Exhibit 10.33





Exhibit 10.33




[THOSE PORTIONS OF THIS AGREEMENT THAT HAVE BEEN OMITTED AND FILED SEPARATELY WITH 

THE U.S. SECURITIES AND EXCHANGE COMMISSION PURSUANT TO HEALTHSPRING,
INC.’S APPLICATION
REQUESTING CONFIDENTIAL TREATMENT ARE MARKED “[***]” HEREIN.]




SECOND AMENDMENT TO AMENDED & RESTATED MANAGEMENT SERVICES AGREEMENT




This Second Amendment, effective as of November 1, 2009 (“Amendment Effective Date”), is to
the Amended & Restated Management Services Agreement dated January 1, 2009, as amended (the “MSA”),
between Argus Health Systems, Inc. (“Argus”) and HealthSpring of Tennessee, Inc., a Tennessee
corporation; HealthSpring of Tennessee, Inc., a Tennessee corporation d/b/a HealthSpring of
Illinois; Texas HealthSpring, LLC, a Texas limited liability company; HealthSpring Life & Health
Insurance Company, Inc., a Texas insurance company; HealthSpring of Florida, Inc., a Florida
corporation; and HealthSpring of Alabama, Inc., an Alabama corporation (individually and
collectively referred to herein as “Customer”).



NOW, THEREFORE, in consideration of the promises, covenants, representations and warranties
set forth herein and other consideration, the sufficiency of which is hereby acknowledged, Argus
and Customer hereby agree as follows:



1. Definitions: Capitalized terms used in this Second Amendment shall have the same meaning as in
the MSA unless otherwise specifically defined herein.



2. Section 2 of the MSA is hereby deleted in its entirety and replaced with the following:




“2. TERM. This MSA shall remain in full force and effect until December 31, 2010.
This MSA shall automatically renew for a two (2) year period unless either party
provides written notice of its intent not to renew at least one hundred-eighty (180)
days prior to the end of the initial term.”



3. Exhibit C to MSA (Fees and Expenses) is deleted in its entirety and replaced with Exhibit C to
MSA (First Revision) attached hereto and incorporated herein by reference with such pricing being
retroactively effective as of January 1, 2009.



4. Section (2) of the penalty calculation for Performance Standard No. 11 provided in Exhibit D to
the MSA is hereby amended to read as follows:




“(2) For files transmitted that contain incorrect information (to be reported by
Customer and verified by Argus), [***] received by Argus during the Quarterly
Reporting Period.”



Second Amendment to Amended & Restated MSA

Page 3






 


 









 







5. The penalty calculation for Performance Standard No.3 provided in Exhibit D to the MSA is hereby
amended to read as follows:




“[***] received by Argus during the Monthly Reporting Period for failure to meet
either or both Standard 3A or 3B for the Monthly Reporting Period.”



6. The following shall be added to the end of the Definitions provided in Exhibit D to the MSA:




“Monthly Reporting Period — A Monthly Reporting Period is a calendar month. Each
subsequent Monthly Reporting Period will begin immediately following the end of the
previous Monthly Reporting Period.”



7. Exhibit F, attached hereto and incorporated herein by reference, shall be added to the MSA.



8. As of the Effective Date, Schedule A to the Services Addendum to MSA for Pharmacy Network
Services (Customer Election of Argus Network) is deleted in its entirety and replaced with Schedule
A (First Revision) to the Services Addendum to MSA for Pharmacy Network Services attached hereto
and incorporated herein by reference.



9. Except as amended and modified by this Amendment, all of the terms and conditions of the MSA
shall remain in full force and effect. This Amendment may not be modified except in writing signed
by both parties hereto. This Amendment, the MSA and exhibits and schedules thereto constitute the
entire agreement of the parties with respect to the subject matter contained therein and supersede
any and all prior agreements between the parties, whether oral or written, concerning the subject
matter contained herein.



IN WITNESS WHEREOF, the parties hereto by their duly authorized representatives executed this
Amendment to be effective as of the Amendment Effective Date.



Second Amendment to Amended & Restated MSA

Page 4





 


 









 







SIGNATURE PAGE




	 	 	 	 	 	 	 
	ARGUS HEALTH SYSTEMS, INC.	 	HEALTHSPRING OF TENNESSEE, INC.
	 
	 	 	 	 	 	 
	By:

	 	/s/ Jonathan Boehm
	 	By:
	 	/s/ Michael G. Mirt
	 

	 	 
	 	 	 	 
	 

	 	Printed Name: Jonathan Boehm
	 	 	 	Printed Name: Michael G. Mirt
	 

	 	Title: President
	 	 	 	Title: CEO
	Date: October 29, 2009	 	Date: October 29, 2009
	 
	 	 	 	 	 	 
	 	 	 	 	HEALTHSPRING OF TENNESSEE, INC

d/b/a HEALTHSPRING OF ILLINOIS
	 
	 	 	 	 	 	 
	 

	 	 	 	By:
	 	/s/ Michael G. Mirt
	 

	 	 	 	 	 	 
	 

	 	 	 	 	 	Printed Name: Michael G. Mirt
	 

	 	 	 	 	 	Title: CEO
	 	 	 	 	Date: October 29, 2009
	 
	 	 	 	 	 	 
	 	 	 	 	TEXAS HEALTHSPRING, LLC
	 
	 	 	 	 	 	 
	 

	 	 	 	By:
	 	/s/ Michael G. Mirt
	 

	 	 	 	 	 	 
	 

	 	 	 	 	 	Printed Name: Michael G. Mirt
	 

	 	 	 	 	 	Title: CEO
	 	 	 	 	Date: October 29, 2009
	 
	 	 	 	 	 	 
	 	 	 	 	HEALTHSPRING OF ALABAMA, INC.
	 
	 	 	 	 	 	 
	 

	 	 	 	By:
	 	/s/ Michael G. Mirt
	 

	 	 	 	 	 	 
	 

	 	 	 	 	 	Printed Name: Michael G. Mirt
	 

	 	 	 	 	 	Title: CEO
	 	 	 	 	Date: October 29, 2009
	 
	 	 	 	 	 	 
	 	 	 	 	HEALTHSPRING OF FLORIDA, INC.
	 
	 	 	 	 	 	 
	 

	 	 	 	By:
	 	/s/ Michael G. Mirt
	 

	 	 	 	 	 	 
	 

	 	 	 	 	 	Printed Name: Michael G. Mirt
	 

	 	 	 	 	 	Title: CEO
	 	 	 	 	Date: October 29, 2009
	 
	 	 	 	 	 	 
	 	 	 	 	HEALTHSPRING LIFE & HEALTH INSURANCE
COMPANY, INC.
	 
