ESBD_360338_1716477854452_Attachment L - Rx Usage for Disruption and pricing April 2023-March 2024.xlsx
XLSX spreadsheet 6 MB Posted
- Solicitation number
- RFp2024-P11
- Issued by
- Hays County, Texas
About this file
The document is a Request for Proposals (RFP) issued by Hays County, Texas, for Employee Group Health, Dental, and Employee Assistance Plans. The County is seeking proposals from qualified companies to provide a comprehensive package that includes Medical, Pharmacy, Dental, and Employee Wellness/Assistance Plan. The intent is to evaluate any combination of plan designs, networks, and services, as well as value added services, and partner with insurance companies to achieve competitive long-term and stable financial success while offering a robust benefits package. The effective date for the chosen plans is January 1, 2025, with open enrollment starting October 1, 2024.
The RFP does not include banking for the Health Savings Account. Pricing terms, set asides, incumbents, funding requirements and sources, and other salient details were not provided in the summary. The County is fully committed to implementing the chosen plans and is looking to partner with insurance companies who can help them achieve their objectives.
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Rx Usage for Disruption and pri
| RFP 2024-P11 Employee Group Health, Dental, and Employee Assistance Plans | ||||||||||||||||||||||||||||||||||||||||||||||||
| Attachment L - Rx Usage For Disruption and Pricing April 2023-March 2024 | ||||||||||||||||||||||||||||||||||||||||||||||||
| Prescription Number | Prescription Count | Filled Date | Adjudication Date | Days Supply Count | Dispense As Written Code | National Drug Code | Drug Name | Medical Span Product Identifier Code | Authorized Refill Count | Compound Indicator | Maintenance Drug Indicator | Drug Type | Generic Number | AHFS Therapeutic Class Code | Standard Therapeutic Class Code | Generic Therapeutic Class Code | Drug Strength Description | Individual ID | Client Drug Cost Tier Code | Dispensing Fee | Contracted Dispensing Fee Amount | Sales Tax Amount | Copay Amount | Deductible Amount | HRA Net Paid Amount | Ancillary Amount | Paid Amount | Covered Amount | Other Payor Paid Amount | Pharmacy Dispenser Type | In Pharmacy Network Indicator | RX Solutions Claim Number | RX Solutions Claim Sequence Number | RX Solutions Claim Status Code | Transaction Status Code | Formulary Indicator | Usual Customary Amount | Customer Segment Number | Benefit Structure One Code | Benefit Structure Two Code | Prior Authorization Number | Claim Price Method Code | Quantity Count | Ingredient Amount | Average Wholesale Amount | Brand/Generic | Specialty Drug Program Indicator | Pharmacy Drug OTC Code |
| 000387972956 | 1 | 6/23/23 | 6/23/23 | 56 | 0 | 57894006103 | STELARA | 9025058500E540 | 0 | N | Y | W | 28159 | 849200 | 99 | 72 | 90 MG/ML | 842940207 | 002 | $0.00 | $0.00 | $0.00 | $5.00 | $0.00 | $0.00 | $30,011.19 | $30,016.19 | $0 | 1 | Y | 231743812282227 | 998 | P | 0 | Y | $33,156.25 | 000912772 | 0002 | 0002 | P-B4807498Q | D | 1 | $30,051.19 | 31820.4 | Brand | Y | R | |
| 000378701466 | 1 | 6/7/23 | 6/16/23 | 56 | 0 | 57894006103 | STELARA | 9025058500E540 | 6 | N | Y | W | 28159 | 849200 | 99 | 72 | 90 MG/ML | 850042578 | 002 | $0.00 | $0.00 | $0.00 | $5.00 | $0.00 | $0.00 | $30,011.19 | $30,016.19 | $0 | 1 | Y | 231674117480241 | 998 | P | 0 | Y | $33,156.25 | 000912772 | 0002 | 0002 | PA-B3970671 | D | 1 | $30,051.19 | 31820.4 | Brand | Y | R | |
| 000378701466 | 1 | 6/7/23 | 6/7/23 | 56 | 0 | 57894006103 | STELARA | 9025058500E540 | 6 | N | Y | W | 28159 | 849200 | 99 | 72 | 90 MG/ML | 850042578 | 002 | $0.00 | $0.00 | $0.00 | $40.00 | $0.00 | $0.00 | $30,011.19 | $30,051.19 | $0 | 1 | Y | 231585045770213 | 999 | P | 0 | Y | $33,156.25 | 000912772 | 0002 | 0002 | PA-B3970671 | D | 1 | $30,051.19 | 31820.4 | Brand | Y | R | |
| 000381685300 | 1 | 5/12/23 | 5/12/23 | 56 | 0 | 57894006103 | STELARA | 9025058500E540 | 0 | N | Y | W | 28159 | 849200 | 99 | 72 | 90 MG/ML | 842940207 | 002 | $0.00 | $0.00 | $0.00 | $5.00 | $0.00 | $0.00 | $28,671.55 | $28,676.55 | $0 | 1 | Y | 231322909173273 | 998 | P | 0 | Y | $33,156.25 | 000912772 | 0002 | 0002 | P-B4807498Q | D | 1 | $28,711.55 | 31820.4 | Brand | Y | R | |
| 000378701466 | 1 | 7/26/23 | 7/26/23 | 56 | 0 | 57894006103 | STELARA | 9025058500E540 | 6 | N | Y | W | 28159 | 849200 | 99 | 72 | 90 MG/ML | 850042578 | 002 | $0.00 | $0.00 | $0.00 | $5.00 | $0.00 | $0.00 | $28,576.09 | $28,581.09 | $0 | 1 | Y | 232072430996280 | 998 | P | 0 | Y | $33,156.25 | 000912772 | 0002 | 0002 | PA-B3970671 | D | 1 | $28,616.09 | 31820.4 | Brand | Y | R | |
| 000403893740 | 1 | 1/30/24 | 1/30/24 | 56 | 0 | 57894006103 | STELARA | 9025058500E540 | 2 | N | Y | W | 28159 | 849200 | 99 | 72 | 90 MG/ML | 842940207 | 002 | $0.00 | $0.00 | $0.00 | $5.00 | $0.00 | $0.00 | $28,449.92 | $28,454.92 | $0 | 1 | Y | 240302509317218 | 998 | P | 0 | Y | $34,813.56 | 000912772 | 0002 | 0002 | P-B4807498Q | D | 1 | $28,489.92 | 33411.42 | Brand | Y | R | |
| 000403893740 | 1 | 3/19/24 | 3/19/24 | 56 | 0 | 57894006103 | STELARA | 9025058500E540 | 2 | N | Y | W | 28159 | 849200 | 99 | 72 | 90 MG/ML | 842940207 | 002 | $0.00 | $0.00 | $0.00 | $40.00 | $0.00 | $0.00 | $28,349.68 | $28,389.68 | $0 | 1 | Y | 240792495543276 | 999 | P | 0 | Y | $34,813.56 | 000912772 | 0002 | 0002 | P-B4807498Q | D | 1 | $28,389.68 | 33411.42 | Brand | Y | R | |
| 000378701466 | 1 | 3/4/24 | 3/4/24 | 56 | 0 | 57894006103 | STELARA | 9025058500E540 | 6 | N | Y | W | 28159 | 849200 | 99 | 72 | 90 MG/ML | 850042578 | 002 | $0.00 | $0.00 | $0.00 | $5.00 | $0.00 | $0.00 | $28,349.68 | $28,354.68 | $0 | 1 | Y | 240647006956279 | 998 | P | 0 | Y | $34,813.56 | 000912772 | 0002 | 0002 | PA-B3970671 | D | 1 | $28,389.68 | 33411.42 | Brand | Y | R | |
| 000397814627 | 1 | 9/19/23 | 9/19/23 | 56 | 0 | 57894006103 | STELARA | 9025058500E540 | 0 | N | Y | W | 28159 | 849200 | 99 | 72 | 90 MG/ML | 842940207 | 002 | $0.00 | $0.00 | $0.00 | $5.00 | $0.00 | $0.00 | $27,140.99 | $27,145.99 | $0 | 15 | Y | 232624022328201 | 998 | P | 0 | Y | $33,156.25 | 000912772 | 0002 | 0002 | P-B4807498Q | D | 1 | $27,180.99 | 31820.4 | Brand | Y | R | |
| 000393011885 | 1 | 8/7/23 | 8/7/23 | 56 | 0 | 57894006103 | STELARA | 9025058500E540 | 0 | N | Y | W | 28159 | 849200 | 99 | 72 | 90 MG/ML | 842940207 | 002 | $0.00 | $0.00 | $0.00 | $5.00 | $0.00 | $0.00 | $27,140.99 | $27,145.99 | $0 | 1 | Y | 232195925448218 | 998 | P | 0 | Y | $33,156.25 | 000912772 | 0002 | 0002 | P-B4807498Q | D | 1 | $27,180.99 | 31820.4 | Brand | Y | R | |
| 000378701466 | 1 | 1/17/24 | 1/17/24 | 56 | 0 | 57894006103 | STELARA | 9025058500E540 | 6 | N | Y | W | 28159 | 849200 | 99 | 72 | 90 MG/ML | 850042578 | 002 | $0.00 | $0.00 | $0.00 | $5.00 | $0.00 | $0.00 | $27,093.26 | $27,098.26 | $0 | 1 | Y | 240174825990207 | 998 | P | 0 | Y | $33,156.25 | 000912772 | 0002 | 0002 | PA-B3970671 | D | 1 | $27,133.26 | 31820.4 | Brand | Y | R | |
| 000403893740 | 1 | 12/19/23 | 12/19/23 | 56 | 0 | 57894006103 | STELARA | 9025058500E540 | 2 | N | Y | W | 28159 | 849200 | 99 | 72 | 90 MG/ML | 842940207 | 002 | $0.00 | $0.00 | $0.00 | $5.00 | $0.00 | $0.00 | $26,950.06 | $26,955.06 | $0 | 1 | Y | 233534373089244 | 998 | P | 0 | Y | $33,156.25 | 000912772 | 0002 | 0002 | P-B4807498Q | D | 1 | $26,990.06 | 31820.4 | Brand | Y | R | |
| 000378701466 | 1 | 11/30/23 | 11/30/23 | 56 | 0 | 57894006103 | STELARA | 9025058500E540 | 6 | N | Y | W | 28159 | 849200 | 99 | 72 | 90 MG/ML | 850042578 | 002 | $0.00 | $0.00 | $0.00 | $5.00 | $0.00 | $0.00 | $26,950.06 | $26,955.06 | $0 | 1 | Y | 233344209310239 | 998 | P | 0 | Y | $33,156.25 | 000912772 | 0002 | 0002 | PA-B3970671 | D | 1 | $26,990.06 | 31820.4 | Brand | Y | R | |
| 000378701466 | 1 | 10/9/23 | 10/9/23 | 56 | 0 | 57894006103 | STELARA | 9025058500E540 | 6 | N | Y | W | 28159 | 849200 | 99 | 72 | 90 MG/ML | 850042578 | 002 | $0.00 | $0.00 | $0.00 | $5.00 | $0.00 | $0.00 | $26,902.33 | $26,907.33 | $0 | 1 | Y | 232825238495255 | 998 | P | 0 | Y | $33,156.25 | 000912772 | 0002 | 0002 | PA-B3970671 | D | 1 | $26,942.33 | 31820.4 | Brand | Y | R | |
| 000394369180 | 1 | 1/4/24 | 1/4/24 | 31 | 0 | 00074107001 | SKYRIZI ON-BODY | 5250406070E220 | 3 | N | Y | W | 52475 | 569200 | 99 | 72 | 360 MG/2.4 | 905905967 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $21,493.37 | $21,513.37 | $0 | 1 | Y | 240045350059201 | 998 | P | 0 | Y | $26,281.70 | 000912772 | 0002 | 0002 | PA-B8632585 | D | 2.4 | $21,513.37 | 25220.830008 | Brand | Y | R | |
