Exhibit A-7 - Medical, prescription drug, Large Claim Report.xls

XLS spreadsheet 12 MB Posted Apr 23, 2026

Attached to: Medical, Dental, Vision Insurance Services
Solicitation number: 2604-002
Issued by: Travis County, Austin City, Texas

View the file

Other files

File	Type	Posted
Exhibit A-3 - 2026 Vision Member Summary.pdf	PDF	Apr 23, 2026
EXHIBIT C - Acknowledgement of Receipt Form.pdf	PDF	Apr 23, 2026
Exhibit A-13 - Medical ASO, Dental, Vision Questionnaire.xlsx	XLSX spreadsheet	Apr 23, 2026
Exhibit A-11 - Vision Provider Report.xlsx	XLSX spreadsheet	Apr 23, 2026
EXHIBIT K - Insurance Coverage.pdf	PDF	Apr 23, 2026
Exhibit A-6 - Vision Plan and Claim Information.xlsx	XLSX spreadsheet	Apr 23, 2026
Exhibit A-15 - Data Requirements.pdf	PDF	Apr 23, 2026
Exhibit A-12 - Census.xlsx	XLSX spreadsheet	Apr 23, 2026
Exhibit B-1 - Medical ASO Pricing Sheet.pdf	PDF	Apr 23, 2026
Exhibit B-3 - Fully-insured Vision Pricing Sheet.pdf	PDF	Apr 23, 2026
Exhibit B-2 - Fully-insured Dental Pricing Sheet.pdf	PDF	Apr 23, 2026
Exhibit A-1 -2026 Medical, Prescription Drug, Summary of Benefit Coverages.pdf	PDF	Apr 23, 2026
EXHIBIT E - Conflict of Interest.pdf	PDF	Apr 23, 2026
Exhibit A-5 - Dental Plan and Claim Information.xlsx	XLSX spreadsheet	Apr 23, 2026
Exhibit A-4 - Medical, Prescription Drug and Claim Information.xlsx	XLSX spreadsheet	Apr 23, 2026
Exhibit A-10 - DPPO Provider Report.xls	XLS spreadsheet	Apr 23, 2026
Exhibit A-14 - PBM Questionnaire.xlsx	XLSX spreadsheet	Apr 23, 2026
EXHIBIT I - Form 1295 Certificate of Interested Parties.pdf	PDF	Apr 23, 2026
Exhibit A-9 - Medical, prescription drug, Provider Utilization Report.xls	XLS spreadsheet	Apr 23, 2026
ESBD_510133_1776997796981_RFP 2604-002 Medical, Dental, Vision.pdf	PDF	Apr 23, 2026
EXHIBIT D - Business Development Form.pdf	PDF	Apr 23, 2026
Exhibit A-8 - Top 50 Drugs Report.xlsx	XLSX spreadsheet	Apr 23, 2026
EXHIBIT G - Sample Contract.pdf	PDF	Apr 23, 2026
Exhibit A-2 - 2026 Dental Summary of Benefit Coverages.pdf	PDF	Apr 23, 2026
Exhibit A - Scope of Work.pdf	PDF	Apr 23, 2026
EXHIBIT F - Certificate of Secretary.pdf	PDF	Apr 23, 2026

Show all 26

On GovTribe

Work with this file

Download the original file
Contacts named in this file
Similar government files
Ask GovTribe AI about this file

Try for free Login

Text version

The file's text, extracted by GovTribe without its formatting.

Large Claims 01-2026

	Large Claim Report
	Plan Sponsor Number:			0285663
	Plan Sponsor Name:			TRAVIS COUNTY HEALTHCARE DISTRICT - CENTRAL HEALTH
	Claim Threshold:			$25,000
	BIC Group:			000,400,410,415,419,420,430,431,432,433,434,435,436,437,455,460,461,465,466,467,470,471,474,475,476,477,478,481,482,490
	Current Period Start Date:			01-2026
	Current Period End Date:			02-2026
	Run Date:			3/7/2026
	CSA		Employee ID	Employee Name	Claimant
Name		Claimant
D.O.B		Clmt #/
Dep Cd	Medical

Current Experience Rated Amount RX Drug Current Experience Rated Amount Total Current Experience Rated Amount Current Pooled Claim Amount