	 	 	 	 	 	 
	 

	 	 	 	By:
	 	/s/ Michael G. Mirt
	 

	 	 	 	 	 	 
	 

	 	 	 	 	 	Printed Name: Michael G. Mirt
	 

	 	 	 	 	 	Title: CEO
	 	 	 	 	Date: October 29, 2009






Second Amendment to Amended & Restated MSA

Page 3





 


 









 







EXHIBIT C TO MSA (FIRST REVISION)****





	1. 	Claims Processing





Electronic Claims Processing (includes standard financial reports)



	 	 	 	 	 
	Claim Volume Threshhold	 	Per Paid Claim Fee	 
	[***]
	 	 	[***]	 
	[***]
	 	 	[***]	 
	[***]
	 	 	[***]	 
	[***]
	 	 	[***]	 
	[***]
	 	 	 	 
	 
	Universal Claim Form (UCF) entered by Argus
	 	 	[***]	 
	Direct Member Reimbursement (DMR) processing
entered by Argus
	 	 	[***]	 
	Adjustments to prior processed claims — customer
ordered and entered by Argus
	 	 	[***]	 
	Adjustments to prior processed claims — customer
entered or batch file provided by customer
	 	 	[***]	 
	IPNS on-line access fee
	 	 	[***]	 







	2. 	Disbursements





	 	 	 	 	 
	Pharmacy Checks
	 	 	[***]	 
	Pharmacy Reconciliation Reports
	 	 	[***]	 
	Member Checks, Explanation of checks (EOC’s)
	 	 	[***]	 
	(includes postage*)
	 	 	 	 







	3. 	Reporting





	 	 	 	 	 
	RxFocus II (Ad Hoc reporting)
	 	 	 	 
	Set up fee (one time)
	 	 	[***]	 
	Per claim
	 	 	[***]	 
	Access fee — License & Maintenance
	 	 	[***]	 
	Additional users
	 	 	[***]	 
	 
	Argus Standard Management Reports- Electronic media
	 	 	[***]	 
	Paid Claims Data/Transmissions (PCT) in existing
	 	 	[***]	 
	Argus format- 1 per financial cycle
	 	 	 	 
	Paid Claims Data/Transmissions (PCT) in existing
	 	 	[***]	 
	Argus format — each additional
	 	 	 	 
	 
	Custom Reporting
	 	 	 	 
	All custom Management & Financial Reports; all PCT’s outside of existing Argus format;
all custom RxFocusII and Rebate reports.
	 	 	 	 
	Development of report
	 	 	[***]	 
	Production of report- Electronic media
	 	 	[***]	 







	4. 	Rebates Administration





	 	 	 	 	 
	Rebate Processing tool and reporting
	 	 	[***]	 
	(quarterly reconciliation)
	 	 	 	 






Second Amendment to Amended & Restated MSA

Page 3




 


 









 






	5. 	Clinical Programs





	 	 	 	 	 
	DUR
	 	 	[***]	 
	Administrative Prior Authorizations
	 	 	[***]	 
	Clinical Authorizations
	 	 	[***]	 
	Step Therapy
	 	 	[***]	 
	Clinical services — quarterly benchmark reports
	 	 	[***]	 







	6. 	Pharmacy Networks





	 	 	 	 	 
	Use of Argus Pharmacy Networks
	 	 	[***]	 
	Desk Top Audits
	 	 	[***]	 
	On-site Pharmacy Audits
	 	 	[***]	 
	Argus MAC
	 	 	[***]	 







	7. 	Provider and Member Support





	 	 	 	 	 
	Pharmacy Call Center — non-dedicated line
	 	 	[***]	 
	Member Call Center support
	 	 	[***]	 
	 
	Tier I calls- 5 minute handling time
	 	 	[***]	 
	Tier II calls- 6 minute handling time
	 	 	[***]	 
	 
	Member Portal- Drug Pricing, Pharmacy Locator, and Claim Search
	 	 	 	 
	License and maintenance
	 	 	[***]	 
	Per pre-adjudication
	 	 	[***]	 
	All other Member Portal components priced on an ad hoc basis
	 	 	 	 







	8. 	ePrescribing





	 	 	 	 	 
	Monthly Maintenance Fee
	 	 	[***]	 
	Transaction fee
	 	 	[***]	 







	9. 	Training





	 	 	 	 	 
	As part of Implementation
	 	 	[***]	 
	Additional Training
	 	 	 	 
	Standard Classes
	 	 	[***]	 
	Special/Custom Training
	 	 	[***]	 







	10. 	Other Services





	 	 	 	 	 
	Professional Fees/Programming/Conversions
	 	 	[***]	 







	11. 	Part D Services (not specified elsewhere in this exhibit)





	 	 	 	 	 
	CMS Reporting
	 	 	[***]	 
	CMS Testing
	 	 	[***]	 
	PDE
	 	 	[***]	 
	LICS claim adjustment
	 	 	[***]	 
	LICS Additional Financial
	 	 	[***]	 
	DMR Letters
	 	 	[***]	 
	EOB’s
	 	 	 	 
	EOB Data File
	 	 	[***]	 
	(available if Argus is not providing EOB print
services)
	 	 	 	 
	Transition Letters
	 	 	 	 
	Print/mail- up to 2 pages/4 images (daily as required)
	 	 	[***]	 
	Additional pages
	 	 	[***]	 
	Transition Claims Data File
	 	 	[***]	 






Second Amendment to Amended & Restated MSA

Page 4




 


 









 








	12. 	PA Vendor Services — Effective December 1, 2009





	 	 	 	 	 
	Implementation Fee
	 	 	 	 
	Authorizations
	 	 	[***]	 
	Eligibility
	 	 	[***]	 
	 
	 	 	 	 
	Maintenance Fee
	 	 	[***]	 
	 
	 	 	 	 
	Transaction Fee
	 	 	 	 
	Eligibility
	 	 	[***]	 
	Authorization
	 	 	[***]	 









				
	 	 	 	 
	13. Out of Pocket Expenses
	 	[***]	 





Including but not limited to:





	 	•	 	Postage for mailing Management and Financial Reports, Paid Claims Tapes, Inserts, etc.






	 	•	 	Airfreight/overnight letters






	 	•	 	Mailings, inserts






	 	•	 	Stop payment or other fees/bank charges






	 	•	 	Archival retrieval of Claim information






	 	•	 	Maintenance fees for direct access communication lines, VPN support and maintenance






	 	•	 	Travel and expenses related to training beyond implementation days






	 	•	 	Non- electronic media creation






	 	•	 	Mailing to Providers, Clients of Customer







				
	 	 	 	 
	14. MONTHLY MINIMUM CLAIMS PROCESSING FEE
	 	[***]	 





	 	 	 
	*	 	Effective January 1 of the year following the first calendar year in which Argus EOB’s/Transition
Letters/DMR Letters/Pharmacy Checks/Member Checks are produced and each January 1 thereafter, the
fee will increase by an amount equal to any increase in the applicable postage rate during the
prior calendar year.