| 000394369180 | 1 | 3/2/24 | 3/2/24 | 31 | 0 | 00074107001 | SKYRIZI ON-BODY | 5250406070E220 | 3 | N | Y | W | 52475 | 569200 | 99 | 72 | 360 MG/2.4 | 905905967 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $21,417.71 | $21,437.71 | $0 | 1 | Y | 240622664621206 | 998 | P | 0 | Y | $26,281.70 | 000912772 | 0002 | 0002 | PA-B8632585 | D | 2.4 | $21,437.71 | 25220.830008 | Brand | Y | R | |
| 000347736329 | 1 | 1/6/23 | 5/18/23 | 31 | 0 | 00074210001 | SKYRIZI PEN | 9025057070D520 | 3 | N | Y | W | 49591 | 849200 | 95 | 86 | 150 MG/ML | 532199466 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $20,286.91 | $20,306.91 | $0 | 1 | Y | 230064910154233 | 995 | P | 0 | Y | $24,678.26 | 000912772 | 0001 | 0001 | PA-A1888347 | D | 1 | $20,306.91 | 23681.53 | Brand | Y | R | |
| 000394369180 | 1 | 8/21/23 | 8/28/23 | 31 | 0 | 00074107001 | SKYRIZI ON-BODY | 5250406070E220 | 3 | N | Y | W | 52475 | 569200 | 99 | 72 | 360 MG/2.4 | 905905967 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $20,215.87 | $20,235.87 | $0 | 15 | Y | 232332695206228 | 997 | P | 0 | Y | $24,678.26 | 000912772 | 0002 | 0002 | PA-B8632585 | D | 2.4 | $20,235.87 | 23681.530008 | Brand | Y | R | |
| 000394369180 | 1 | 11/7/23 | 11/7/23 | 31 | 0 | 00074107001 | SKYRIZI ON-BODY | 5250406070E220 | 3 | N | Y | W | 52475 | 569200 | 99 | 72 | 360 MG/2.4 | 905905967 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $20,073.78 | $20,093.78 | $0 | 1 | Y | 233113903217270 | 998 | P | 0 | Y | $24,678.26 | 000912772 | 0002 | 0002 | PA-B8632585 | D | 2.4 | $20,093.78 | 23681.530008 | Brand | Y | R | |
| 000353243944 | 1 | 5/19/23 | 5/19/23 | 30 | 0 | 69656010330 | ZEJULA | 21535550200120 | 12 | N | N | W | 43217 | 100000 | 30 | 26 | 100 MG | 61057651 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $18,569.46 | $18,589.46 | $0 | 15 | Y | 231394616279216 | 999 | P | 0 | Y | $21,621.63 | 000912772 | 0002 | 0002 | PA-A4257214 | D | 60 | $18,589.46 | 20747.16 | Brand | Y | R | |
| 000353243944 | 1 | 7/19/23 | 7/19/23 | 30 | 0 | 69656010330 | ZEJULA | 21535550200120 | 12 | N | N | W | 43217 | 100000 | 30 | 26 | 100 MG | 61057651 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $18,503.06 | $18,523.06 | $0 | 1 | Y | 232005037426276 | 999 | P | 0 | Y | $21,621.63 | 000912772 | 0002 | 0002 | PA-A4257214 | D | 60 | $18,523.06 | 20747.16 | Brand | Y | R | |
| 000395032242 | 1 | 8/25/23 | 8/25/23 | 30 | 0 | 00173090913 | ZEJULA | 21535550200320 | 5 | N | N | W | 54055 | 100000 | 30 | 26 | 100 MG | 61057651 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $17,511.35 | $17,531.35 | $0 | 15 | Y | 232372666156266 | 999 | P | 0 | Y | $21,621.63 | 000912772 | 0002 | 0002 | PA-A4257214 | D | 30 | $17,531.35 | 20747.16 | Brand | Y | R | |
| 000395032242 | 1 | 9/19/23 | 9/19/23 | 30 | 0 | 00173090913 | ZEJULA | 21535550200320 | 5 | N | N | W | 54055 | 100000 | 30 | 26 | 100 MG | 61057651 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $17,507.20 | $17,527.20 | $0 | 1 | Y | 232622301013227 | 998 | P | 0 | Y | $21,621.63 | 000912772 | 0002 | 0002 | PA-C0067483 | D | 30 | $17,527.20 | 20747.16 | Brand | Y | R | |
| 000375913225 | 1 | 5/5/23 | 5/5/23 | 30 | 0 | 00078068266 | TAFINLAR | 21532025100120 | 3 | N | N | W | 34723 | 100000 | 30 | 26 | 50 MG | 1580791309 | 003 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $16,834.75 | $16,834.75 | $0 | 1 | Y | 231254066766215 | 997 | P | 0 | N | $19,633.98 | 000912772 | 0002 | 0002 | PA-B2332559 | D | 180 | $16,879.75 | 18839.0106 | Brand | Y | R | |
| 000388816139 | 1 | 6/30/23 | 6/30/23 | 30 | 0 | 00078111215 | MEKINIST | 21533570100330 | 3 | N | N | W | 34727 | 100000 | 30 | 26 | 2 MG | 1580791309 | 003 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $16,618.09 | $16,618.09 | $0 | 1 | Y | 231813942130253 | 998 | P | 0 | N | $18,315.61 | 000912772 | 0002 | 0002 | PA-B2332554 | D | 30 | $16,663.09 | 17573.3901 | Brand | Y | R | |
| 000375913223 | 1 | 6/5/23 | 6/5/23 | 30 | 0 | 00078111215 | MEKINIST | 21533570100330 | 3 | N | N | W | 34727 | 100000 | 30 | 26 | 2 MG | 1580791309 | 003 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $16,618.09 | $16,618.09 | $0 | 1 | Y | 231562818890209 | 998 | P | 0 | N | $18,315.61 | 000912772 | 0002 | 0002 | PA-B2332554 | D | 30 | $16,663.09 | 17573.3901 | Brand | Y | R | |
| 000365272498 | 1 | 6/21/23 | 6/21/23 | 30 | 0 | 59676060012 | ERLEADA | 21402410000320 | 11 | N | N | W | 44446 | 100000 | 30 | 26 | 60 MG | 1583880520 | 002 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $16,014.13 | $16,014.13 | $0 | 15 | Y | 231722292720279 | 998 | P | 0 | Y | $17,763.21 | 000912772 | 0002 | 0002 | PA-A5451024 | D | 120 | $16,034.13 | 17043.0804 | Brand | Y | R | |
| 000375913225 | 1 | 4/11/23 | 4/11/23 | 30 | 0 | 00078068266 | TAFINLAR | 21532025100120 | 3 | N | N | W | 34723 | 100000 | 30 | 26 | 50 MG | 1580791309 | 003 | $0.00 | $0.00 | $0.00 | $45.00 | $0.00 | $0.00 | $15,930.48 | $15,975.48 | $0 | 1 | Y | 231012592462203 | 999 | P | 0 | N | $19,633.98 | 000912772 | 0002 | 0002 | PA-B2332559 | D | 180 | $15,975.48 | 18839.0106 | Brand | Y | R | |
| 000375913223 | 1 | 5/5/23 | 5/5/23 | 30 | 0 | 00078111215 | MEKINIST | 21533570100330 | 3 | N | N | W | 34727 | 100000 | 30 | 26 | 2 MG | 1580791309 | 003 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $15,929.21 | $15,929.21 | $0 | 1 | Y | 231254066464259 | 997 | P | 0 | N | $18,315.61 | 000912772 | 0002 | 0002 | PA-B2332554 | D | 30 | $15,974.21 | 17573.3901 | Brand | Y | R | |
| 000388816139 | 1 | 7/31/23 | 7/31/23 | 30 | 0 | 00078111215 | MEKINIST | 21533570100330 | 3 | N | N | W | 34727 | 100000 | 30 | 26 | 2 MG | 1580791309 | 003 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $15,880.01 | $15,880.01 | $0 | 15 | Y | 232123189423255 | 998 | P | 0 | N | $18,315.61 | 000912772 | 0002 | 0002 | PA-B2332554 | D | 30 | $15,925.01 | 17573.3901 | Brand | Y | R | |
| 000365272498 | 1 | 5/17/23 | 5/17/23 | 30 | 0 | 59676060012 | ERLEADA | 21402410000320 | 11 | N | N | W | 44446 | 100000 | 30 | 26 | 60 MG | 1583880520 | 002 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $15,250.60 | $15,250.60 | $0 | 1 | Y | 231375178694229 | 998 | P | 0 | Y | $17,763.21 | 000912772 | 0002 | 0002 | PA-A5451024 | D | 120 | $15,270.60 | 17043.0804 | Brand | Y | R | |
| 000365272498 | 1 | 7/19/23 | 7/19/23 | 30 | 0 | 59676060012 | ERLEADA | 21402410000320 | 11 | N | N | W | 44446 | 100000 | 30 | 26 | 60 MG | 1583880520 | 002 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $15,196.06 | $15,196.06 | $0 | 1 | Y | 232003158681216 | 998 | P | 0 | Y | $17,763.21 | 000912772 | 0002 | 0002 | PA-A5451024 | D | 120 | $15,216.06 | 17043.0804 | Brand | Y | R | |
| 000375913223 | 1 | 4/10/23 | 4/10/23 | 30 | 0 | 00078111215 | MEKINIST | 21533570100330 | 3 | N | N | W | 34727 | 100000 | 30 | 26 | 2 MG | 1580791309 | 003 | $0.00 | $0.00 | $0.00 | $45.00 | $0.00 | $0.00 | $15,191.13 | $15,236.13 | $0 | 1 | Y | 231002879562265 | 999 | P | 0 | N | $18,315.61 | 000912772 | 0002 | 0002 | PA-B2332554 | D | 30 | $15,236.13 | 17573.3901 | Brand | Y | R | |
| 000385639531 | 1 | 6/5/23 | 6/5/23 | 30 | 0 | 00078068166 | TAFINLAR | 21532025100130 | 3 | N | N | W | 34724 | 100000 | 30 | 26 | 75 MG | 1580791309 | 003 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $15,182.65 | $15,182.65 | $0 | 1 | Y | 231563380555260 | 997 | P | 0 | N | $16,870.26 | 000912772 | 0002 | 0002 | PA-B2332559 | D | 120 | $15,227.65 | 16185.8496 | Brand | Y | R | |
| 000401276980 | 1 | 2/16/24 | 2/16/24 | 30 | 0 | 59676060430 | ERLEADA | 21402410000360 | 11 | N | N | W | 53749 | 100000 | 30 | 26 | 240 MG | 1583880520 | 002 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $15,069.27 | $15,069.27 | $0 | 15 | Y | 240473087216231 | 998 | P | 0 | Y | $18,650.88 | 000912772 | 0012 | 0012 | PA-C1455948 | D | 30 | $15,089.27 | 17895.24 | Brand | Y | R | |
| 000401276980 | 1 | 3/19/24 | 3/19/24 | 30 | 0 | 59676060430 | ERLEADA | 21402410000360 | 11 | N | N | W | 53749 | 100000 | 30 | 26 | 240 MG | 1583880520 | 002 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $15,012.00 | $15,012.00 | $0 | 1 | Y | 240792137075259 | 998 | P | 0 | Y | $18,650.88 | 000912772 | 0012 | 0012 | PA-C1455948 | D | 30 | $15,032.00 | 17895.24 | Brand | Y | R | |