181116-11-001	102-68-5769	HELMICK, M	MIRANDA	11/20/1971	1/0	$39,082.01	$4,099.44	$43,181.45	$0.00
181116-17-001	102-68-5769	HELMICK, M	MIRANDA	11/20/1971	1/0	$0.00	$844.14	$844.14	$0.00
TOTAL	102-68-5769	HELMICK, M	MIRANDA	11/20/1971	1/0	$39,082.01	$4,943.58	$44,025.59	$0.00
181116-13-001	161-64-4727	SLOAN, J	CRAIG	7/4/1969	3/2	$2,411.37	$28,010.69	$30,422.06	$0.00
181116-10-001	199-76-0532	PARKER, G	GRACE	11/19/1996	1/0	$37,104.01	$12.16	$37,116.17	$0.00
181116-11-101	226-27-4309	CURTIS, L	LINDA	12/25/1967	1/0	$22,719.49	$21,658.52	$44,378.01	$0.00
181116-16-001	266-33-7894	HELD, T	THEODORE	8/25/1966	1/0	$26,552.70	$1,765.14	$28,317.84	$0.00
181116-13-002	325-68-2844	RANDOLPH, D	DARRELL	11/6/1976	1/0	$0.00	$0.00	$0.00	$47,205.24
181116-10-002	334-66-3807	GUTIERREZ, J	JEANETTE	10/7/1971	1/0	$1,127.69	$867.08	$1,994.77	$54,138.40
181116-12-001	449-33-0614	CERDA-PRAZAK, A	THOMAS	3/10/1962	2/2	$34,558.60	$31.38	$34,589.98	$0.00
181116-10-001	457-61-9577	JIMENEZ, G	GRACIE	10/22/1981	1/0	$0.00	$0.00	$0.00	$122.72
181116-12-001	457-61-9577	JIMENEZ, G	GRACIE	10/22/1981	1/0	$0.00	$0.00	$0.00	$(22,310.58)
TOTAL	457-61-9577	JIMENEZ, G	GRACIE	10/22/1981	1/0	$0.00	$0.00	$0.00	$(22,187.86)
181116-10-001	461-69-0563	GONZALEZ, I	JORGE	11/24/1972	2/2	$282.00	$0.00	$282.00	$80,059.44
181116-12-001	461-69-0563	GONZALEZ, I	JORGE	11/24/1972	2/2	$1,077.44	$0.00	$1,077.44	$(11,046.82)
TOTAL	461-69-0563	GONZALEZ, I	JORGE	11/24/1972	2/2	$1,359.44	$0.00	$1,359.44	$69,012.62
181116-11-002	462-65-1323	PEREZ, J	JUANITA	1/26/1976	1/0	$48,363.37	$185.13	$48,548.50	$0.00
181116-11-001	464-33-7413	DEFALCO, P	PHILIP	1/14/1959	1/0	$147.60	$0.00	$147.60	$33,789.00
WARNING -- For any employees who changed accounts during the current policy period, claim amounts shown on this report may be understated by amounts recorded under the prior account number.
INDIVIDUAL'S PRIVACY CONCERN -- This report contains information which is personal and confidential and, without the express written consent of the individual to which the material pertains, should not be used or disclosed for any purpose other than auditing and/or evaluating the benefit program.
181116-10-001	464-45-1863	LEAL, J	ANDREW	2/5/2003	2/3	$0.00	$0.00	$0.00	$149,336.22
181116-11-001	464-77-3880	WOODARD, H	HOPE	6/23/1983	1/0	$63,174.51	$99.83	$63,274.34	$0.00
181116-13-001	464-77-3880	WOODARD, H	HOPE	6/23/1983	1/0	$1,054.33	$198.82	$1,253.15	$0.00
TOTAL	464-77-3880	WOODARD, H	HOPE	6/23/1983	1/0	$64,228.84	$298.65	$64,527.49	$0.00
181116-12-001	464-93-9487	BERNO JONES, D	DIANA	4/20/1975	1/0	$294.10	$52.11	$346.21	$0.00
181116-16-001	464-93-9487	BERNO JONES, D	DIANA	4/20/1975	1/0	$50,327.39	$2.65	$50,330.04	$0.00
TOTAL	464-93-9487	BERNO JONES, D	DIANA	4/20/1975	1/0	$50,621.49	$54.76	$50,676.25	$0.00
181116-12-001	465-85-5729	DEJESUS, H	VICTOR	8/13/1979	2/2	$320.00	$59,683.17	$60,003.17	$0.00
181116-11-002	466-97-3278	SANCHEZ, R	KAI	10/23/2021	2/3	$41,716.49	$180.20	$41,896.69	$0.00
181116-10-001	471-86-4187	AMBROSE, O	CARL	12/31/2008	2/3	$254,640.78	$0.90	$254,641.68	$72,300.84
181116-12-001	471-86-4187	AMBROSE, O	CARL	12/31/2008	2/3	$167.49	$0.00	$167.49	$4,579.64