	 
	**	 	Subject to change as described in
Section 5 of E-Prescribing Services Addendum.

	 
	***	 	HealthSpring may terminate use of the Rebates Administration service upon 60 days prior written
notice. Both parties shall mutually agree upon any transition services and fees to be provided
after the date of termination.

	 
	****	 	The parties hereby agree that any interest owed by Customer to Argus that accrues prior to
November 30, 2009, relating to late payments as provided in Section 7 of the MSA or otherwise shall
not be settled upon a cash basis but shall be available to offset any current or future fees or
penalties owed by Argus to Customer under the MSA. Any interest owed by Customer to Argus that
accrues on or after December 1, 2009, relating to late payments as provided in Section 7 of the MSA
or otherwise shall be payable in accordance with the MSA.




Second Amendment to Amended & Restated MSA

Page 5





 


 









 







EXHIBIT F




PA Vendor Services




Argus will provide web service connectivity with Customer’s contracted prior authorization vendor
(“PA Vendor”) allowing for eligibility searches and the entry of multiple Argus authorization types
currently offered in Argus IPNS. Argus will perform implementation activities necessary to allow
Customer to utilize the PA Vendor application including: (a) send and receive data to and from PA
Vendor by using third party internet browsers, and (b) web service feeds to the PA Vendor system.
Argus will also provide web service integration with Argus’ IPNS for eligibility and
authorizations.



Customer shall provide reasonable written notice to Argus of the date its agreement with the PA
Vendor is to expire, terminate or will otherwise be altered in a manner that will prohibit Argus
from providing the services as provided herein (“PA Termination Date”). On the PA Termination Date,
except as otherwise agreed to by the parties, this Exhibit F will be null and void and neither
party will have any additional obligations under this Exhibit F except that this termination shall
not relieve Customer of paying Argus fees for any services provided prior to receipt of such
notification. The parties hereby agree that Customer may, upon 90 days advance written notice,
terminate this Exhibit F for any reason.



Second Amendment to Amended & Restated MSA

Page 3



 


 









 





SCHEDULE A (FIRST REVISION) TO SERVICES ADDENDUM TO MSA FOR

PHARMACY NETWORK SERVICES

CUSTOMER ELECTION OF ARGUS NETWORK




The capitalized terms used in this Schedule are defined in Exhibit A to the MSA. For the selected
network schedule to apply, Argus must receive Claims in Argus Format at point of sale from
Contracted Pharmacy. Customer understands that Argus Pharmacies may terminate their participation
in an Argus Network upon six months notice, or as otherwise negotiated, and thus that the
composition of the Network selected by Customer may change during the term of this agreement. The
Argus Network pricing established herein represents the rates targeted for contract negotiations
with Argus Pharmacies. Argus warrants that Customer will receive the benefit of any and all rates
negotiated for Customer even to the extent that contracted rates result in lower reimbursements
than indicated in the rates set forth below. The parties agree that Participating Pharmacies that
elect to participate in the pharmacy network developed by Argus and utilized by Customer shall be
reimbursed in accordance with the contracted rates. Adherence with the contracted rates shall be
measured by Customer through an audit right, including the use of a third party auditor, to verify
Argus’ adherence to the transparency and pass through pricing objectives.



Network Reimbursement Rates for Argus Pharmacies*





Retail Network paid on a per-claim, pass through, and lesser of the AWP discount, Usual and
Customary (U&C) or MAC.




	 	•	 	Brand [***]






	 	•	 	Brand Dispensing Fee — [***]






	 	•	 	Generic [***]






	 	•	 	Generic Dispensing Fee — [***]






Retail — Extended Supply Claims for 31 — 34 Days Supply paid on a per-claim, pass through, and
lesser of the AWP discount, Usual and Customary (U&C) or MAC.




	 	•	 	Brand [***]






	 	•	 	Dispensing Fee — [***]






	 	•	 	Generic [***]






	 	•	 	Dispense Fee — [***]






Retail — Extended Supply Claims for 35 — 60 Days Supply paid on a per-claim, pass through, and
lesser of the AWP discount, Usual and Customary (U&C) or MAC.




	 	•	 	Brand [***]






	 	•	 	Dispensing Fee — [***]






	 	•	 	Generic [***]






	 	•	 	Dispense Fee — [***]





Second Amendment to Amended & Restated MSA

Page 4



 


 









 






Retail — Extended Supply Claims for 61 — 84 Days Supply paid on a per-claim, pass through, and
lesser of the AWP discount, Usual and Customary (U&C) or MAC.




	 	•	 	Brand [***]






	 	•	 	Dispensing Fee — [***]






	 	•	 	Generic [***]






	 	•	 	Dispense Fee — [***]






Retail — Extended Supply Claims for 85 and more Days Supply paid on a per-claim, pass through,
and lesser of the AWP discount, Usual and Customary (U&C) or MAC.




	 	•	 	Brand [***]






	 	•	 	Dispensing Fee — [***]






	 	•	 	Generic [***]






	 	•	 	Dispense Fee — [***]






Mail Order Network paid on a per-claim, pass through, and lesser of the AWP discount or MAC




	 	•	 	Brand [***]






	 	•	 	Generic [***]






	 	•	 	Dispensing Fee — [***]





Specialty Pharmacy paid on a per-claim, pass through basis




	 	•	 	Brand [***]
	 
	 	•	 	Generic [***]
	 
	 	•	 	Dispensing Fee — [***]






Long Term Pharmacies paid on a per-claim, pass through, and lesser of the AWP discount or MAC if
applicable




	 	•	 	Brand @ [***]






	 	•	 	Generic Effective Rate @ [***]






	 	•	 	Dispensing Fee — @ [***]







	 	 	 
	*	 	Notes




Second Amendment to Amended & Restated MSA

Page 5



 


 









 





[***]





[Three pages have been omitted and filed separately with the U.S. Securities and Exchange
Commission pursuant to HealthSpring, Inc.’s application requesting confidential treatment.]



Second Amendment to Amended & Restated MSA

Page 6





 


 









 







Summary




[***]




[This page has been omitted and filed separately with the U.S. Securities and Exchange Commission
pursuant to HealthSpring, Inc.’s application requesting confidential treatment.]