| 000365272498 | 1 | 4/13/23 | 4/13/23 | 30 | 0 | 59676060012 | ERLEADA | 21402410000320 | 11 | N | N | W | 44446 | 100000 | 30 | 26 | 60 MG | 1583880520 | 002 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $14,432.53 | $14,432.53 | $0 | 1 | Y | 231032893873252 | 998 | P | 0 | Y | $17,763.21 | 000912772 | 0002 | 0002 | PA-A5451024 | D | 120 | $14,452.53 | 17043.0804 | Brand | Y | R | |
| 000385639531 | 1 | 7/31/23 | 7/31/23 | 30 | 0 | 00078068166 | TAFINLAR | 21532025100130 | 3 | N | N | W | 34724 | 100000 | 30 | 26 | 75 MG | 1580791309 | 003 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $14,405.73 | $14,405.73 | $0 | 15 | Y | 232123182319260 | 998 | P | 0 | N | $16,870.26 | 000912772 | 0002 | 0002 | PA-B2332559 | D | 120 | $14,450.73 | 16185.8496 | Brand | Y | R | |
| 000385639531 | 1 | 7/7/23 | 7/7/23 | 30 | 0 | 00078068166 | TAFINLAR | 21532025100130 | 3 | N | N | W | 34724 | 100000 | 30 | 26 | 75 MG | 1580791309 | 003 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $14,405.73 | $14,405.73 | $0 | 1 | Y | 231884437537279 | 998 | P | 0 | N | $16,870.26 | 000912772 | 0002 | 0002 | PA-B2332559 | D | 120 | $14,450.73 | 16185.8496 | Brand | Y | R | |
| 000365272498 | 1 | 9/19/23 | 9/19/23 | 30 | 0 | 59676060012 | ERLEADA | 21402410000320 | 11 | N | N | W | 44446 | 100000 | 30 | 26 | 60 MG | 1583880520 | 002 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $14,377.99 | $14,377.99 | $0 | 1 | Y | 232622635719267 | 998 | P | 0 | Y | $17,763.21 | 000912772 | 0002 | 0002 | PA-A5451024 | D | 120 | $14,397.99 | 17043.0804 | Brand | Y | R | |
| 000365272498 | 1 | 8/18/23 | 8/18/23 | 30 | 0 | 59676060012 | ERLEADA | 21402410000320 | 11 | N | N | W | 44446 | 100000 | 30 | 26 | 60 MG | 1583880520 | 002 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $14,377.99 | $14,377.99 | $0 | 1 | Y | 232305597301224 | 998 | P | 0 | Y | $17,763.21 | 000912772 | 0002 | 0002 | PA-A5451024 | D | 120 | $14,397.99 | 17043.0804 | Brand | Y | R | |
| 000401276980 | 1 | 1/15/24 | 1/15/24 | 30 | 0 | 59676060430 | ERLEADA | 21402410000360 | 11 | N | N | W | 53749 | 100000 | 30 | 26 | 240 MG | 1583880520 | 002 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $14,350.73 | $14,350.73 | $0 | 1 | Y | 240153349808230 | 998 | P | 0 | Y | $17,763.21 | 000912772 | 0012 | 0012 | PA-C1455948 | D | 30 | $14,370.73 | 17043.0801 | Brand | Y | R | |
| 000401276980 | 1 | 12/15/23 | 12/15/23 | 30 | 0 | 59676060430 | ERLEADA | 21402410000360 | 11 | N | N | W | 53749 | 100000 | 30 | 26 | 240 MG | 1583880520 | 002 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $14,268.92 | $14,268.92 | $0 | 1 | Y | 233493970315205 | 998 | P | 0 | Y | $17,763.21 | 000912772 | 0012 | 0012 | PA-C1455948 | D | 30 | $14,288.92 | 17043.0801 | Brand | Y | R | |
| 000401276980 | 1 | 11/18/23 | 11/18/23 | 30 | 0 | 59676060430 | ERLEADA | 21402410000360 | 11 | N | N | W | 53749 | 100000 | 30 | 26 | 240 MG | 1583880520 | 002 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $14,268.92 | $14,268.92 | $0 | 1 | Y | 233223054732275 | 998 | P | 0 | Y | $17,763.21 | 000912772 | 0002 | 0002 | PA-C1455948 | D | 30 | $14,288.92 | 17043.0801 | Brand | Y | R | |
| 000401276980 | 1 | 10/23/23 | 10/30/23 | 30 | 0 | 59676060430 | ERLEADA | 21402410000360 | 11 | N | N | W | 53749 | 100000 | 30 | 26 | 240 MG | 1583880520 | 002 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $14,241.65 | $14,241.65 | $0 | 1 | Y | 233035615109239 | 998 | P | 0 | Y | $17,763.21 | 000912772 | 0002 | 0002 | PA-C1455948 | D | 30 | $14,261.65 | 17043.0801 | Brand | Y | R | |
| 000392436070 | 1 | 8/2/23 | 8/2/23 | 31 | 0 | 00074153903 | HUMIRA(CF) PEN PSOR-UV-ADOL HS | 6627001500F450 | 0 | N | Y | W | 44954 | 923600 | 42 | 12 | 80 MG-40MG | 532199466 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $13,693.46 | $13,713.46 | $0 | 1 | Y | 232142628522250 | 995 | P | 0 | Y | $17,316.59 | 000912772 | 0001 | 0001 | PA-B7939944 | D | 3 | $13,713.46 | 16614.32001 | Brand | Y | R | |
| 000015215195 | 1 | 3/1/24 | 3/1/24 | 30 | 0 | 66215050130 | OPSUMIT | 40160050000320 | 11 | N | Y | W | 35443 | 484812 | 71 | 41 | 10 MG | 1585676561 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $12,837.69 | $12,857.69 | $0 | 1 | Y | 240612841763202 | 999 | P | 0 | Y | $22,743.60 | 000912772 | 0011 | 0011 | PA-C6739923 | D | 30 | $12,857.69 | 15162.3699 | Brand | Y | R | |
| 000001640574 | 1 | 7/18/23 | 7/18/23 | 90 | 0 | 73562011401 | ZENPEP | 51200024006783 | 3 | N | Y | W | 44136 | 561600 | 69 | 65 | 40-126-168 | 905905967 | 002 | $0.25 | $0.25 | $0.00 | $40.00 | $0.00 | $0.00 | $10,389.52 | $10,429.52 | $0 | 1 | Y | 231992771032250 | 998 | P | 0 | Y | $12,564.89 | 000912772 | 0002 | 0002 | D | 720 | $10,429.27 | 13265.424 | Brand | N | R | ||
| 000364321833 | 1 | 6/19/23 | 6/19/23 | 28 | 0 | 59627022205 | AVONEX | 6240306045F830 | 11 | N | Y | W | 20147 | 922000 | 99 | 44 | 30MCG/.5ML | 1586693232 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $8,952.90 | $8,972.90 | $0 | 1 | Y | 231705410649230 | 999 | P | 0 | Y | $9,944.91 | 000912772 | 0011 | 0011 | D | 1 | $8,972.90 | 9537.52 | Brand | Y | R | ||
| 000006903020 | 1 | 8/7/23 | 8/7/23 | 90 | 0 | 64896066930 | EMVERM | 15000010000505 | 0 | N | N | W | 43181 | 080800 | 31 | 23 | 100 MG | 1587044632 | 003 | $0.25 | $0.25 | $0.00 | $90.00 | $0.00 | $0.00 | $8,650.99 | $8,740.99 | $0 | 1 | Y | 232193979889208 | 999 | P | 0 | N | $11,117.70 | 000912772 | 0002 | 0002 | D | 15 | $8,740.74 | 11117.7 | Brand | N | R | ||
| 000364321833 | 1 | 5/22/23 | 5/22/23 | 28 | 0 | 59627022205 | AVONEX | 6240306045F830 | 11 | N | Y | W | 20147 | 922000 | 99 | 44 | 30MCG/.5ML | 1586693232 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $8,525.62 | $8,545.62 | $0 | 1 | Y | 231425586558243 | 999 | P | 0 | Y | $9,944.91 | 000912772 | 0011 | 0011 | D | 1 | $8,545.62 | 9537.52 | Brand | Y | R | ||
| 000364321833 | 1 | 7/18/23 | 7/18/23 | 28 | 0 | 59627022205 | AVONEX | 6240306045F830 | 11 | N | Y | W | 20147 | 922000 | 99 | 44 | 30MCG/.5ML | 1586693232 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $8,495.10 | $8,515.10 | $0 | 15 | Y | 231992980286245 | 999 | P | 0 | Y | $9,944.91 | 000912772 | 0011 | 0011 | D | 1 | $8,515.10 | 9537.52 | Brand | Y | R | ||
| 000405818435 | 1 | 2/28/24 | 2/28/24 | 28 | 0 | 59627022205 | AVONEX | 6240306045F830 | 11 | N | Y | W | 20147 | 922000 | 99 | 44 | 30MCG/.5ML | 1586693232 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $8,343.71 | $8,363.71 | $0 | 1 | Y | 240595927221268 | 999 | P | 0 | Y | $10,342.30 | 000912772 | 0011 | 0011 | D | 1 | $8,363.71 | 9919.01 | Brand | Y | R | ||
| 000405818435 | 1 | 1/30/24 | 1/30/24 | 28 | 0 | 59627022205 | AVONEX | 6240306045F830 | 11 | N | Y | W | 20147 | 922000 | 99 | 44 | 30MCG/.5ML | 1586693232 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $8,343.71 | $8,363.71 | $0 | 1 | Y | 240304766624271 | 999 | P | 0 | Y | $10,342.30 | 000912772 | 0011 | 0011 | D | 1 | $8,363.71 | 9919.01 | Brand | Y | R | ||
| 000405818435 | 1 | 1/2/24 | 1/2/24 | 28 | 0 | 59627022205 | AVONEX | 6240306045F830 | 11 | N | Y | W | 20147 | 922000 | 99 | 44 | 30MCG/.5ML | 1586693232 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $8,343.71 | $8,363.71 | $0 | 1 | Y | 240025807464229 | 999 | P | 0 | Y | $10,342.30 | 000912772 | 0011 | 0011 | D | 1 | $8,363.71 | 9919.01 | Brand | Y | R | ||
| 000405818435 | 1 | 3/27/24 | 3/27/24 | 28 | 0 | 59627022205 | AVONEX | 6240306045F830 | 11 | N | Y | W | 20147 | 922000 | 99 | 44 | 30MCG/.5ML | 1586693232 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $8,311.97 | $8,331.97 | $0 | 1 | Y | 240874073222269 | 999 | P | 0 | Y | $10,342.30 | 000912772 | 0011 | 0011 | D | 1 | $8,331.97 | 9919.01 | Brand | Y | R | ||
| 000364321833 | 1 | 4/24/23 | 4/24/23 | 28 | 0 | 59627022205 | AVONEX | 6240306045F830 | 11 | N | Y | W | 20147 | 922000 | 99 | 44 | 30MCG/.5ML | 1586693232 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $8,067.82 | $8,087.82 | $0 | 1 | Y | 231143665010280 | 999 | P | 0 | Y | $9,944.91 | 000912772 | 0011 | 0011 | D | 1 | $8,087.82 | 9537.52 | Brand | Y | R | ||
| 000364321833 | 1 | 9/12/23 | 9/12/23 | 28 | 0 | 59627022205 | AVONEX | 6240306045F830 | 11 | N | Y | W | 20147 | 922000 | 99 | 44 | 30MCG/.5ML | 1586693232 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $8,037.30 | $8,057.30 | $0 | 1 | Y | 232553919903232 | 999 | P | 0 | Y | $9,944.91 | 000912772 | 0011 | 0011 | D | 1 | $8,057.30 | 9537.52 | Brand | Y | R | ||