TOTAL	471-86-4187	AMBROSE, O	CARL	12/31/2008	2/3	$254,808.27	$0.90	$254,809.17	$76,880.48
181116-10-001	521-85-9899	MOORE, R	JEREMY	7/24/1985	2/2	$90.00	$0.00	$90.00	$69,144.83
181116-12-001	597-48-3512	BUSTELO, L	LUCAS	8/31/1995	1/0	$30,226.53	$0.00	$30,226.53	$0.00
181116-10-001	613-26-2472	POMROY, G	GINA	6/22/1984	1/0	$60,704.17	$475.06	$61,179.23	$0.00
181116-11-002	629-16-7011	CORONADO, M	MADALINA	2/28/1990	1/0	$25,611.01	$15.44	$25,626.45	$0.00
181116-13-001	629-20-7088	SANCHEZ, J	JUSTINE	1/27/1989	1/0	$2,708.00	$34,431.26	$37,139.26	$0.00
181116-10-002	630-26-4207	JAIMES, J	JAVIER	7/2/1982	2/2	$15,314.91	$11,754.88	$27,069.79	$0.00
181116-11-002	631-10-3072	CANAVA, R	ARIA	11/22/2024	3/3	$43,316.06	$0.00	$43,316.06	$0.00
181116-12-001	633-22-8219	LOPEZ AGUILAR, M	VALENTINA	12/12/2025	7/3	$28,851.77	$0.00	$28,851.77	$0.00
181116-12-001	633-22-8219	LOPEZ AGUILAR, M	JIMENA	12/12/2025	8/3	$47,462.05	$0.00	$47,462.05	$0.00
181116-10-001	633-74-2801	SOW, M	MOUHAMADO	1/1/1973	1/0	$484.64	$59,009.86	$59,494.50	$0.00
181116-13-002	635-19-8825	VEGA, S	RYAN	6/17/2020	2/3	$37,624.63	$0.00	$37,624.63	$0.00
181116-11-002	637-01-0452	ZAVALA, O	ODILIA	8/12/1967	1/0	$1,763.31	$34,476.24	$36,239.55	$0.00
181116-11-001	637-10-9523	LINAN, M	MADDEX	11/9/2021	2/3	$23,496.14	$0.00	$23,496.14	$0.00
181116-13-001	637-10-9523	LINAN, M	MADDEX	11/9/2021	2/3	$8,272.43	$0.00	$8,272.43	$0.00
TOTAL	637-10-9523	LINAN, M	MADDEX	11/9/2021	2/3	$31,768.57	$0.00	$31,768.57	$0.00
181116-10-001	639-28-0327	CHAPA, A	ANGELICA	5/28/1987	1/0	$350.92	$36,470.76	$36,821.68	$0.00
181116-17-002	640-68-0417	RIVERA, M	MARIA	11/9/1999	1/0	$32,808.19	$0.00	$32,808.19	$0.00
181116-13-001	641-22-2343	BAZARTE, T	JAMIN	11/8/2025	3/3	$114,016.75	$32.57	$114,049.32	$0.00
181116-13-002	642-30-8755	MARTINEZ, A	PEDRO	12/6/1989	2/2	$30,501.44	$0.00	$30,501.44	$0.00
WARNING -- For any employees who changed accounts during the current policy period, claim amounts shown on this report may be understated by amounts recorded under the prior account number.
INDIVIDUAL'S PRIVACY CONCERN -- This report contains information which is personal and confidential and, without the express written consent of the individual to which the material pertains, should not be used or disclosed for any purpose other than auditing and/or evaluating the benefit program.
181116-17-002	644-66-1668	SALVADOR, K	KIMBERLY	6/18/1999	1/0	$60,873.14	$252.42	$61,125.56	$0.00
181116-10-002	644-68-2672	REYNOSO, G	GISELLE	12/9/1999	1/0	$318.56	$13,665.28	$13,983.84	$0.00
181116-12-002	644-68-2672	REYNOSO, G	GISELLE	12/9/1999	1/0	$128.27	$13,645.01	$13,773.28	$0.00
TOTAL	644-68-2672	REYNOSO, G	GISELLE	12/9/1999	1/0	$446.83	$27,310.29	$27,757.12	$0.00
WARNING -- For any employees who changed accounts during the current policy period, claim amounts shown on this report may be understated by amounts recorded under the prior account number.
INDIVIDUAL'S PRIVACY CONCERN -- This report contains information which is personal and confidential and, without the express written consent of the individual to which the material pertains, should not be used or disclosed for any purpose other than auditing and/or evaluating the benefit program.