 


 












 









Brand HS




	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Wtd	 	 	Wtd	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Dispense Fees	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Avg	 	 	Avg	 	 	AWP	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Act	 	 	Target	 	 	 	 
	Cust	 	Clm	 	Date	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Ingred	 	 	Disp	 	 	AWP	 	 	 	 	 	 	Disc	 	 	Disp	 	 	Prices	 	 	Actual	 	 	Target	 	 	 	 	 	 	Disp	 	 	Disp	 	 	 	 
	Id	 	#	 	Filled	 	NDC	 	Label Name	 	GPI	 	 	Qty	 	 	D.S.	 	 	Count	 	 	Ext. AWP	 	 	Cost	 	 	Fee	 	 	Disc	 	 	Count	 	 	Rate	 	 	Fee	 	 	Total AWP	 	 	IC	 	 	IC	 	 	Variance	 	 	Fees	 	 	Fees	 	 	Variance	 
	359
	 	27	 	1/23/2009	 	00486111101	 	K-PHOS ORIGINAL TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	45	 	1/23/2009	 	52268040001	 	NULYTELY WITH FLAVOR PACKS SOL	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	26	 	1/23/2009	 	08290320119	 	BD UF MINI PEN NEEDLE 31GX3/16	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	97	 	1/23/2009	 	08290320109	 	BD UF SHORT PEN NEEDL 31GX5/16	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	13	 	1/23/2009	 	00173068220	 	VENTOLIN HFA 90 MCG INHALER	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	91	 	1/23/2009	 	08290328468	 	BD UF INS SYR 0.5 ML 31GX5/16"	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	358
	 	63	 	1/23/2009	 	00046110281	 	PREMARIN 0.625 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	74	 	1/23/2009	 	00046087506	 	PREMPRO 0.625-2.5 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	15	 	1/23/2009	 	65597010330	 	BENICAR 20 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	70	 	1/23/2009	 	00186108805	 	TOPROL XL 25 MG TABLET SA	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	358
	 	94	 	1/23/2009	 	00006095254	 	COZAAR 50 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	46	 	1/23/2009	 	65726025110	 	INNOPRAN XL 120 MG CAP SA	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	358
	 	34	 	1/23/2009	 	65597010430	 	BENICAR 40 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	41	 	1/23/2009	 	00078035834	 	DIOVAN 80 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	75	 	1/23/2009	 	65597010530	 	BENICAR HCT 20-12.5 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	358
	 	95	 	1/23/2009	 	00071101568	 	LYRICA 100 MG CAPSULE	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 






 


 









 









	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Wtd	 	 	Wtd	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Dispense Fees	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Avg	 	 	Avg	 	 	AWP	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Act	 	 	Target	 	 	 	 
	Cust	 	Clm	 	Date	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Ingred	 	 	Disp	 	 	AWP	 	 	 	 	 	 	Disc	 	 	Disp	 	 	Prices	 	 	Actual	 	 	Target	 	 	 	 	 	 	Disp	 	 	Disp	 	 	 	 
	Id	 	#	 	Filled	 	NDC	 	Label Name	 	GPI	 	 	Qty	 	 	D.S.	 	 	Count	 	 	Ext. AWP	 	 	Cost	 	 	Fee	 	 	Disc	 	 	Count	 	 	Rate	 	 	Fee	 	 	Total AWP	 	 	IC	 	 	IC	 	 	Variance	 	 	Fees	 	 	Fees	 	 	Variance	 
	358
	 	99	 	1/23/2009	 	00023918703	 	LUMIGAN 0.03% EYE DROPS	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	17	 	1/23/2009	 	00078048515	 	TEKTURNA 150 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	358
	 	76	 	1/23/2009	 	00013830304	 	XALATAN 0.005% EYE DROPS	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	72	 	1/23/2009	 	00013830301	 	XALATAN 0.005% EYE DROPS	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	55	 	1/23/2009	 	00078031534	 	DIOVAN HCT 160-12.5 MG TAB	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	44	 	1/23/2009	 	00002831501	 	HUMULIN N 100 UNITS/ML VIAL	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	358
	 	51	 	1/23/2009	 	00456202001	 	LEXAPRO 20 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	84	 	1/23/2009	 	00071015523	 	LIPITOR 10 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	89	 	1/23/2009	 	00071015523	 	LIPITOR 10 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	47	 	1/23/2009	 	65597010730	 	BENICAR HCT 40-25 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	61	 	1/23/2009	 	00149047201	 	ACTONEL 35 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	87	 	1/23/2009	 	00149047201	 	ACTONEL 35 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	24	 	1/23/2009	 	00149047201	 	ACTONEL 35 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	98	 	1/23/2009	 	00078036034	 	DIOVAN 320 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	358
	 	60	 	1/23/2009	 	00173071215	 	AVODART 0.5 MG SOFTGEL	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	358
	 	71	 	1/23/2009	 	00173071215	 	AVODART 0.5 MG SOFTGEL	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	 	 	 	 	[***]	%	 	 	 	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	66	 	1/23/2009	 	00597005801	 	FLOMAX 0.4 MG CAPSULE SA	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	62	 	1/23/2009	 	66582031331	 	VYTORIN 10-40 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 






 


 









 










	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Wtd	 	 	Wtd	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Dispense Fees	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Avg	 	 	Avg	 	 	AWP	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Act	 	 	Target	 	 	 	 
	Cust	 	Clm	 	Date	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Ingred	 	 	Disp	 	 	AWP	 	 	 	 	 	 	Disc	 	 	Disp	 	 	Prices	 	 	Actual	 	 	Target	 	 	 	 	 	 	Disp	 	 	Disp	 	 	 	 
	Id	 	#	 	Filled	 	NDC	 	Label Name	 	GPI	 	 	Qty	 	 	D.S.	 	 	Count	 	 	Ext. AWP	 	 	Cost	 	 	Fee	 	 	Disc	 	 	Count	 	 	Rate	 	 	Fee	 	 	Total AWP	 	 	IC	 	 	IC	 	 	Variance	 	 	Fees	 	 	Fees	 	 	Variance	 
	359
	 	16	 	1/23/2009	 	00078047134	 	DIOVAN HCT 320-12.5 MG TAB	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	358
	 	39	 	1/23/2009	 	00078047134	 	DIOVAN HCT 320-12.5 MG TAB	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	 	 	 	 	[***]	%	 	 	 	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	358
	 	93	 	1/23/2009	 	00002416502	 	EVISTA 60 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	64	 	1/23/2009	 	00002416502	 	EVISTA 60 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	12	 	1/23/2009	 	00002323560	 	CYMBALTA 20 MG CAPSULE	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	68	 	1/23/2009	 	00006011754	 	SINGULAIR 10 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	358
	 	14	 	1/23/2009	 	00006011731	 	SINGULAIR 10 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	31	 	1/23/2009	 	00006011731	 	SINGULAIR 10 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	 	 	 	 	[***]	%	 	 	 	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	358
	 	58	 	1/23/2009	 	00006011731	 	SINGULAIR 10 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	35	 	1/23/2009	 	00310075190	 	CRESTOR 10 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	37	 	1/23/2009	 	00007337113	 	COREG CR 20 MG CAPSULE	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	82	 	1/23/2009	 	00074612390	 	TRICOR 145 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	358
	 	18	 	1/23/2009	 	00074612390	 	TRICOR 145 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	92	 	1/23/2009	 	00008083321	 	EFFEXOR XR 75 MG CAPSULE	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	358
	 	10	 	1/23/2009	 	00002323730	 	CYMBALTA 60 MG CAPSULE	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	50	 	1/23/2009	 	00002323730	 	CYMBALTA 60 MG CAPSULE	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	73	 	1/23/2009	 	00002324030	 	CYMBALTA 30 MG CAPSULE	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	 	 	 	 	[***]	%	 	 	 	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	5	 	1/23/2009	 	00071015723	 	LIPITOR 40 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	358
	 	21	 	1/23/2009	 	00071015723	 	LIPITOR 40 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	29	 	1/23/2009	 	00071015623	 	LIPITOR 20 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	 	 	 	 	[***]	%	 	 	 	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 