| 000364321833 | 1 | 8/15/23 | 8/15/23 | 28 | 0 | 59627022205 | AVONEX | 6240306045F830 | 11 | N | Y | W | 20147 | 922000 | 99 | 44 | 30MCG/.5ML | 1586693232 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $8,037.30 | $8,057.30 | $0 | 1 | Y | 232273497528208 | 999 | P | 0 | Y | $9,944.91 | 000912772 | 0011 | 0011 | D | 1 | $8,057.30 | 9537.52 | Brand | Y | R | ||
| 000405818435 | 1 | 11/28/23 | 11/28/23 | 28 | 0 | 59627022205 | AVONEX | 6240306045F830 | 11 | N | Y | W | 20147 | 922000 | 99 | 44 | 30MCG/.5ML | 1586693232 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $7,976.26 | $7,996.26 | $0 | 1 | Y | 233325298576243 | 999 | P | 0 | Y | $9,944.91 | 000912772 | 0011 | 0011 | D | 1 | $7,996.26 | 9537.52 | Brand | Y | R | ||
| 000364321833 | 1 | 11/7/23 | 11/7/23 | 28 | 0 | 59627022205 | AVONEX | 6240306045F830 | 11 | N | Y | W | 20147 | 922000 | 99 | 44 | 30MCG/.5ML | 1586693232 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $7,976.26 | $7,996.26 | $0 | 1 | Y | 233115092119261 | 999 | P | 0 | Y | $9,944.91 | 000912772 | 0011 | 0011 | D | 1 | $7,996.26 | 9537.52 | Brand | Y | R | ||
| 000364321833 | 1 | 10/10/23 | 10/10/23 | 28 | 0 | 59627022205 | AVONEX | 6240306045F830 | 11 | N | Y | W | 20147 | 922000 | 99 | 44 | 30MCG/.5ML | 1586693232 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $7,961.00 | $7,981.00 | $0 | 1 | Y | 232832311885243 | 999 | P | 0 | Y | $9,944.91 | 000912772 | 0011 | 0011 | D | 1 | $7,981.00 | 9537.52 | Brand | Y | R | ||
| 000369764436 | 1 | 6/22/23 | 6/22/23 | 28 | 0 | 58406003204 | ENBREL SURECLICK | 6629003000D530 | 11 | N | Y | W | 97724 | 923600 | 42 | 12 | 50MG/ML(1) | 1582504004 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $7,922.35 | $7,942.35 | $0 | 1 | Y | 231733133145227 | 996 | P | 0 | Y | $8,821.68 | 000912772 | 0011 | 0011 | PA-A9186954 | D | 4 | $7,942.35 | 8459.21 | Brand | Y | R | |
| 000350740476 | 1 | 6/20/23 | 6/20/23 | 28 | 0 | 00074055402 | HUMIRA(CF) PEN | 6627001500F430 | 11 | N | Y | W | 43506 | 923600 | 42 | 12 | 40MG/0.4ML | 1588169730 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $7,733.88 | $7,753.88 | $0 | 1 | Y | 231714140782244 | 998 | P | 0 | Y | $8,663.28 | 000912772 | 0002 | 0002 | PA-A3407298 | D | 2 | $7,753.88 | 8307.14 | Brand | Y | R | |
| 000375610058 | 1 | 6/19/23 | 6/19/23 | 28 | 0 | 00074055402 | HUMIRA(CF) PEN | 6627001500F430 | 6 | N | Y | W | 43506 | 923600 | 42 | 12 | 40MG/0.4ML | 1588340287 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $7,733.88 | $7,753.88 | $0 | 1 | Y | 231702585684251 | 998 | P | 0 | Y | $8,663.28 | 000912772 | 0001 | 0001 | PA-A4907586 | D | 2 | $7,753.88 | 8307.14 | Brand | Y | R | |
| 000386708778 | 1 | 6/15/23 | 6/15/23 | 28 | 0 | 00074055402 | HUMIRA(CF) PEN | 6627001500F430 | 5 | N | Y | W | 43506 | 923600 | 42 | 12 | 40MG/0.4ML | 176085455 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $7,733.88 | $7,753.88 | $0 | 1 | Y | 231664628727239 | 998 | P | 0 | Y | $8,663.28 | 000912772 | 0001 | 0001 | PA-A5013839 | D | 2 | $7,753.88 | 8307.14 | Brand | Y | R | |
| 000369764436 | 1 | 5/30/23 | 5/30/23 | 28 | 0 | 58406003204 | ENBREL SURECLICK | 6629003000D530 | 11 | N | Y | W | 97724 | 923600 | 42 | 12 | 50MG/ML(1) | 1582504004 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $7,531.54 | $7,551.54 | $0 | 1 | Y | 231505013874215 | 999 | P | 0 | Y | $8,821.68 | 000912772 | 0011 | 0011 | PA-A9186954 | D | 4 | $7,551.54 | 8459.21 | Brand | Y | R | |
| 000369764436 | 1 | 7/17/23 | 7/17/23 | 28 | 0 | 58406003204 | ENBREL SURECLICK | 6629003000D530 | 11 | N | Y | W | 97724 | 923600 | 42 | 12 | 50MG/ML(1) | 1582504004 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $7,503.62 | $7,523.62 | $0 | 1 | Y | 231982759371236 | 999 | P | 0 | Y | $8,821.68 | 000912772 | 0011 | 0011 | PA-A9186954 | D | 4 | $7,523.62 | 8459.21 | Brand | Y | R | |
| 000407237437 | 1 | 2/7/24 | 2/7/24 | 28 | 0 | 58406003204 | ENBREL SURECLICK | 6629003000D530 | 11 | N | Y | W | 97724 | 923600 | 42 | 12 | 50MG/ML(1) | 1582504004 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $7,425.95 | $7,445.95 | $0 | 1 | Y | 240380134854213 | 999 | P | 0 | Y | $9,262.29 | 000912772 | 0011 | 0011 | PA-C3539230 | D | 4 | $7,445.95 | 8882.2 | Brand | Y | R | |
| 000407237437 | 1 | 1/17/24 | 1/17/24 | 28 | 0 | 58406003204 | ENBREL SURECLICK | 6629003000D530 | 11 | N | Y | W | 97724 | 923600 | 42 | 12 | 50MG/ML(1) | 1582504004 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $7,425.95 | $7,445.95 | $0 | 1 | Y | 240173298822204 | 999 | P | 0 | Y | $9,262.29 | 000912772 | 0011 | 0011 | PA-C3539230 | D | 4 | $7,445.95 | 8882.2 | Brand | Y | R | |
| 000407237437 | 1 | 3/6/24 | 3/6/24 | 28 | 0 | 58406003204 | ENBREL SURECLICK | 6629003000D530 | 11 | N | Y | W | 97724 | 923600 | 42 | 12 | 50MG/ML(1) | 1582504004 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $7,396.64 | $7,416.64 | $0 | 1 | Y | 240662151615265 | 999 | P | 0 | Y | $9,262.29 | 000912772 | 0011 | 0011 | PA-C3539230 | D | 4 | $7,416.64 | 8882.2 | Brand | Y | R | |
| 000375610058 | 1 | 5/26/23 | 5/26/23 | 28 | 0 | 00074055402 | HUMIRA(CF) PEN | 6627001500F430 | 6 | N | Y | W | 43506 | 923600 | 42 | 12 | 40MG/0.4ML | 1588340287 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $7,315.20 | $7,335.20 | $0 | 1 | Y | 231462916297240 | 998 | P | 0 | Y | $8,663.28 | 000912772 | 0001 | 0001 | PA-A4907586 | D | 2 | $7,335.20 | 8307.14 | Brand | Y | R | |
| 000350740476 | 1 | 5/24/23 | 5/24/23 | 28 | 0 | 00074055402 | HUMIRA(CF) PEN | 6627001500F430 | 11 | N | Y | W | 43506 | 923600 | 42 | 12 | 40MG/0.4ML | 1588169730 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $7,315.20 | $7,335.20 | $0 | 1 | Y | 231445849077270 | 999 | P | 0 | Y | $8,663.28 | 000912772 | 0002 | 0002 | PA-A3407298 | D | 2 | $7,335.20 | 8307.14 | Brand | Y | R | |
| 000371309036 | 1 | 5/23/23 | 5/23/23 | 28 | 0 | 00074055402 | HUMIRA(CF) PEN | 6627001500F430 | 5 | N | Y | W | 43506 | 923600 | 42 | 12 | 40MG/0.4ML | 176085455 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $7,315.20 | $7,335.20 | $0 | 15 | Y | 231434060229216 | 998 | P | 0 | Y | $8,663.28 | 000912772 | 0001 | 0001 | PA-A5013839 | D | 2 | $7,335.20 | 8307.14 | Brand | Y | R | |
| 000375610058 | 1 | 5/3/23 | 5/3/23 | 28 | 0 | 00074055402 | HUMIRA(CF) PEN | 6627001500F430 | 6 | N | Y | W | 43506 | 923600 | 42 | 12 | 40MG/0.4ML | 1588340287 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $7,315.20 | $7,335.20 | $0 | 1 | Y | 231235777729257 | 998 | P | 0 | Y | $8,663.28 | 000912772 | 0001 | 0001 | PA-A4907586 | D | 2 | $7,335.20 | 8307.14 | Brand | Y | R | |
| 000386708778 | 1 | 7/21/23 | 7/21/23 | 28 | 0 | 00074055402 | HUMIRA(CF) PEN | 6627001500F430 | 5 | N | Y | W | 43506 | 923600 | 42 | 12 | 40MG/0.4ML | 176085455 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $7,285.30 | $7,305.30 | $0 | 1 | Y | 232023390394212 | 998 | P | 0 | Y | $8,663.28 | 000912772 | 0001 | 0001 | PA-A5013839 | D | 2 | $7,305.30 | 8307.14 | Brand | Y | R | |
| 000389816221 | 1 | 7/11/23 | 7/11/23 | 28 | 0 | 00074055402 | HUMIRA(CF) PEN | 6627001500F430 | 11 | N | Y | W | 43506 | 923600 | 42 | 12 | 40MG/0.4ML | 1588169730 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $7,285.30 | $7,305.30 | $0 | 1 | Y | 231922580509268 | 999 | P | 0 | Y | $8,663.28 | 000912772 | 0002 | 0002 | PA-A3407298 | D | 2 | $7,305.30 | 8307.14 | Brand | Y | R | |
| 000369764436 | 1 | 4/26/23 | 4/26/23 | 28 | 0 | 58406003204 | ENBREL SURECLICK | 6629003000D530 | 11 | N | Y | W | 97724 | 923600 | 42 | 12 | 50MG/ML(1) | 1582504004 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $7,112.81 | $7,132.81 | $0 | 1 | Y | 231163774404210 | 999 | P | 0 | Y | $8,821.68 | 000912772 | 0011 | 0011 | PA-A9186954 | D | 4 | $7,132.81 | 8459.21 | Brand | Y | R | |
| 000369764436 | 1 | 9/27/23 | 9/27/23 | 28 | 0 | 58406003204 | ENBREL SURECLICK | 6629003000D530 | 11 | N | Y | W | 97724 | 923600 | 42 | 12 | 50MG/ML(1) | 1582504004 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $7,084.89 | $7,104.89 | $0 | 1 | Y | 232704223460236 | 999 | P | 0 | Y | $8,821.68 | 000912772 | 0011 | 0011 | PA-A9186954 | D | 4 | $7,104.89 | 8459.21 | Brand | Y | R | |
| 000369764436 | 1 | 9/6/23 | 9/6/23 | 28 | 0 | 58406003204 | ENBREL SURECLICK | 6629003000D530 | 11 | N | Y | W | 97724 | 923600 | 42 | 12 | 50MG/ML(1) | 1582504004 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $7,084.89 | $7,104.89 | $0 | 1 | Y | 232493036276269 | 999 | P | 0 | Y | $8,821.68 | 000912772 | 0011 | 0011 | PA-A9186954 | D | 4 | $7,104.89 | 8459.21 | Brand | Y | R | |