Large Claims 3.1.24 Cover

TRAVIS COUNTY HEALTHCARE DISTRICT - CENT

Plan Sponsor ID 0000000097013764

Catastrophic Claimant Detail by Medical and Pharmacy by Diagnosis Code

Current Data For Claims Incurred March 01, 2024 - February 28, 2025 with 2 months lag

&C&G&L&8© Aetna Integrated Informatics® 2026&R&8Page &P of &N Run Date: 2/24/2026

Large Claims 3.1.24 Criteria

TRAVIS COUNTY HEALTHCARE DISTRICT - CENT - 0000000097013764
Current Data For Claims Incurred March 01, 2024 - February 28, 2025 with 2 months lag
Catastrophic Claimant Detail by Medical and Pharmacy by Diagnosis Code
Funding Category:	Account Structure:
Self Insured	ALL
Product:	Large Claimant Threshold:
ALL	$150,000
	MDC Exclusion:
	None
	Member Network Service Area:
	ALL
	Par Indicator:
	ALL
	Primary Payer:
	ALL
	Relationship:
	ALL
	Run By:
	Medical-Pharmacy by Diagnosis Code

&C&G&L&8© Aetna Integrated Informatics® 2026&R&8Page &P of &N Run Date: 2/24/2026

Large Claims 3.1.24 Report

	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT - 0000000097013764
	Current Data For Claims Incurred March 01, 2024 - February 28, 2025 with 2 months lag
	Catastrophic Claimant Detail by Medical and Pharmacy by Diagnosis Code
	Claimant	Total Medical/RX
Paid Amount	Pharmacy
Paid Amount	Medical
Paid Amount	Inpatient
Paid Amount	Ambulatory
Paid Amount	Diagnosis
Code	Description	Service Rendered in Last Quarter
	1	$662,102	$661,749	$354	$0	$354	D66	HEREDITARY FACTOR VIII DEFICIENCY	Yes
	2	$357,456	$228	$357,228	$347,256	$9,972	A41.9	SEPSIS, UNSPECIFIED ORGANISM	No
	3	$304,652	$0	$304,652	$304,652	$0	Z38.01	SINGLE LIVEBORN INFANT, DELIVERED BY CESAREAN	No
	4	$300,520	$290,027	$10,492	$0	$10,492	C90.00	MULTIPLE MYELOMA NOT HAVING ACHIEVED REMISSION	Yes
	5	$298,958	$14,475	$284,482	$281,097	$3,385	I21.4	NON-ST ELEVATION (NSTEMI) MYOCARDIAL INFARCTION	Yes
	6	$251,635	$222,271	$29,364	$0	$29,364	C34.11	MALIGNANT NEOPLASM OF UPPER LOBE, RIGHT BRONCHUS OR LUNG	Yes
	7	$196,363	$0	$196,363	$0	$196,363	F84.0	AUTISTIC DISORDER	Yes
	8	$193,723	$177,467	$16,255	$0	$16,255	C50.411	MALIG NEOPLM OF UPPER-OUTER QUADRANT OF RIGHT FEMALE BREAST	Yes
	9	$191,648	$9	$191,639	$0	$191,639	F84.0	AUTISTIC DISORDER	Yes
	10	$187,415	$175,444	$11,971	$0	$11,971	C50.411	MALIG NEOPLM OF UPPER-OUTER QUADRANT OF RIGHT FEMALE BREAST	Yes
	11	$185,315	$17,181	$168,133	$126,962	$41,171	G50.0	TRIGEMINAL NEURALGIA	Yes
	12	$169,010	$100,543	$68,468	$52,888	$15,580	E10.621	TYPE 1 DIABETES MELLITUS WITH FOOT ULCER	Yes
	13	$165,170	$15,179	$149,991	$0	$149,991	D80.6	ANTIBODY DEFIC W NEAR-NORM IMMUNOGLOB OR W HYPERIMMUNOGLOB	Yes
	14	$164,733	$3,475	$161,258	$143,122	$18,136	D50.0	IRON DEFICIENCY ANEMIA SECONDARY TO BLOOD LOSS (CHRONIC)	Yes
	15	$159,979	$1,738	$158,241	$149,020	$9,221	K29.40	CHRONIC ATROPHIC GASTRITIS WITHOUT BLEEDING	Yes
	16	$155,899	$254	$155,646	$122,802	$32,844	A41.9	SEPSIS, UNSPECIFIED ORGANISM	Yes
	17	$151,817	$0	$151,817	$151,210	$608	Z38.00	SINGLE LIVEBORN INFANT, DELIVERED VAGINALLY	Yes
	Total	$4,096,395	$1,680,041	$2,416,354	$1,679,009	$737,346