 


 









 











	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Wtd	 	 	Wtd	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Dispense Fees	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Avg	 	 	Avg	 	 	AWP	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Act	 	 	Target	 	 	 	 
	Cust	 	Clm	 	Date	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Ingred	 	 	Disp	 	 	AWP	 	 	 	 	 	 	Disc	 	 	Disp	 	 	Prices	 	 	Actual	 	 	Target	 	 	 	 	 	 	Disp	 	 	Disp	 	 	 	 
	Id	 	#	 	Filled	 	NDC	 	Label Name	 	GPI	 	 	Qty	 	 	D.S.	 	 	Count	 	 	Ext. AWP	 	 	Cost	 	 	Fee	 	 	Disc	 	 	Count	 	 	Rate	 	 	Fee	 	 	Total AWP	 	 	IC	 	 	IC	 	 	Variance	 	 	Fees	 	 	Fees	 	 	Variance	 
	358
	 	56	 	1/23/2009	 	00071015823	 	LIPITOR 80 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	 	 	 	 	[***]	%	 	 	 	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	90	 	1/23/2009	 	00009519101	 	DETROL LA 4 MG CAPSULE	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	88	 	1/23/2009	 	00310027110	 	SEROQUEL 100 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	100	 	1/23/2009	 	00310027110	 	SEROQUEL 100 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	11	 	1/23/2009	 	00009454402	 	DETROL 2 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	33	 	1/23/2009	 	63653117106	 	PLAVIX 75 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	9	 	1/23/2009	 	63653117106	 	PLAVIX 75 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	358
	 	19	 	1/23/2009	 	63653117106	 	PLAVIX 75 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	 	 	 	 	[***]	%	 	 	 	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	358
	 	20	 	1/23/2009	 	63653117106	 	PLAVIX 75 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	 	 	 	 	[***]	%	 	 	 	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	32	 	1/23/2009	 	63653117106	 	PLAVIX 75 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	 	 	 	 	[***]	%	 	 	 	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	358
	 	52	 	1/23/2009	 	63653117106	 	PLAVIX 75 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	 	 	 	 	[***]	%	 	 	 	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	358
	 	86	 	1/23/2009	 	63653117101	 	PLAVIX 75 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	28	 	1/23/2009	 	00597000160	 	AGGRENOX CAPSULE SA	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	48	 	1/23/2009	 	00456321060	 	NAMENDA 10 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	59	 	1/23/2009	 	00186504031	 	NEXIUM 40 MG CAPSULE	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	358
	 	69	 	1/23/2009	 	00597007541	 	SPIRIVA 18 MCG CP-HANDIHALER	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	358
	 	40	 	1/23/2009	 	00597007541	 	SPIRIVA 18 MCG CP-HANDIHALER	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	77	 	1/23/2009	 	00186037220	 	SYMBICORT 80-4.5 MCG INHALER	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	78	 	1/23/2009	 	00074712613	 	DEPAKOTE ER 500 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 






 


 









 









	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Wtd	 	 	Wtd	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Dispense Fees	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Avg	 	 	Avg	 	 	AWP	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Act	 	 	Target	 	 	 	 
	Cust	 	Clm	 	Date	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Ingred	 	 	Disp	 	 	AWP	 	 	 	 	 	 	Disc	 	 	Disp	 	 	Prices	 	 	Actual	 	 	Target	 	 	 	 	 	 	Disp	 	 	Disp	 	 	 	 
	Id	 	#	 	Filled	 	NDC	 	Label Name	 	GPI	 	 	Qty	 	 	D.S.	 	 	Count	 	 	Ext. AWP	 	 	Cost	 	 	Fee	 	 	Disc	 	 	Count	 	 	Rate	 	 	Fee	 	 	Total AWP	 	 	IC	 	 	IC	 	 	Variance	 	 	Fees	 	 	Fees	 	 	Variance	 
	359
	 	25	 	1/23/2009	 	00006022131	 	JANUVIA 25 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	81	 	1/23/2009	 	00169368712	 	LEVEMIR 100 UNITS/ML VIAL	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	38	 	1/23/2009	 	00074712653	 	DEPAKOTE ER 500 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	358
	 	67	 	1/23/2009	 	00088222060	 	LANTUS SOLOSTAR 100 UNITS/ML	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	53	 	1/23/2009	 	00049397060	 	GEODON 40 MG CAPSULE	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	8	 	1/23/2009	 	00029316013	 	AVANDIA 8 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	4	 	1/23/2009	 	00173069600	 	ADVAIR 250-50 DISKUS	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	85	 	1/23/2009	 	59011010310	 	OXYCONTIN 20 MG TABLET SA	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	22	 	1/23/2009	 	00310027810	 	SEROQUEL 50 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	80	 	1/23/2009	 	00456202001	 	LEXAPRO 20 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	2	 	1/23/2009	 	50458030250	 	RISPERDAL 0.5 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	358
	 	49	 	1/23/2009	 	58914079010	 	URSO FORTE 500 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	83	 	1/23/2009	 	00088222033	 	LANTUS 100 UNITS/ML VIAL	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	42	 	1/23/2009	 	00310027460	 	SEROQUEL 300 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	36	 	1/23/2009	 	50458055101	 	INVEGA 6 MG ER TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	3	 	1/23/2009	 	00173064460	 	LAMICTAL 200 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	7	 	1/23/2009	 	00088222052	 	LANTUS 100 UNITS/ML CARTRIDGE	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	54	 	1/23/2009	 	00049397060	 	GEODON 40 MG CAPSULE	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	6	 	1/23/2009	 	00310027534	 	SEROQUEL 25 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	65	 	1/23/2009	 	62856024630	 	ARICEPT 10 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 