| 000369764436 | 1 | 8/15/23 | 8/15/23 | 28 | 0 | 58406003204 | ENBREL SURECLICK | 6629003000D530 | 11 | N | Y | W | 97724 | 923600 | 42 | 12 | 50MG/ML(1) | 1582504004 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $7,084.89 | $7,104.89 | $0 | 1 | Y | 232274973575250 | 999 | P | 0 | Y | $8,821.68 | 000912772 | 0011 | 0011 | PA-A9186954 | D | 4 | $7,104.89 | 8459.21 | Brand | Y | R | |
| 000407237437 | 1 | 12/13/23 | 12/13/23 | 28 | 0 | 58406003204 | ENBREL SURECLICK | 6629003000D530 | 11 | N | Y | W | 97724 | 923600 | 42 | 12 | 50MG/ML(1) | 1582504004 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $7,029.06 | $7,049.06 | $0 | 1 | Y | 233473109288233 | 999 | P | 0 | Y | $8,821.68 | 000912772 | 0011 | 0011 | PA-C3539230 | D | 4 | $7,049.06 | 8459.21 | Brand | Y | R | |
| 000407237437 | 1 | 12/13/23 | 12/19/23 | 28 | 0 | 58406003204 | ENBREL SURECLICK | 6629003000D530 | 11 | N | Y | W | 97724 | 923600 | 42 | 12 | 50MG/ML(1) | 1582504004 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $7,029.06 | $7,049.06 | $0 | 1 | Y | 233531978748235 | 999 | P | 0 | Y | $8,821.68 | 000912772 | 0011 | 0011 | PA-C3539230 | D | 4 | $7,049.06 | 8459.21 | Brand | Y | R | |
| 000369764436 | 1 | 11/20/23 | 11/20/23 | 28 | 0 | 58406003204 | ENBREL SURECLICK | 6629003000D530 | 11 | N | Y | W | 97724 | 923600 | 42 | 12 | 50MG/ML(1) | 1582504004 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $7,029.06 | $7,049.06 | $0 | 1 | Y | 233242189236262 | 999 | P | 0 | Y | $8,821.68 | 000912772 | 0011 | 0011 | PA-A9186954 | D | 4 | $7,049.06 | 8459.21 | Brand | Y | R | |
| 000369764436 | 1 | 10/18/23 | 10/18/23 | 28 | 0 | 58406003204 | ENBREL SURECLICK | 6629003000D530 | 11 | N | Y | W | 97724 | 923600 | 42 | 12 | 50MG/ML(1) | 1582504004 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $7,015.52 | $7,035.52 | $0 | 1 | Y | 232912185418214 | 999 | P | 0 | Y | $8,821.68 | 000912772 | 0011 | 0011 | PA-A9186954 | D | 4 | $7,035.52 | 8459.21 | Brand | Y | R | |
| 000385319545 | 1 | 6/23/23 | 6/23/23 | 30 | 0 | 00074230630 | RINVOQ | 66603072007520 | 2 | N | Y | W | 46822 | 923600 | 42 | 11 | 15 MG | 1586960982 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $6,878.66 | $6,898.66 | $0 | 1 | Y | 231742952851225 | 998 | P | 0 | Y | $7,666.20 | 000912772 | 0016 | 0016 | PA-B5442589 | D | 30 | $6,898.66 | 7349.9499 | Brand | Y | R | |
| 000378019851 | 1 | 6/20/23 | 6/20/23 | 30 | 0 | 00074230630 | RINVOQ | 66603072007520 | 2 | N | Y | W | 46822 | 923600 | 42 | 11 | 15 MG | 1588935996 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $6,878.66 | $6,898.66 | $0 | 1 | Y | 231712293243262 | 998 | P | 0 | Y | $7,666.20 | 000912772 | 0011 | 0011 | PA-A6942100 | D | 30 | $6,898.66 | 7349.9499 | Brand | Y | R | |
| 000354912759 | 1 | 1/6/23 | 5/18/23 | 28 | 0 | 00074055402 | HUMIRA(CF) PEN | 6627001500F430 | 6 | N | Y | W | 43506 | 923600 | 42 | 12 | 40MG/0.4ML | 1588340287 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $6,866.62 | $6,886.62 | $0 | 1 | Y | 230064368088260 | 995 | P | 0 | Y | $8,663.28 | 000912772 | 0001 | 0001 | PA-A4907586 | D | 2 | $6,886.62 | 8307.14 | Brand | Y | R | |
| 000350688629 | 1 | 1/19/23 | 5/18/23 | 28 | 0 | 00074055402 | HUMIRA(CF) PEN | 6627001500F430 | 5 | N | Y | W | 43506 | 923600 | 42 | 12 | 40MG/0.4ML | 33894852 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $6,866.62 | $6,886.62 | $0 | 1 | Y | 230193510059270 | 995 | P | 0 | Y | $8,663.28 | 000912772 | 0016 | 0016 | PA-A3658670 | D | 2 | $6,886.62 | 8307.14 | Brand | Y | R | |
| 000350740476 | 1 | 4/24/23 | 4/24/23 | 28 | 0 | 00074055402 | HUMIRA(CF) PEN | 6627001500F430 | 11 | N | Y | W | 43506 | 923600 | 42 | 12 | 40MG/0.4ML | 1588169730 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $6,866.62 | $6,886.62 | $0 | 15 | Y | 231143688526203 | 999 | P | 0 | Y | $8,663.28 | 000912772 | 0002 | 0002 | PA-A3407298 | D | 2 | $6,886.62 | 8307.14 | Brand | Y | R | |
| 000371309036 | 1 | 4/21/23 | 4/21/23 | 28 | 0 | 00074055402 | HUMIRA(CF) PEN | 6627001500F430 | 5 | N | Y | W | 43506 | 923600 | 42 | 12 | 40MG/0.4ML | 176085455 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $6,866.62 | $6,886.62 | $0 | 1 | Y | 231112607471265 | 998 | P | 0 | Y | $8,663.28 | 000912772 | 0001 | 0001 | PA-A5013839 | D | 2 | $6,886.62 | 8307.14 | Brand | Y | R | |
| 000375610058 | 1 | 4/12/23 | 4/12/23 | 28 | 0 | 00074055402 | HUMIRA(CF) PEN | 6627001500F430 | 6 | N | Y | W | 43506 | 923600 | 42 | 12 | 40MG/0.4ML | 1588340287 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $6,866.62 | $6,886.62 | $0 | 1 | Y | 231022757303203 | 998 | P | 0 | Y | $8,663.28 | 000912772 | 0001 | 0001 | PA-A4907586 | D | 2 | $6,886.62 | 8307.14 | Brand | Y | R | |
| 000399372936 | 1 | 10/3/23 | 10/3/23 | 28 | 0 | 00074055402 | HUMIRA(CF) PEN | 6627001500F430 | 7 | N | Y | W | 43506 | 923600 | 42 | 12 | 40MG/0.4ML | 1588340287 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $6,836.71 | $6,856.71 | $0 | 15 | Y | 232763461978268 | 999 | P | 0 | Y | $8,663.28 | 000912772 | 0001 | 0001 | PA-C0655283 | D | 2 | $6,856.71 | 8307.14 | Brand | Y | R | |
| 000386708778 | 1 | 9/25/23 | 9/25/23 | 28 | 0 | 00074055402 | HUMIRA(CF) PEN | 6627001500F430 | 5 | N | Y | W | 43506 | 923600 | 42 | 12 | 40MG/0.4ML | 176085455 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $6,836.71 | $6,856.71 | $0 | 1 | Y | 232681924500220 | 998 | P | 0 | Y | $8,663.28 | 000912772 | 0001 | 0001 | PA-C0316473 | D | 2 | $6,856.71 | 8307.14 | Brand | Y | R | |
| 000389816221 | 1 | 9/20/23 | 9/20/23 | 28 | 0 | 00074055402 | HUMIRA(CF) PEN | 6627001500F430 | 11 | N | Y | W | 43506 | 923600 | 42 | 12 | 40MG/0.4ML | 1588169730 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $6,836.71 | $6,856.71 | $0 | 1 | Y | 232632698225239 | 999 | P | 0 | Y | $8,663.28 | 000912772 | 0002 | 0002 | PA-B8381035 | D | 2 | $6,856.71 | 8307.14 | Brand | Y | R | |
| 000392432890 | 1 | 9/12/23 | 9/12/23 | 28 | 0 | 00074055402 | HUMIRA(CF) PEN | 6627001500F430 | 5 | N | Y | W | 43506 | 923600 | 42 | 12 | 40MG/0.4ML | 532199466 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $6,836.71 | $6,856.71 | $0 | 1 | Y | 232554072538229 | 998 | P | 0 | Y | $8,663.28 | 000912772 | 0001 | 0001 | PA-B7939944 | D | 2 | $6,856.71 | 8307.14 | Brand | Y | R | |
| 000389816221 | 1 | 8/30/23 | 8/30/23 | 28 | 0 | 00074055402 | HUMIRA(CF) PEN | 6627001500F430 | 11 | N | Y | W | 43506 | 923600 | 42 | 12 | 40MG/0.4ML | 1588169730 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $6,836.71 | $6,856.71 | $0 | 1 | Y | 232422611623241 | 999 | P | 0 | Y | $8,663.28 | 000912772 | 0002 | 0002 | PA-B8381035 | D | 2 | $6,856.71 | 8307.14 | Brand | Y | R | |
| 000375610058 | 1 | 8/19/23 | 8/19/23 | 28 | 0 | 00074055402 | HUMIRA(CF) PEN | 6627001500F430 | 6 | N | Y | W | 43506 | 923600 | 42 | 12 | 40MG/0.4ML | 1588340287 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $6,836.71 | $6,856.71 | $0 | 1 | Y | 232313059102222 | 998 | P | 0 | Y | $8,663.28 | 000912772 | 0001 | 0001 | PA-A4907586 | D | 2 | $6,856.71 | 8307.14 | Brand | Y | R | |
| 000386708778 | 1 | 8/17/23 | 8/17/23 | 28 | 0 | 00074055402 | HUMIRA(CF) PEN | 6627001500F430 | 5 | N | Y | W | 43506 | 923600 | 42 | 12 | 40MG/0.4ML | 176085455 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $6,836.71 | $6,856.71 | $0 | 15 | Y | 232295356787232 | 998 | P | 0 | Y | $8,663.28 | 000912772 | 0001 | 0001 | PA-A5013839 | D | 2 | $6,856.71 | 8307.14 | Brand | Y | R | |
| 000389816221 | 1 | 8/9/23 | 8/9/23 | 28 | 0 | 00074055402 | HUMIRA(CF) PEN | 6627001500F430 | 11 | N | Y | W | 43506 | 923600 | 42 | 12 | 40MG/0.4ML | 1588169730 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $6,836.71 | $6,856.71 | $0 | 1 | Y | 232212786194208 | 999 | P | 0 | Y | $8,663.28 | 000912772 | 0002 | 0002 | PA-B8381035 | D | 2 | $6,856.71 | 8307.14 | Brand | Y | R | |
| 000399471211 | 1 | 2/28/24 | 2/28/24 | 28 | 0 | 00074055402 | HUMIRA(CF) PEN | 6627001500F430 | 11 | N | Y | W | 43506 | 923600 | 42 | 12 | 40MG/0.4ML | 1585321424 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $6,821.76 | $6,841.76 | $0 | 15 | Y | 240593468108221 | 998 | P | 0 | Y | $8,663.28 | 000912772 | 0001 | 0001 | PA-C0679222 | D | 2 | $6,841.76 | 8307.14 | Brand | Y | R | |
| 000413384656 | 1 | 2/20/24 | 2/20/24 | 28 | 0 | 00074055402 | HUMIRA(CF) PEN | 6627001500F430 | 5 | N | Y | W | 43506 | 923600 | 42 | 12 | 40MG/0.4ML | 176085455 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $6,821.76 | $6,841.76 | $0 | 1 | Y | 240513415213253 | 999 | P | 0 | Y | $8,663.28 | 000912772 | 0001 | 0001 | PA-C0316473 | D | 2 | $6,841.76 | 8307.14 | Brand | Y | R | |