&C&G&L&8© Aetna Integrated Informatics® 2026&R&8Page &P of &N Run Date: 2/24/2026

Large Claims 3.1.25 Cover

TRAVIS COUNTY HEALTHCARE DISTRICT - CENT

Plan Sponsor ID 0000000097013764

Catastrophic Claimant Detail by Medical and Pharmacy by Diagnosis Code

Current Data For Claims Incurred March 01, 2025 - December 31, 2025 with 2 months lag

Large Claims 3.1.25 Criteria

TRAVIS COUNTY HEALTHCARE DISTRICT - CENT - 0000000097013764
Current Data For Claims Incurred March 01, 2025 - December 31, 2025 with 2 months lag
Catastrophic Claimant Detail by Medical and Pharmacy by Diagnosis Code
Funding Category:	Account Structure:
Self Insured	ALL
Product:	Large Claimant Threshold:
ALL	$150,000
	MDC Exclusion:
	None
	Member Network Service Area:
	ALL
	Par Indicator:
	ALL
	Primary Payer:
	ALL
	Relationship:
	ALL
	Run By:
	Medical-Pharmacy by Diagnosis Code

Large Claims 3.1.25 Report

	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT - 0000000097013764
	Current Data For Claims Incurred March 01, 2025 - December 31, 2025 with 2 months lag
	Catastrophic Claimant Detail by Medical and Pharmacy by Diagnosis Code
	Claimant	Total Medical/RX
Paid Amount	Pharmacy
Paid Amount	Medical
Paid Amount	Inpatient
Paid Amount	Ambulatory
Paid Amount	Diagnosis
Code	Description	Service Rendered in Last Quarter
	1	$568,034	$567,573	$460	$0	$460	D66	HEREDITARY FACTOR VIII DEFICIENCY	Yes
	2	$544,010	$81,619	$462,391	$303,859	$158,532	M48.02	SPINAL STENOSIS, CERVICAL REGION	Yes
	3	$417,022	$356,896	$60,126	$0	$60,126	B20	HUMAN IMMUNODEFICIENCY VIRUS (HIV) DISEASE	Yes
	4	$410,324	$24,300	$386,025	$0	$386,025	E75.22	GAUCHER DISEASE	Yes
	5	$287,804	$77,385	$210,419	$0	$210,419	D47.2	MONOCLONAL GAMMOPATHY	Yes
	6	$282,601	$18,110	$264,491	$195,731	$68,760	I63.9	CEREBRAL INFARCTION, UNSPECIFIED	Yes
	7	$270,558	$252,407	$18,151	$0	$18,151	R55	SYNCOPE AND COLLAPSE	Yes
	8	$201,004	$545	$200,459	$0	$200,459	F84.0	AUTISTIC DISORDER	Yes
	9	$195,091	$192,852	$2,239	$320	$1,919	K52.9	NONINFECTIVE GASTROENTERITIS AND COLITIS, UNSPECIFIED	Yes
	10	$194,815	$182,800	$12,014	$0	$12,014	C50.411	MALIG NEOPLM OF UPPER-OUTER QUADRANT OF RIGHT FEMALE BREAST	Yes
	11	$188,839	$178,840	$9,998	$0	$9,998	C50.411	MALIG NEOPLM OF UPPER-OUTER QUADRANT OF RIGHT FEMALE BREAST	Yes
	12	$166,616	$145,288	$21,329	$96	$21,232	R07.9	CHEST PAIN, UNSPECIFIED	Yes
	13	$164,702	$161,888	$2,814	$0	$2,814	K52.89	OTHER SPECIFIED NONINFECTIVE GASTROENTERITIS AND COLITIS	Yes
	14	$162,736	$0	$162,736	$0	$162,736	F84.0	AUTISTIC DISORDER	Yes
	15	$162,371	$0	$162,371	$0	$162,371	F84.0	AUTISTIC DISORDER	Yes
	16	$161,653	$158,239	$3,414	$0	$3,414	G35	MULTIPLE SCLEROSIS	Yes
	17	$154,720	$4	$154,716	$149,829	$4,887	G82.20	PARAPLEGIA, UNSPECIFIED	Yes
	18	$151,055	$150,376	$679	$0	$679	R09.89	OTH SYMPTOMS AND SIGNS INVOLVING THE CIRC AND RESP SYSTEMS	Yes
	Total	$4,683,955	$2,549,123	$2,134,832	$649,835	$1,484,997