 


 









 










	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Wtd	 	 	Wtd	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Dispense Fees	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Avg	 	 	Avg	 	 	AWP	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Act	 	 	Target	 	 	 	 
	Cust	 	Clm	 	Date	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Ingred	 	 	Disp	 	 	AWP	 	 	 	 	 	 	Disc	 	 	Disp	 	 	Prices	 	 	Actual	 	 	Target	 	 	 	 	 	 	Disp	 	 	Disp	 	 	 	 
	Id	 	#	 	Filled	 	NDC	 	Label Name	 	GPI	 	 	Qty	 	 	D.S.	 	 	Count	 	 	Ext. AWP	 	 	Cost	 	 	Fee	 	 	Disc	 	 	Count	 	 	Rate	 	 	Fee	 	 	Total AWP	 	 	IC	 	 	IC	 	 	Variance	 	 	Fees	 	 	Fees	 	 	Variance	 
	359
	 	57	 	1/23/2009	 	59148000813	 	ABILIFY 10 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	1	 	1/23/2009	 	00074621553	 	DEPAKOTE 500 MG TABLET EC	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	30	 	1/23/2009	 	63459020101	 	PROVIGIL 200 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	79	 	1/23/2009	 	00310027910	 	SEROQUEL 400 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	43	 	1/23/2009	 	59148000913	 	ABILIFY 15 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	96	 	1/23/2009	 	00173074200	 	EPZICOM TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	23	 	1/23/2009	 	00049318030	 	VFEND 200 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Rx Count	 	 	AWP	 	 	Ing Cost	 	 	Disp Fee	 	 	Total Cost	 	 	 	 	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	 
	 	 	 	 	 	 	 	Totals	 	 	 	 	 	 	 	 	 	 	 	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 
	 	 	 	 	 	 	 	Net Effective AWP Discount Rate	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	[***]	%	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	 	 	 	 	 	 	Target AWP Discount Rate	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	[***]	%	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	 	 	 	 	 	 	Net Effective Disp Fee	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	$	[***]	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	 	 	 	 	 	 	Target Dispense Fee	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	$	[***]	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 
	 	 	 	 	 	 	 	Monetary Value of Discount Rate Difference	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	$	[***]	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	 	 	 	 	 	 	Monetary Value of Dispense Fee Difference *	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	$	[***]	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	 	 	 	 	 	 	Total	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	$	[***]	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 
	 	 	 	 	 	 	 	* Monetary Value of Dispense Fee Difference Calculation:	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 
	 	 	 	 	 	 	 	Target Dispense Fee	 	 	 	 	 	 	 	 	 	 	 	 	 	$	[***]	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	 	 	 	 	 	 	Weighted Average Dispense Fees	 	 	 	 	 	 	 	 	 	 	 	 	 	$	[***]	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	 	 	 	 	 	 	Dispense Fee Difference	 	 	 	 	 	 	 	 	 	 	 	 	 	$	[***]	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	 	 	 	 	 	 	Actual Claims	 	 	 	 	 	 	 	 	 	 	 	 	 	 	[***]	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	 	 	 	 	 	 	Monetary Value of Dispense Fee Difference	 	 	 	 	 	 	 	 	 	 	 	 	 	$	[***]	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 





 


 









 









Generic HS



	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Based on	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Claim	 	 	 	 	 	 	Real HS Approach	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Counts	 	 	 	 	 	 	AWP Prices	 	 	Dispense Fees	 
	Cust	 	Clm	 	Date	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Ext.	 	 	Ingred	 	 	 	 	 	 	IngredDis	 	 	 	 	 	 	Wtd Avg	 	 	Wtd Avg	 	 	Total	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Act Disp	 	 	Target	 	 	 	 
	Id	 	#	 	Filled	 	NDC	 	Label Name	 	GPI	 	 	Qty	 	 	D.S.	 	 	Count	 	 	AWP	 	 	Cost	 	 	Disp Fee	 	 	count	 	 	Count	 	 	Disc Rate	 	 	Disp Fee	 	 	AWP	 	 	Actual IC	 	 	Target IC	 	 	Variance	 	 	Fees	 	 	Disp Fees	 	 	Variance	 
	359
	 	1	 	1/23/2009	 	00378020810	 	FUROSEMIDE 20 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	2	 	1/23/2009	 	00172208380	 	HYDROCHLOROTHIAZIDE 25 MG TAB	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	 	 	 	 	[***]	%	 	 	 	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	3	 	1/23/2009	 	00172208380	 	HYDROCHLOROTHIAZIDE 25 MG TAB	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	 	 	 	 	[***]	%	 	 	 	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	4	 	1/23/2009	 	00172208380	 	HYDROCHLOROTHIAZIDE 25 MG TAB	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	 	 	 	 	[***]	%	 	 	 	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	358
	 	5	 	1/23/2009	 	00172208380	 	HYDROCHLOROTHIAZIDE 25 MG TAB	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	358
	 	6	 	1/23/2009	 	00143147710	 	PREDNISONE 20 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	7	 	1/23/2009	 	00527132401	 	DIGOXIN 125 MCG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	358
	 	8	 	1/23/2009	 	62584098901	 	DIGOXIN 125 MCG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	9	 	1/23/2009	 	00172290880	 	FUROSEMIDE 20 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	 	 	 	 	[***]	%	 	 	 	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	358
	 	10	 	1/23/2009	 	00378020810	 	FUROSEMIDE 20 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	11	 	1/23/2009	 	00781196610	 	FUROSEMIDE 40 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	12	 	1/23/2009	 	00781196610	 	FUROSEMIDE 40 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	13	 	1/23/2009	 	00378021610	 	FUROSEMIDE 40 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	 	 	 	 	[***]	%	 	 	 	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	14	 	1/23/2009	 	00378021610	 	FUROSEMIDE 40 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	15	 	1/23/2009	 	00472030180	 	TRIAMCINOLONE 0.1% CREAM	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	16	 	1/23/2009	 	00168005430	 	NYSTATIN 100,000 UNIT/GM CREAM	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	358
	 	17	 	1/23/2009	 	00527134510	 	LEVOTHYROXINE 100 MCG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	18	 	1/23/2009	 	00781155601	 	ISOSORBIDE DN 10 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	19	 	1/23/2009	 	00781112305	 	TRIAMTERENE-HCTZ 37.5-25 MG TB	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	20	 	1/23/2009	 	00832108000	 	BENZTROPINE MES 0.5 MG TAB	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	21	 	1/23/2009	 	00378180901	 	LEVOTHYROXINE 100 MCG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	358
	 	22	 	1/23/2009	 	00093063710	 	TRAZODONE 50 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	23	 	1/23/2009	 	00378214605	 	SPIRONOLACTONE 25 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	358
	 	24	 	1/23/2009	 	50111043302	 	TRAZODONE 50 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	358
	 	25	 	1/23/2009	 	00093834301	 	GLYBURIDE 2.5 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	358
	 	26	 	1/23/2009	 	00245005810	 	KLOR-CON M20 TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	358
	 	27	 	1/23/2009	 	00378018105	 	ALLOPURINOL 300 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	 	 	 	 	[***]	%	 	 	 	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	358
	 	28	 	1/23/2009	 	00378018105	 	ALLOPURINOL 300 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 