| 000402661558 | 1 | 2/10/24 | 2/10/24 | 28 | 0 | 00074055402 | HUMIRA(CF) PEN | 6627001500F430 | 11 | N | Y | W | 43506 | 923600 | 42 | 12 | 40MG/0.4ML | 1588340287 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $6,821.76 | $6,841.76 | $0 | 1 | Y | 240413050042264 | 998 | P | 0 | Y | $8,663.28 | 000912772 | 0001 | 0001 | PA-C0655283 | D | 2 | $6,841.76 | 8307.14 | Brand | Y | R | |
| 000399471211 | 1 | 2/2/24 | 2/2/24 | 28 | 0 | 00074055402 | HUMIRA(CF) PEN | 6627001500F430 | 11 | N | Y | W | 43506 | 923600 | 42 | 12 | 40MG/0.4ML | 1585321424 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $6,821.76 | $6,841.76 | $0 | 1 | Y | 240333097696223 | 998 | P | 0 | Y | $8,663.28 | 000912772 | 0001 | 0001 | PA-C0679222 | D | 2 | $6,841.76 | 8307.14 | Brand | Y | R | |
| 000413384656 | 1 | 1/30/24 | 1/30/24 | 28 | 0 | 00074055402 | HUMIRA(CF) PEN | 6627001500F430 | 5 | N | Y | W | 43506 | 923600 | 42 | 12 | 40MG/0.4ML | 176085455 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $6,821.76 | $6,841.76 | $0 | 1 | Y | 240302624530269 | 998 | P | 0 | Y | $8,663.28 | 000912772 | 0001 | 0001 | PA-C0316473 | D | 2 | $6,841.76 | 8307.14 | Brand | Y | R | |
| 000402661558 | 1 | 1/17/24 | 1/17/24 | 28 | 0 | 00074055402 | HUMIRA(CF) PEN | 6627001500F430 | 11 | N | Y | W | 43506 | 923600 | 42 | 12 | 40MG/0.4ML | 1588340287 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $6,821.76 | $6,841.76 | $0 | 1 | Y | 240175823989226 | 998 | P | 0 | Y | $8,663.28 | 000912772 | 0001 | 0001 | PA-C0655283 | D | 2 | $6,841.76 | 8307.14 | Brand | Y | R | |
| 000386708778 | 1 | 1/9/24 | 1/9/24 | 28 | 0 | 00074055402 | HUMIRA(CF) PEN | 6627001500F430 | 5 | N | Y | W | 43506 | 923600 | 42 | 12 | 40MG/0.4ML | 176085455 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $6,821.76 | $6,841.76 | $0 | 1 | Y | 240094064599239 | 998 | P | 0 | Y | $8,663.28 | 000912772 | 0001 | 0001 | PA-C0316473 | D | 2 | $6,841.76 | 8307.14 | Brand | Y | R | |
| 000399471211 | 1 | 1/8/24 | 1/8/24 | 28 | 0 | 00074055402 | HUMIRA(CF) PEN | 6627001500F430 | 11 | N | Y | W | 43506 | 923600 | 42 | 12 | 40MG/0.4ML | 1585321424 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $6,821.76 | $6,841.76 | $0 | 1 | Y | 240083817250280 | 998 | P | 0 | Y | $8,663.28 | 000912772 | 0001 | 0001 | PA-C0679222 | D | 2 | $6,841.76 | 8307.14 | Brand | Y | R | |
| 000392432890 | 1 | 1/3/24 | 1/3/24 | 28 | 0 | 00074055402 | HUMIRA(CF) PEN | 6627001500F430 | 5 | N | Y | W | 43506 | 923600 | 42 | 12 | 40MG/0.4ML | 532199466 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $6,821.76 | $6,841.76 | $0 | 1 | Y | 240032630869223 | 999 | P | 0 | Y | $8,663.28 | 000912772 | 0001 | 0001 | PA-B7939944 | D | 2 | $6,841.76 | 8307.14 | Brand | Y | R | |
| 000399471211 | 1 | 3/27/24 | 3/27/24 | 28 | 0 | 74055402 | HUMIRA(CF) PEN | 6627001500F430 | 11 | N | Y | W | 43506 | 923600 | 42 | 12 | 40MG/0.4ML | 1585321424 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $6,791.85 | $6,811.85 | $0 | 1 | Y | 240873720261268 | 998 | P | 0 | Y | $8,663.28 | 000912772 | 0001 | 0001 | PA-C0679222 | D | 2 | $6,811.85 | 8307.14 | Brand | Y | R | |
| 000392432890 | 1 | 3/26/24 | 3/26/24 | 28 | 0 | 74055402 | HUMIRA(CF) PEN | 6627001500F430 | 5 | N | Y | W | 43506 | 923600 | 42 | 12 | 40MG/0.4ML | 532199466 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $6,791.85 | $6,811.85 | $0 | 1 | Y | 240862321084202 | 999 | P | 0 | Y | $8,663.28 | 000912772 | 0001 | 0001 | PA-B7939944 | D | 2 | $6,811.85 | 8307.14 | Brand | Y | R | |
| 000402661558 | 1 | 3/7/24 | 3/7/24 | 28 | 0 | 00074055402 | HUMIRA(CF) PEN | 6627001500F430 | 11 | N | Y | W | 43506 | 923600 | 42 | 12 | 40MG/0.4ML | 1588340287 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $6,791.85 | $6,811.85 | $0 | 1 | Y | 240674868670273 | 998 | P | 0 | Y | $8,663.28 | 000912772 | 0001 | 0001 | PA-C0655283 | D | 2 | $6,811.85 | 8307.14 | Brand | Y | R | |
| 000402661558 | 1 | 12/26/23 | 12/26/23 | 28 | 0 | 00074055402 | HUMIRA(CF) PEN | 6627001500F430 | 11 | N | Y | W | 43506 | 923600 | 42 | 12 | 40MG/0.4ML | 1588340287 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $6,776.90 | $6,796.90 | $0 | 1 | Y | 233602784455206 | 999 | P | 0 | Y | $8,663.28 | 000912772 | 0001 | 0001 | PA-C0655283 | D | 2 | $6,796.90 | 8307.14 | Brand | Y | R | |
| 000402661558 | 1 | 12/26/23 | 1/5/24 | 28 | 0 | 00074055402 | HUMIRA(CF) PEN | 6627001500F430 | 11 | N | Y | W | 43506 | 923600 | 42 | 12 | 40MG/0.4ML | 1588340287 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $6,776.90 | $6,796.90 | $0 | 1 | Y | 233602784455206 | 997 | P | 0 | Y | $8,663.28 | 000912772 | 0001 | 0001 | PA-C0655283 | D | 2 | $6,796.90 | 8307.14 | Brand | Y | R | |
| 000399471211 | 1 | 12/18/23 | 12/18/23 | 28 | 0 | 00074055402 | HUMIRA(CF) PEN | 6627001500F430 | 11 | N | Y | W | 43506 | 923600 | 42 | 12 | 40MG/0.4ML | 1585321424 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $6,776.90 | $6,796.90 | $0 | 1 | Y | 233525302042211 | 998 | P | 0 | Y | $8,663.28 | 000912772 | 0001 | 0001 | PA-C0679222 | D | 2 | $6,796.90 | 8307.14 | Brand | Y | R | |
| 000392432890 | 1 | 12/5/23 | 12/5/23 | 28 | 0 | 00074055402 | HUMIRA(CF) PEN | 6627001500F430 | 5 | N | Y | W | 43506 | 923600 | 42 | 12 | 40MG/0.4ML | 532199466 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $6,776.90 | $6,796.90 | $0 | 15 | Y | 233394055093265 | 999 | P | 0 | Y | $8,663.28 | 000912772 | 0001 | 0001 | PA-B7939944 | D | 2 | $6,796.90 | 8307.14 | Brand | Y | R | |
| 000402661558 | 1 | 11/25/23 | 11/25/23 | 28 | 0 | 00074055402 | HUMIRA(CF) PEN | 6627001500F430 | 11 | N | Y | W | 43506 | 923600 | 42 | 12 | 40MG/0.4ML | 1588340287 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $6,776.90 | $6,796.90 | $0 | 1 | Y | 233294379999266 | 999 | P | 0 | Y | $8,663.28 | 000912772 | 0001 | 0001 | PA-C0655283 | D | 2 | $6,796.90 | 8307.14 | Brand | Y | R | |
| 000399471211 | 1 | 11/24/23 | 11/24/23 | 28 | 0 | 00074055402 | HUMIRA(CF) PEN | 6627001500F430 | 11 | N | Y | W | 43506 | 923600 | 42 | 12 | 40MG/0.4ML | 1585321424 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $6,776.90 | $6,796.90 | $0 | 1 | Y | 233284643055232 | 998 | P | 0 | Y | $8,663.28 | 000912772 | 0001 | 0001 | PA-C0679222 | D | 2 | $6,796.90 | 8307.14 | Brand | Y | R | |
| 000386708778 | 1 | 11/7/23 | 11/7/23 | 28 | 0 | 00074055402 | HUMIRA(CF) PEN | 6627001500F430 | 5 | N | Y | W | 43506 | 923600 | 42 | 12 | 40MG/0.4ML | 176085455 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $6,776.90 | $6,796.90 | $0 | 1 | Y | 233115166035224 | 998 | P | 0 | Y | $8,663.28 | 000912772 | 0001 | 0001 | PA-C0316473 | D | 2 | $6,796.90 | 8307.14 | Brand | Y | R | |
| 000392432890 | 1 | 11/3/23 | 11/3/23 | 28 | 0 | 00074055402 | HUMIRA(CF) PEN | 6627001500F430 | 5 | N | Y | W | 43506 | 923600 | 42 | 12 | 40MG/0.4ML | 532199466 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $6,776.90 | $6,796.90 | $0 | 1 | Y | 233075549264205 | 999 | P | 0 | Y | $8,663.28 | 000912772 | 0001 | 0001 | PA-B7939944 | D | 2 | $6,796.90 | 8307.14 | Brand | Y | R | |
| 000399471211 | 1 | 10/30/23 | 10/30/23 | 28 | 0 | 00074055402 | HUMIRA(CF) PEN | 6627001500F430 | 11 | N | Y | W | 43506 | 923600 | 42 | 12 | 40MG/0.4ML | 1585321424 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $6,761.95 | $6,781.95 | $0 | 1 | Y | 233033716545258 | 998 | P | 0 | Y | $8,663.28 | 000912772 | 0001 | 0001 | PA-C0679222 | D | 2 | $6,781.95 | 8307.14 | Brand | Y | R | |
| 000399471211 | 1 | 10/30/23 | 11/2/23 | 28 | 0 | 00074055402 | HUMIRA(CF) PEN | 6627001500F430 | 11 | N | Y | W | 43506 | 923600 | 42 | 12 | 40MG/0.4ML | 1585321424 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $6,761.95 | $6,781.95 | $0 | 1 | Y | 233063051238257 | 998 | P | 0 | Y | $8,663.28 | 000912772 | 0001 | 0001 | PA-C0679222 | D | 2 | $6,781.95 | 8307.14 | Brand | Y | R | |
| 000402159347 | 1 | 10/26/23 | 10/26/23 | 28 | 0 | 00074055402 | HUMIRA(CF) PEN | 6627001500F430 | 7 | N | Y | W | 43506 | 923600 | 42 | 12 | 40MG/0.4ML | 1588340287 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $6,761.95 | $6,781.95 | $0 | 1 | Y | 232993291833227 | 999 | P | 0 | Y | $8,663.28 | 000912772 | 0001 | 0001 | PA-C0655283 | D | 2 | $6,781.95 | 8307.14 | Brand | Y | R | |