Prescription Drug Claim Detail

CARRIER_CD	CARRIER_NM	PS_UNIQUE_ID	GROUP_CTL_NM	GROUP_NBR	BRND_GEN_CD	COMPOUND_FLG	DAW_CD	DAYS_SUPPLY	LABEL_NM	FILL_DT	FORMULARY_IND	DRUG_NMRC_TIER_NBR	CHANNEL_CD	MSB_SSB_GEN	NABP_NBR	NDC_CD	OTC_FLG	PHARMACY_NM	PHARMACY_ST	QTY	SPEC_UNIV_FLG	MEMBER_ID	VACCINE_IND
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	90.00	METFORMIN TAB 500MG ER	2/2/25	Y	1	R	GENERIC	4553079	29300038905	N	HEB PHARMACY	TX	180.00	N	17068160477925	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	7.00	AMOX/K CLAV TAB 875-125	2/2/25	Y	1	R	GENERIC	4569010	81964022114	N	HEB PHARMACY	TX	14.00	N	18186612129325	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	B	N	0	28.00	TEZSPIRE INJ 210MG	2/2/25	Y	2	S	SSB	3137141	55513012301	N	CAREMARK SPECIALTY PHARMACY	NJ	1.91	Y	35705156571825	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	B	N	0	28.00	MOUNJARO INJ 2.5/0.5	2/2/25	Y	2	R	SSB	4516540	00002150680	N	HEB PHARMACY	TX	2.00	N	23130783164725	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	B	N	0	84.00	LO LOESTRIN TAB 1-10-10	2/2/25	Y	2	R	SSB	5934799	00430042014	N	CVS PHARMACY	TX	84.00	N	17393346687525	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	B	N	0	84.00	SKYRIZI PEN INJ 150MG/ML	2/2/25	Y	2	S	SSB	1715830	00074210001	N	CAREMARK SPECIALTY PHARMACY	KS	1.00	Y	40699375710125	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	6.00	PREDNISONE TAB 10MG	2/2/25	Y	1	R	GENERIC	4529496	70954005920	N	WALGREENS	TX	28.00	N	18839640977125	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	B	N	0	28.00	MOUNJARO INJ 10MG/0.5	2/2/25	Y	2	R	SSB	4520258	00002147180	N	HEB PHARMACY	TX	2.00	N	36523197761725	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	B	N	0	30.00	LINZESS CAP 145MCG	2/2/25	Y	2	R	SSB	4553144	00456120130	N	WALGREENS	TX	30.00	N	15162414923725	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	67.00	TIMOLOL MAL SOL 0.5% OP	2/2/25	Y	1	R	GENERIC	4513532	70069070801	N	HEB PHARMACY	TX	15.00	N	25269856647725	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	90.00	FAMOTIDINE TAB 20MG	2/2/25	Y	1	R	GENERIC	5934799	62332000131	N	CVS PHARMACY	TX	90.00	N	17393346687525	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	90.00	SERTRALINE TAB 50MG	2/2/25	Y	1	R	GENERIC	4569010	16714061205	N	HEB PHARMACY	TX	270.00	N	14370063808025	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	24.00	LISINOPRIL TAB 20MG	2/2/25	Y	1	R	GENERIC	4507488	68180098103	N	CVS PHARMACY	TX	24.00	N	25379684085425	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	90.00	VALSARTAN TAB 320MG	2/2/25	Y	1	R	GENERIC	4553079	43547037009	N	HEB PHARMACY	TX	90.00	N	17068160477925	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	30.00	PROPRANOLOL TAB 10MG	2/2/25	Y	1	R	GENERIC	4543369	69238207707	N	CVS PHARMACY	TX	60.00	N	38402903760225	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	7.00	DOXYCYCL HYC CAP 100MG	2/2/25	Y	1	R	GENERIC	4570683	27808023302	N	HEB PHARMACY	TX	14.00	N	27312327634225	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	30.00	MONTELUKAST CHW 5MG	2/2/25	Y	1	R	GENERIC	4584567	31722072890	N	CVS PHARMACY	TX	30.00	N	28518625241425	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	