14344.92|12193.18|12193.18|413.13 108065|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|BEVACIZUMAB