| 000386708778 | 1 | 10/25/23 | 10/25/23 | 28 | 0 | 00074055402 | HUMIRA(CF) PEN | 6627001500F430 | 5 | N | Y | W | 43506 | 923600 | 42 | 12 | 40MG/0.4ML | 176085455 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $6,761.95 | $6,781.95 | $0 | 1 | Y | 232978100206257 | 996 | P | 0 | Y | $8,663.28 | 000912772 | 0001 | 0001 | PA-C0316473 | D | 2 | $6,781.95 | 8307.14 | Brand | Y | R | |
| 000399471211 | 1 | 10/4/23 | 10/9/23 | 28 | 0 | 00074055402 | HUMIRA(CF) PEN | 6627001500F430 | 11 | N | Y | W | 43506 | 923600 | 42 | 12 | 40MG/0.4ML | 1585321424 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $6,761.95 | $6,781.95 | $0 | 1 | Y | 232771919982242 | 997 | P | 0 | Y | $8,663.28 | 000912772 | 0001 | 0001 | PA-C0679222 | D | 2 | $6,781.95 | 8307.14 | Brand | Y | R | |
| 000386708778 | 1 | 10/4/23 | 10/4/23 | 28 | 0 | 00074055402 | HUMIRA(CF) PEN | 6627001500F430 | 5 | N | Y | W | 43506 | 923600 | 42 | 12 | 40MG/0.4ML | 176085455 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $6,761.95 | $6,781.95 | $0 | 1 | Y | 232775989310233 | 997 | P | 0 | Y | $8,663.28 | 000912772 | 0001 | 0001 | PA-C0316473 | D | 2 | $6,781.95 | 8307.14 | Brand | Y | R | |
| 000384985209 | 1 | 5/30/23 | 5/30/23 | 30 | 0 | 00074230630 | RINVOQ | 66603072007520 | 2 | N | Y | W | 46822 | 923600 | 42 | 11 | 15 MG | 1586960982 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $6,536.89 | $6,556.89 | $0 | 1 | Y | 231502353839229 | 998 | P | 0 | Y | $7,666.20 | 000912772 | 0016 | 0016 | PA-B5442589 | D | 30 | $6,556.89 | 7349.9499 | Brand | Y | R | |
| 000374008998 | 1 | 5/6/23 | 5/6/23 | 30 | 0 | 00074230630 | RINVOQ | 66603072007520 | 2 | N | Y | W | 46822 | 923600 | 42 | 11 | 15 MG | 1586960982 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $6,536.89 | $6,556.89 | $0 | 1 | Y | 231263054064247 | 998 | P | 0 | Y | $7,666.20 | 000912772 | 0016 | 0016 | PA-A1957056 | D | 30 | $6,556.89 | 7349.9499 | Brand | Y | R | |
| 000378019851 | 1 | 7/21/23 | 7/21/23 | 30 | 0 | 00074230630 | RINVOQ | 66603072007520 | 2 | N | Y | W | 46822 | 923600 | 42 | 11 | 15 MG | 1588935996 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $6,512.64 | $6,532.64 | $0 | 1 | Y | 232022049124226 | 998 | P | 0 | Y | $7,666.20 | 000912772 | 0011 | 0011 | PA-A6942100 | D | 30 | $6,532.64 | 7349.9499 | Brand | Y | R | |
| 000385319545 | 1 | 7/19/23 | 7/19/23 | 30 | 0 | 00074230630 | RINVOQ | 66603072007520 | 2 | N | Y | W | 46822 | 923600 | 42 | 11 | 15 MG | 1586960982 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $6,512.64 | $6,532.64 | $0 | 1 | Y | 232000125556238 | 997 | P | 0 | Y | $7,666.20 | 000912772 | 0016 | 0016 | PA-B5442589 | D | 30 | $6,532.64 | 7349.9499 | Brand | Y | R | |
| 000410414492 | 1 | 2/27/24 | 2/27/24 | 30 | 0 | 00074230630 | RINVOQ | 66603072007520 | 2 | N | Y | W | 46822 | 923600 | 42 | 11 | 15 MG | 1588935996 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $6,441.82 | $6,461.82 | $0 | 1 | Y | 240578078169249 | 997 | P | 0 | Y | $8,049.01 | 000912772 | 0011 | 0011 | PA-C1317317 | D | 30 | $6,461.82 | 7717.4499 | Brand | Y | R | |
| 000410531478 | 1 | 2/8/24 | 2/8/24 | 30 | 0 | 00074230630 | RINVOQ | 66603072007520 | 1 | N | Y | W | 46822 | 923600 | 42 | 11 | 15 MG | 1586960982 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $6,441.82 | $6,461.82 | $0 | 1 | Y | 240393344124241 | 998 | P | 0 | Y | $8,049.01 | 000912772 | 0016 | 0016 | PA-B5442589 | D | 30 | $6,461.82 | 7717.4499 | Brand | Y | R | |
| 000410414492 | 1 | 1/31/24 | 1/31/24 | 30 | 0 | 00074230630 | RINVOQ | 66603072007520 | 2 | N | Y | W | 46822 | 923600 | 42 | 11 | 15 MG | 1588935996 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $6,441.82 | $6,461.82 | $0 | 1 | Y | 240308231041232 | 997 | P | 0 | Y | $8,049.01 | 000912772 | 0011 | 0011 | PA-C1317317 | D | 30 | $6,461.82 | 7717.4499 | Brand | Y | R | |
| 000410531478 | 1 | 1/9/24 | 1/9/24 | 30 | 0 | 00074230630 | RINVOQ | 66603072007520 | 1 | N | Y | W | 46822 | 923600 | 42 | 11 | 15 MG | 1586960982 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $6,441.82 | $6,461.82 | $0 | 1 | Y | 240093046809226 | 998 | P | 0 | Y | $8,049.01 | 000912772 | 0016 | 0016 | PA-B5442589 | D | 30 | $6,461.82 | 7717.4499 | Brand | Y | R | |
| 000410414492 | 1 | 1/8/24 | 1/8/24 | 30 | 0 | 00074230630 | RINVOQ | 66603072007520 | 2 | N | Y | W | 46822 | 923600 | 42 | 11 | 15 MG | 1588935996 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $6,441.82 | $6,461.82 | $0 | 1 | Y | 240082461993208 | 998 | P | 0 | Y | $8,049.01 | 000912772 | 0011 | 0011 | PA-C1317317 | D | 30 | $6,461.82 | 7717.4499 | Brand | Y | R | |
| 000417293503 | 1 | 3/26/24 | 3/26/24 | 30 | 0 | 74230630 | RINVOQ | 66603072007520 | 2 | N | Y | W | 46822 | 923600 | 42 | 11 | 15 MG | 1586960982 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $6,416.35 | $6,436.35 | $0 | 1 | Y | 240858136810272 | 997 | P | 0 | Y | $8,049.01 | 000912772 | 0016 | 0016 | PA-B5442589 | D | 30 | $6,436.35 | 7717.4499 | Brand | Y | R | |
| 000417293503 | 1 | 3/2/24 | 3/2/24 | 30 | 0 | 00074230630 | RINVOQ | 66603072007520 | 2 | N | Y | W | 46822 | 923600 | 42 | 11 | 15 MG | 1586960982 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $6,416.35 | $6,436.35 | $0 | 1 | Y | 240620139601261 | 998 | P | 0 | Y | $8,049.01 | 000912772 | 0016 | 0016 | PA-B5442589 | D | 30 | $6,436.35 | 7717.4499 | Brand | Y | R | |
| 000410552053 | 1 | 2/10/24 | 2/10/24 | 20 | 0 | 00169770521 | NORDITROPIN FLEXPRO | 3010002000D230 | 3 | N | Y | W | 24146 | 683004 | 64 | 68 | 10MG/1.5ML | 570136966 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $6,318.18 | $6,338.18 | $0 | 1 | Y | 240413315894271 | 999 | P | 0 | Y | $8,064.50 | 000912772 | 0002 | 0002 | PA-C2620271 | D | 6 | $6,338.18 | 7732.32 | Brand | Y | R | |
| 000410552053 | 1 | 1/23/24 | 1/23/24 | 20 | 0 | 00169770521 | NORDITROPIN FLEXPRO | 3010002000D230 | 3 | N | Y | W | 24146 | 683004 | 64 | 68 | 10MG/1.5ML | 570136966 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $6,318.18 | $6,338.18 | $0 | 1 | Y | 240233305609212 | 999 | P | 0 | Y | $8,064.50 | 000912772 | 0002 | 0002 | PA-C2620271 | D | 6 | $6,338.18 | 7732.32 | Brand | Y | R | |
| 000410552053 | 1 | 1/8/24 | 1/8/24 | 20 | 0 | 00169770521 | NORDITROPIN FLEXPRO | 3010002000D230 | 3 | N | Y | W | 24146 | 683004 | 64 | 68 | 10MG/1.5ML | 570136966 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $6,318.18 | $6,338.18 | $0 | 1 | Y | 240084816120271 | 997 | P | 0 | Y | $8,064.50 | 000912772 | 0002 | 0002 | PA-C2620271 | D | 6 | $6,338.18 | 7732.32 | Brand | Y | R | |
| 000001285657 | 1 | 1/26/24 | 1/26/24 | 90 | 0 | 61958200201 | DESCOVY | 12109902290320 | 0 | N | Y | W | 40953 | 081808 | 33 | 21 | 200MG-25MG | 1587468899 | 010 | $0.25 | $0.25 | $0.00 | $0.00 | $0.00 | $0.00 | $6,233.46 | $6,233.46 | $0 | 1 | Y | 240263579179270 | 999 | P | 0 | N | $7,554.99 | 000912772 | 0001 | 0001 | PA-C2166595 | D | 90 | $6,233.21 | 7928.28 | Brand | N | R | |
| 000362634061 | 1 | 1/15/23 | 5/18/23 | 30 | 0 | 00074230630 | RINVOQ | 66603072007520 | 2 | N | Y | W | 46822 | 923600 | 42 | 11 | 15 MG | 1586960982 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $6,170.86 | $6,190.86 | $0 | 1 | Y | 230154999412228 | 995 | P | 0 | Y | $7,666.20 | 000912772 | 0016 | 0016 | PA-A1957056 | D | 30 | $6,190.86 | 7349.9499 | Brand | Y | R | |
| 000360194780 | 1 | 1/20/23 | 5/18/23 | 30 | 0 | 00074230630 | RINVOQ | 66603072007520 | 5 | N | Y | W | 46822 | 923600 | 42 | 11 | 15 MG | 1588935996 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $6,170.86 | $6,190.86 | $0 | 1 | Y | 230202688794259 | 995 | P | 0 | Y | $7,666.20 | 000912772 | 0011 | 0011 | PA-A6942100 | D | 30 | $6,190.86 | 7349.9499 | Brand | Y | R | |
| 000374008998 | 1 | 4/11/23 | 4/11/23 | 30 | 0 | 00074230630 | RINVOQ | 66603072007520 | 2 | N | Y | W | 46822 | 923600 | 42 | 11 | 15 MG | 1586960982 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $6,170.86 | $6,190.86 | $0 | 1 | Y | 231016579555217 | 998 | P | 0 | Y | $7,666.20 | 000912772 | 0016 | 0016 | PA-A1957056 | D | 30 | $6,190.86 | 7349.9499 | Brand | Y | R | |
| 000396791073 | 1 | 9/21/23 | 9/21/23 | 30 | 0 | 00074230630 | RINVOQ | 66603072007520 | 2 | N | Y | W | 46822 | 923600 | 42 | 11 | 15 MG | 1588935996 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $6,146.61 | $6,166.61 | $0 | 1 | Y | 232645319772277 | 998 | P | 0 | Y | $7,666.20 | 000912772 | 0011 | 0011 | PA-A6942100 | D | 30 | $6,166.61 | 7349.9499 | Brand | Y | R | |