B	N	0	30.00	ELIQUIS TAB 5MG	2/2/25	Y	2	R	SSB	4553144	00003089421	N	WALGREENS	TX	60.00	N	15162414923725	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	B	N	0	28.00	MOUNJARO INJ 7.5/0.5	2/2/25	Y	2	R	SSB	4566658	00002148480	N	HEB PHARMACY	TX	2.00	N	22594156310425	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	B	N	0	28.00	MOUNJARO INJ 7.5/0.5	2/2/25	Y	2	R	SSB	4553079	00002148480	N	HEB PHARMACY	TX	2.00	N	17068160477925	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	B	N	0	84.00	OZEMPIC INJ 8MG/3ML	2/2/25	Y	2	R	SSB	4501311	00169477212	N	CVS PHARMACY	TX	9.00	N	41015116602925	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	2.00	GG/CODEINE SOL 100-10/5	2/2/25	N	1	R	GENERIC	4570683	00121077516	Y	HEB PHARMACY	TX	100.00	N	27312327634225	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	17.00	ALBUTEROL AER HFA	2/2/25	Y	1	R	GENERIC	4513532	68180096301	N	HEB PHARMACY	TX	8.50	N	25269856647725	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	30.00	MELOXICAM TAB 15MG	2/2/25	Y	1	R	GENERIC	4559033	29300012510	N	HEB PHARMACY	TX	30.00	N	28515395553625	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	30.00	LABETALOL TAB 100MG	2/2/25	Y	1	R	GENERIC	4519320	72888012005	N	HEB PHARMACY	TX	60.00	N	18422185426725	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	90.00	OMEPRAZOLE CAP 40MG	2/2/25	Y	1	R	GENERIC	4566658	68382050010	N	HEB PHARMACY	TX	90.00	N	22594156310425	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	30.00	GLIPIZIDE TAB 5MG	2/2/25	Y	1	R	GENERIC	5919583	60505014101	N	HEB PHARMACY	TX	30.00	N	26352465827425	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	30.00	VENLAFAXINE TAB 225MG ER	2/2/25	Y	1	R	GENERIC	4570683	70710135203	N	HEB PHARMACY	TX	30.00	N	27308327634225	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	30.00	LEVETIRACETA TAB 500MG ER	2/2/25	Y	1	R	GENERIC	4519320	43547034506	N	HEB PHARMACY	TX	150.00	N	18422185426725	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	2.00	FLUCONAZOLE TAB 150MG	2/2/25	Y	1	R	GENERIC	4543369	57237000511	N	CVS PHARMACY	TX	2.00	N	38402903760225	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	42.00	ESTRADIOL CRE 0.01%	2/2/25	Y	1	R	GENERIC	4513532	45802009735	N	HEB PHARMACY	TX	42.50	N	25269856647725	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	90.00	METOPROL TAR TAB 25MG	2/2/25	Y	1	R	GENERIC	5919583	65862006299	N	HEB PHARMACY	TX	180.00	N	26352465827425	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	5.00	CLINDAMYCIN CRE 2% VAG	2/2/25	Y	1	R	GENERIC	4543369	59762500901	N	CVS PHARMACY	TX	40.00	N	38402903760225	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	30.00	METFORMIN TAB 850MG	2/2/25	Y	1	R	GENERIC	5919583	23155084210	N	HEB PHARMACY	TX	60.00	N	26352465827425	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	90.00	RISPERIDONE TAB 1MG	2/2/25	Y	1	R	GENERIC	4549335	43547034106	N	CVS PHARMACY	TX	90.00	N	17329103999925	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	5.00	TRAMADOL HCL TAB 50MG	2/2/25	Y	1	R	GENERIC	4559033	29300035510	N	HEB PHARMACY	TX	20.00	N	28515395553625	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	10.00	CYCLOBENZAPR TAB 10MG	2/2/25	Y	1	R	GENERIC	4554007	69097084615	