Mail Order Program. Co-pay per prescription—90 Day Supply Generic $10.00 Formulary Brand $20.00 Non- Formulary Brand $50.00 A. A1 Account Clerk
Appears in 2 contracts
Sources: Master Agreement, Master Agreement
Mail Order Program. Co-pay per prescription—90 Day Supply Generic $10.00 Formulary Brand $20.00 Non- Formulary Brand $50.00 A. A1 Account ClerkClerk II A2 Account Clerk I
Appears in 1 contract
Sources: Master Agreement