| 000396777744 | 1 | 9/11/23 | 9/11/23 | 30 | 0 | 00074230630 | RINVOQ | 66603072007520 | 2 | N | Y | W | 46822 | 923600 | 42 | 11 | 15 MG | 1586960982 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $6,146.61 | $6,166.61 | $0 | 1 | Y | 232544124830250 | 998 | P | 0 | Y | $7,666.20 | 000912772 | 0016 | 0016 | PA-B5442589 | D | 30 | $6,166.61 | 7349.9499 | Brand | Y | R | |
| 000378019851 | 1 | 8/19/23 | 8/19/23 | 30 | 0 | 00074230630 | RINVOQ | 66603072007520 | 2 | N | Y | W | 46822 | 923600 | 42 | 11 | 15 MG | 1588935996 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $6,146.61 | $6,166.61 | $0 | 1 | Y | 232312139627261 | 998 | P | 0 | Y | $7,666.20 | 000912772 | 0011 | 0011 | PA-A6942100 | D | 30 | $6,166.61 | 7349.9499 | Brand | Y | R | |
| 000385319545 | 1 | 8/17/23 | 8/17/23 | 30 | 0 | 00074230630 | RINVOQ | 66603072007520 | 2 | N | Y | W | 46822 | 923600 | 42 | 11 | 15 MG | 1586960982 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $6,146.61 | $6,166.61 | $0 | 1 | Y | 232293618033252 | 998 | P | 0 | Y | $7,666.20 | 000912772 | 0016 | 0016 | PA-B5442589 | D | 30 | $6,166.61 | 7349.9499 | Brand | Y | R | |
| 000001216642 | 1 | 7/27/23 | 7/27/23 | 90 | 0 | 61958200202 | DESCOVY | 12109902290320 | 0 | N | Y | W | 40953 | 081808 | 33 | 21 | 200MG-25MG | 1587468899 | 010 | $0.25 | $0.25 | $0.00 | $0.00 | $0.00 | $0.00 | $6,111.24 | $6,111.24 | $0 | 1 | Y | 232082498818216 | 999 | P | 0 | N | $7,406.99 | 000912772 | 0001 | 0001 | APP-8765081 | D | 90 | $6,110.99 | 7772.8203 | Brand | N | R | |
| 000001110936 | 1 | 6/29/23 | 6/29/23 | 90 | 0 | 61958200202 | DESCOVY | 12109902290320 | 0 | N | Y | W | 40953 | 081808 | 33 | 21 | 200MG-25MG | 1587468899 | 010 | $0.25 | $0.25 | $0.00 | $0.00 | $0.00 | $0.00 | $6,111.24 | $6,111.24 | $0 | 1 | Y | 231803815284223 | 999 | P | 0 | N | $7,406.99 | 000912772 | 0001 | 0001 | APP-8765081 | D | 90 | $6,110.99 | 7772.8203 | Brand | N | R | |
| 000396791073 | 1 | 12/15/23 | 12/15/23 | 30 | 0 | 00074230630 | RINVOQ | 66603072007520 | 2 | N | Y | W | 46822 | 923600 | 42 | 11 | 15 MG | 1588935996 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $6,097.36 | $6,117.36 | $0 | 1 | Y | 233493935961208 | 998 | P | 0 | Y | $7,666.20 | 000912772 | 0011 | 0011 | PA-C1317317 | D | 30 | $6,117.36 | 7349.9499 | Brand | Y | R | |
| 000396791073 | 1 | 11/19/23 | 11/19/23 | 30 | 0 | 00074230630 | RINVOQ | 66603072007520 | 2 | N | Y | W | 46822 | 923600 | 42 | 11 | 15 MG | 1588935996 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $6,097.36 | $6,117.36 | $0 | 1 | Y | 233231851839224 | 998 | P | 0 | Y | $7,666.20 | 000912772 | 0011 | 0011 | PA-C1317317 | D | 30 | $6,117.36 | 7349.9499 | Brand | Y | R | |
| 000396777744 | 1 | 11/3/23 | 11/3/23 | 30 | 0 | 00074230630 | RINVOQ | 66603072007520 | 2 | N | Y | W | 46822 | 923600 | 42 | 11 | 15 MG | 1586960982 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $6,097.36 | $6,117.36 | $0 | 1 | Y | 233076198356275 | 998 | P | 0 | Y | $7,666.20 | 000912772 | 0016 | 0016 | PA-B5442589 | D | 30 | $6,117.36 | 7349.9499 | Brand | Y | R | |
| 000396777744 | 1 | 10/9/23 | 10/10/23 | 30 | 0 | 00074230630 | RINVOQ | 66603072007520 | 2 | N | Y | W | 46822 | 923600 | 42 | 11 | 15 MG | 1586960982 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $6,085.60 | $6,105.60 | $0 | 1 | Y | 232831464069232 | 998 | P | 0 | Y | $7,666.20 | 000912772 | 0016 | 0016 | PA-B5442589 | D | 30 | $6,105.60 | 7349.9499 | Brand | Y | R | |
| 000356670533 | 1 | 5/30/23 | 5/31/23 | 28 | 0 | 50474071079 | CIMZIA | 5250502010F840 | 11 | N | Y | W | 23471 | 923600 | 99 | 12 | 400 MG/2ML | 1588108494 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $5,723.17 | $5,743.17 | $0 | 1 | Y | 231513634957267 | 999 | P | 0 | Y | $6,490.67 | 000912772 | 0002 | 0002 | PA-A7048450 | D | 1 | $5,743.17 | 6480.67 | Brand | Y | R | |
| 000356670533 | 1 | 5/2/23 | 5/2/23 | 28 | 0 | 50474071079 | CIMZIA | 5250502010F840 | 11 | N | Y | W | 23471 | 923600 | 99 | 12 | 400 MG/2ML | 1588108494 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $5,723.17 | $5,743.17 | $0 | 15 | Y | 231227573444239 | 999 | P | 0 | Y | $6,490.67 | 000912772 | 0002 | 0002 | PA-A7048450 | D | 1 | $5,743.17 | 6480.67 | Brand | Y | R | |
| 000356670533 | 1 | 7/3/23 | 7/3/23 | 28 | 0 | 50474071079 | CIMZIA | 5250502010F840 | 11 | N | Y | W | 23471 | 923600 | 99 | 12 | 400 MG/2ML | 1588108494 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $5,700.49 | $5,720.49 | $0 | 1 | Y | 231843662746216 | 999 | P | 0 | Y | $6,490.67 | 000912772 | 0002 | 0002 | PA-A7048450 | D | 1 | $5,720.49 | 6480.67 | Brand | Y | R | |
| 000402467657 | 1 | 2/23/24 | 2/23/24 | 28 | 0 | 50474071079 | CIMZIA | 5250502010F840 | 11 | N | Y | W | 23471 | 923600 | 99 | 12 | 400 MG/2ML | 1588108494 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $5,666.02 | $5,686.02 | $0 | 1 | Y | 240541749428246 | 999 | P | 0 | Y | $6,873.03 | 000912772 | 0002 | 0002 | PA-C2678414 | D | 1 | $5,686.02 | 6863.03 | Brand | Y | R | |
| 000402467657 | 1 | 1/24/24 | 1/24/24 | 28 | 0 | 50474071079 | CIMZIA | 5250502010F840 | 11 | N | Y | W | 23471 | 923600 | 99 | 12 | 400 MG/2ML | 1588108494 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $5,666.02 | $5,686.02 | $0 | 15 | Y | 240245806315214 | 999 | P | 0 | Y | $6,873.03 | 000912772 | 0002 | 0002 | PA-C2678414 | D | 1 | $5,686.02 | 6863.03 | Brand | Y | R | |
| 000418738019 | 1 | 3/19/24 | 3/19/24 | 28 | 0 | 3218851 | ORENCIA CLICKJECT | 6640001000D520 | 11 | N | Y | W | 41656 | 923600 | 42 | 11 | 125 MG/ML | 1588108494 | 003 | $0.00 | $0.00 | $0.00 | $45.00 | $0.00 | $0.00 | $5,647.99 | $5,692.99 | $0 | 1 | Y | 240792792905239 | 999 | P | 0 | N | $7,129.09 | 000912772 | 0002 | 0002 | PA-C8148062 | D | 4 | $5,692.99 | 6834.32 | Brand | Y | R | |
| 000418170806 | 1 | 3/14/24 | 3/14/24 | 90 | 0 | 72618300002 | NURTEC ODT | 67701060707220 | 3 | N | N | W | 47762 | 283212 | 41 | 02 | 75 MG | 1957934692 | 002 | $0.00 | $0.00 | $0.00 | $40.00 | $0.00 | $0.00 | $5,390.65 | $5,430.65 | $0 | 5 | Y | 240742726994244 | 998 | P | 0 | Y | $7,502.65 | 000912772 | 0001 | 0001 | PA-B8479030 | D | 48 | $5,430.65 | 7192.92 | Brand | N | R | |
| 000356670533 | 1 | 4/2/23 | 4/2/23 | 28 | 0 | 50474071079 | CIMZIA | 5250502010F840 | 11 | N | Y | W | 23471 | 923600 | 99 | 12 | 400 MG/2ML | 1588108494 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $5,382.93 | $5,402.93 | $0 | 1 | Y | 230924874963215 | 999 | P | 0 | Y | $6,490.67 | 000912772 | 0002 | 0002 | PA-A7048450 | D | 1 | $5,402.93 | 6480.67 | Brand | Y | R | |
| 000356670533 | 1 | 8/28/23 | 8/28/23 | 28 | 0 | 50474071079 | CIMZIA | 5250502010F840 | 11 | N | Y | W | 23471 | 923600 | 99 | 12 | 400 MG/2ML | 1588108494 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $5,360.25 | $5,380.25 | $0 | 1 | Y | 232403208679241 | 999 | P | 0 | Y | $6,490.67 | 000912772 | 0002 | 0002 | PA-A7048450 | D | 1 | $5,380.25 | 6480.67 | Brand | Y | R | |
| 000356670533 | 1 | 8/3/23 | 8/3/23 | 28 | 0 | 50474071079 | CIMZIA | 5250502010F840 | 11 | N | Y | W | 23471 | 923600 | 99 | 12 | 400 MG/2ML | 1588108494 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $5,360.25 | $5,380.25 | $0 | 1 | Y | 232154256277203 | 999 | P | 0 | Y | $6,490.67 | 000912772 | 0002 | 0002 | PA-A7048450 | D | 1 | $5,380.25 | 6480.67 | Brand | Y | R | |
| 000402467657 | 1 | 12/26/23 | 12/26/23 | 28 | 0 | 50474071079 | CIMZIA | 5250502010F840 | 11 | N | Y | W | 23471 | 923600 | 99 | 12 | 400 MG/2ML | 1588108494 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $5,314.89 | $5,334.89 | $0 | 1 | Y | 233608179116243 | 999 | P | 0 | Y | $6,490.67 | 000912772 | 0002 | 0002 | PA-C2678414 | D | 1 | $5,334.89 | 6480.67 | Brand | Y | R | |
| 000402467657 | 1 | 10/30/23 | 10/30/23 | 28 | 0 | 50474071079 | CIMZIA | 5250502010F840 | 11 | N | Y | W | 23471 | 923600 | 99 | 12 | 400 MG/2ML | 1588108494 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $5,303.87 | $5,323.87 | $0 | 1 | Y | 233033119195274 | 999 | P | 0 | Y | $6,490.67 | 000912772 | 0002 | 0002 | PA-A7048450 | D | 1 | $5,323.87 | 6480.67 | Brand | Y | R | |
| 000376942887 | 1 | 8/21/23 | 8/21/23 | 22 | 0 | 50242007601 | NUTROPIN AQ NUSPIN | 3010002000D250 | 3 | N | Y | W | 39698 | 683004 | 64 | 68 | 20 MG/2 ML | 570136966 | 002 | $0.00 | $0.00 | $0.00 | $20.00 | $0.00 | $0.00 | $5,037.53 | $5,057.53 | $0 | 1 | Y | 232333487086276 | 999 | P | 0 | Y | $6,296.70 | 000912772 | 0002 | 0002 | PA-A5241837 | D | 4 | $5,057.53 | 6035.24 | Brand | Y | R |
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File details come from the government source that posted it. Updated .