 


 









 










	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Based on	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Claim	 	 	 	 	 	 	Real HS Approach	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Counts	 	 	 	 	 	 	AWP Prices	 	 	Dispense Fees	 
	Cust	 	Clm	 	Date	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Ext.	 	 	Ingred	 	 	 	 	 	 	IngredDis	 	 	 	 	 	 	Wtd Avg	 	 	Wtd Avg	 	 	Total	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Act Disp	 	 	Target	 	 	 	 
	Id	 	#	 	Filled	 	NDC	 	Label Name	 	GPI	 	 	Qty	 	 	D.S.	 	 	Count	 	 	AWP	 	 	Cost	 	 	Disp Fee	 	 	count	 	 	Count	 	 	Disc Rate	 	 	Disp Fee	 	 	AWP	 	 	Actual IC	 	 	Target IC	 	 	Variance	 	 	Fees	 	 	Disp Fees	 	 	Variance	 
	358
	 	29	 	1/23/2009	 	58177000104	 	POTASSIUM CL 10 MEQ CAP SA	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	30	 	1/23/2009	 	00603373934	 	FUROSEMIDE 20 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	31	 	1/23/2009	 	62175011937	 	ISOSORBIDE MN 60 MG TAB SA	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	32	 	1/23/2009	 	68462018801	 	NAPROXEN 250 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	358
	 	33	 	1/23/2009	 	00781144605	 	FUROSEMIDE 80 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	34	 	1/23/2009	 	00378021810	 	ATENOLOL 25 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	35	 	1/23/2009	 	00093712901	 	TORSEMIDE 20 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	358
	 	36	 	1/23/2009	 	00781100805	 	TRIAMTERENE-HCTZ 75-50 MG TAB	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	37	 	1/23/2009	 	68180051303	 	LISINOPRIL 5 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	38	 	1/23/2009	 	00008060601	 	PANTOPRAZOLE SOD 20 MG TAB EC	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	39	 	1/23/2009	 	68180051403	 	LISINOPRIL 10 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	358
	 	40	 	1/23/2009	 	00591533710	 	TRIHEXYPHENIDYL 5 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	41	 	1/23/2009	 	53489011010	 	CARISOPRODOL 350 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	42	 	1/23/2009	 	59762374301	 	CLINDAMYCIN PH 1% GEL	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	43	 	1/23/2009	 	64679092503	 	ENALAPRIL MALEATE 10 MG TAB	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	44	 	1/23/2009	 	00378003210	 	METOPROLOL TARTRATE 50 MG TAB	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	 	 	 	 	[***]	%	 	 	 	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	45	 	1/23/2009	 	00378003210	 	METOPROLOL TARTRATE 50 MG TAB	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	 	 	 	 	[***]	%	 	 	 	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	358
	 	46	 	1/23/2009	 	00378003210	 	METOPROLOL TARTRATE 50 MG TAB	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	358
	 	47	 	1/23/2009	 	00603497528	 	OXYBUTYNIN 5 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	358
	 	48	 	1/23/2009	 	00591086001	 	LISINOPRIL-HCTZ 10-12.5 MG TAB	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	358
	 	49	 	1/23/2009	 	00172503260	 	LISINOPRIL-HCTZ 20-25 MG TAB	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	358
	 	50	 	1/23/2009	 	00172409660	 	BACLOFEN 10 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	51	 	1/23/2009	 	59762502201	 	QUINAPRIL 40 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	358
	 	52	 	1/23/2009	 	58177022208	 	ISOSORBIDE MN 30 MG TAB SA	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	53	 	1/23/2009	 	00591320301	 	HYDROCODONE-APAP 7.5-325 TAB	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	358
	 	54	 	1/23/2009	 	00093834410	 	GLYBURIDE 5 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	358
	 	55	 	1/23/2009	 	00338004902	 	SODIUM CHLORIDE 0.9% SOLN	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	358
	 	56	 	1/23/2009	 	00172433180	 	METFORMIN HCL 500 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	57	 	1/23/2009	 	00093104598	 	QUINAPRIL 20 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	58	 	1/23/2009	 	00228277911	 	PROPRANOLOL 80 MG CAPSULE SA	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	59	 	1/23/2009	 	00378644001	 	VERAPAMIL ER 240 MG CAP	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 






 


 









 









	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Based on	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Claim	 	 	 	 	 	 	Real HS Approach	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Counts	 	 	 	 	 	 	AWP Prices	 	 	Dispense Fees	 
	Cust	 	Clm	 	Date	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Ext.	 	 	Ingred	 	 	 	 	 	 	IngredDis	 	 	 	 	 	 	Wtd Avg	 	 	Wtd Avg	 	 	Total	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Act Disp	 	 	Target	 	 	 	 
	Id	 	#	 	Filled	 	NDC	 	Label Name	 	GPI	 	 	Qty	 	 	D.S.	 	 	Count	 	 	AWP	 	 	Cost	 	 	Disp Fee	 	 	count	 	 	Count	 	 	Disc Rate	 	 	Disp Fee	 	 	AWP	 	 	Actual IC	 	 	Target IC	 	 	Variance	 	 	Fees	 	 	Disp Fees	 	 	Variance	 
	358
	 	60	 	1/23/2009	 	00591038705	 	HYDROCODONE-APAP 7.5-750 TAB	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	358
	 	61	 	1/23/2009	 	00472037945	 	CLOTRIMAZOLE-BETAMETHASONE CRM	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	62	 	1/23/2009	 	68382012205	 	AMLODIPINE BESYLATE 5 MG TAB	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	358
	 	63	 	1/23/2009	 	00172572860	 	FAMOTIDINE 20 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	64	 	1/23/2009	 	00781212801	 	RAMIPRIL 5 MG CAPSULE	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	358
	 	65	 	1/23/2009	 	00591050205	 	HYDROCODONE-APAP 7.5-650 TAB	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	66	 	1/23/2009	 	53489046710	 	METFORMIN HCL 500 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	67	 	1/23/2009	 	60505019001	 	METFORMIN HCL 500 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	68	 	1/23/2009	 	00591565801	 	CYCLOBENZAPRINE 10 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	69	 	1/23/2009	 	00378521077	 	AMLODIPINE BESYLATE 10 MG TAB	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	70	 	1/23/2009	 	00378521005	 	AMLODIPINE BESYLATE 10 MG TAB	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	71	 	1/23/2009	 	00093722398	 	FOSINOPRIL SODIUM 20 MG TAB	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	72	 	1/23/2009	 	68462019005	 	NAPROXEN 500 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	73	 	1/23/2009	 	00591317801	 	CITALOPRAM HBR 40 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	74	 	1/23/2009	 	59762490004	 	SERTRALINE HCL 50 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	75	 	1/23/2009	 	00093517244	 	ALENDRONATE SODIUM 35 MG TAB	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	76	 	1/23/2009	 	00172433180	 	METFORMIN HCL 500 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	77	 	1/23/2009	 	00172443280	 	METFORMIN HCL 1,000 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	78	 	1/23/2009	 	00172435770	 	RANITIDINE 150 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	 	 	 	 	[***]	%	 	 	 	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	79	 	1/23/2009	 	00172435770	 	RANITIDINE 150 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	80	 	1/23/2009	 	68180050103	 	MELOXICAM 7.5 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	81	 	1/23/2009	 	00093737301	 	AMLODIPINE-BENAZEPRIL 10-20 MG	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	82	 	1/23/2009	 	65162062711	 	TRAMADOL HCL 50 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	83	 	1/23/2009	 	00185014460	 	AMIODARONE HCL 200 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	358
	 	84	 	1/23/2009	 	00781104801	 	PERPHENAZINE 8 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	358
	 	85	 	1/23/2009	 	00054004421	 	CILOSTAZOL 100 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	86	 	1/23/2009	 	00093031101	 	LOPERAMIDE 2 MG CAPSULE	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	87	 	1/23/2009	 	00172572960	 	FAMOTIDINE 40 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	88	 	1/23/2009	 	00591083960	 	BUPROPION SR 150 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	89	 	1/23/2009	 	00093001298	 	PANTOPRAZOLE SOD 40 MG TAB DR	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 






 


 









 









	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Based on	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Claim	 	 	 	 	 	 	Real HS Approach	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Counts	 	 	 	 	 	 	AWP Prices	 	 	Dispense Fees	 
	Cust	 	Clm	 	Date	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Ext.	 	 	Ingred	 	 	 	 	 	 	IngredDis	 	 	 	 	 	 	Wtd Avg	 	 	Wtd Avg	 	 	Total	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Act Disp	 	 	Target	 	 	 	 
	Id	 	#	 	Filled	 	NDC	 	Label Name	 	GPI	 	 	Qty	 	 	D.S.	 	 	Count	 	 	AWP	 	 	Cost	 	 	Disp Fee	 	 	count	 	 	Count	 	 	Disc Rate	 	 	Disp Fee	 	 	AWP	 	 	Actual IC	 	 	Target IC	 	 	Variance	 	 	Fees	 	 	Disp Fees	 	 	Variance	 
	358
	 	90	 	1/23/2009	 	68180046903	 	LOVASTATIN 40 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	 	 	 	 	[***]	%	 	 	 	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	91	 	1/23/2009	 	68180046903	 	LOVASTATIN 40 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	92	 	1/23/2009	 	00781223310	 	OMEPRAZOLE 20 MG CAPSULE DR	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	358
	 	93	 	1/23/2009	 	00781223310	 	OMEPRAZOLE 20 MG CAPSULE DR	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	 	 	 	 	[***]	%	 	 	 	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	358
	 	94	 	1/23/2009	 	00781223310	 	OMEPRAZOLE 20 MG CAPSULE DR	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	358
	 	95	 	1/23/2009	 	68180048003	 	SIMVASTATIN 40 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	 	 	 	 	[***]	%	 	 	 	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	96	 	1/23/2009	 	68180047903	 	SIMVASTATIN 20 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	 	 	 	 	[***]	%	 	 	 	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	97	 	1/23/2009	 	00093715598	 	SIMVASTATIN 40 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	98	 	1/23/2009	 	68180047903	 	SIMVASTATIN 20 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	359
	 	99	 	1/23/2009	 	68462013001	 	ZONISAMIDE 100 MG CAPSULE	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	358
	 	100	 	1/23/2009	 	00093724306	 	RISPERIDONE 4 MG TABLET	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	%	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Rx Count	 	AWP	 	 	Ing Cost	 	 	Disp Fee	 	 	Total Cost	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	 	 	 	 	 	 	Totals	 	 	 	 	 	 	 	 	 	 	 	 	 	 	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	 	[***]	 	 	 	[***]	%	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 	 	$	[***]	 
	 
	 
	 	 	 	 	 	 	 	Net Effective AWP Discount Rate	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	[***]	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	 	 	 	 	 	 	Target AWP Discount Rate	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	[***]	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 
	 	 	 	 	 	 	 	Net Effective Disp Fee	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	$	[***]	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 
	 	 	 	 	 	 	 	Target Dispense Fee	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	$	[***]	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 
	 	 	 	 	 	 	 	Monetary Value of Discount Rate Difference	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	$	[***]	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	 	 	 	 	 	 	Monetary Value of Dispense Fee Difference	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	$	[***]	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	 	 	 	 	 	 	Total	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	$	[***]	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 
	 	 	 	 	 	 	 	* Monetary Value of Dispense Fee Difference Calculation:	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 
	 	 	 	 	 	 	 	Target Dispense Fee	 	 	 	 	 	 	 	 	 	 	 	 	 	$	[***]	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	 	 	 	 	 	 	Weighted Average Dispense Fees	 	 	 	 	 	 	 	 	 	 	 	 	 	$	[***]	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 
	 	 	 	 	 	 	 	Dispense Fee Difference	 	 	 	 	 	 	 	 	 	 	 	 	 	$	[***]	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	 	 	 	 	 	 	Actual Claims	 	 	 	 	 	 	 	 	 	 	 	 	 	 	[***]	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 
	 	 	 	 	 	 	 	Monetary Value of Dispense Fee  Difference	 	 	 	 	 	 	 	 	 	 	 	 	 	 	[***]