N	CVS PHARMACY	TX	30.00	N	37551421619225	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	30.00	SPIRONOLACT TAB 50MG	2/2/25	Y	1	R	GENERIC	4588781	69584085310	N	WALGREENS	TX	30.00	N	27073774924325	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	7.00	METRONIDAZOL TAB 500MG	2/2/25	Y	1	R	GENERIC	4588781	50111033402	N	WALGREENS	TX	14.00	N	15062596669125	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	90.00	LOSARTAN POT TAB 100MG	2/2/25	Y	1	R	GENERIC	4594493	31722070210	N	HEB PHARMACY	TX	90.00	N	24249382962225	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	5.00	OSELTAMIVIR CAP 75MG	2/2/25	Y	1	R	GENERIC	4568222	31722063231	N	WALGREENS	TX	10.00	N	16046704207925	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	30.00	FLUTICASONE SPR 50MCG	2/2/25	Y	1	R	GENERIC	4584567	00054327099	N	CVS PHARMACY	TX	16.00	N	28518625241425	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	30.00	TORSEMIDE TAB 20MG	2/2/25	Y	1	R	GENERIC	5900596	31722053101	N	CVS PHARMACY	TX	30.00	N	25104461928625	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	84.00	NORELGE/ETHI DIS 150/35	2/3/25	Y	1	R	GENERIC	4550782	70710119003	N	CVS PHARMACY	TX	9.00	N	23120904698725	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	8.00	CLOTRIMAZOLE CRE 1%	2/3/25	Y	1	R	GENERIC	4582385	51672127501	N	HEB PHARMACY	TX	15.00	N	24089567794225	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	30.00	AMPHET/DEXTR TAB 10MG	2/3/25	Y	1	R	GENERIC	5900774	00555097202	N	WALGREENS	TX	60.00	N	16984978929325	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	3.00	APAP/CODEINE TAB 300-30MG	2/3/25	Y	1	R	GENERIC	4548220	64380044601	N	CVS PHARMACY	TX	18.00	N	13791261674925	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	5.00	OSELTAMIVIR CAP 75MG	2/3/25	Y	1	R	GENERIC	5916626	64380079901	N	HEB PHARMACY	TX	10.00	N	17744082613425	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	10.00	ONDANSETRON TAB 4MG	2/3/25	Y	1	R	GENERIC	4568222	68462010530	N	WALGREENS	TX	30.00	N	27273784283325	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	90.00	LOSARTAN POT TAB 100MG	2/3/25	Y	1	R	GENERIC	4501311	68382013716	N	CVS PHARMACY	TX	90.00	N	21179050455525	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	60.00	FLUOXETINE CAP 20MG	2/3/25	Y	1	R	GENERIC	5923859	50228011410	N	SYMPHONY PHARMACY	TX	60.00	N	29292369272525	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	90.00	METFORMIN TAB 500MG ER	2/3/25	Y	1	R	GENERIC	4566658	29300038905	N	HEB PHARMACY	TX	360.00	N	13757875475225	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	B	N	0	30.00	EMGALITY INJ 120MG/ML	2/3/25	Y	2	R	SSB	5900964	00002143611	N	WALGREENS	TX	2.00	N	17468988873925	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	B	N	0	28.00	MOUNJARO INJ 5MG/0.5	2/3/25	Y	2	R	SSB	5914545	00002149580	N	WALMART PHARMACY	TX	2.00	N	30192199835225	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	B	N	0	30.00	QULIPTA TAB 60MG	2/3/25	Y	2	R	SSB	4573196	00074709430	N	WALGREENS	TX	30.00	N	22944842750925	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	B	N	0	28.00	GAMMAGARD INJ 30GM/300	2/3/25	N	3	S	SSB	3137141	00944270007	N	CAREMARK SPECIALTY PHARMACY	NJ	600.00	Y	22091237797425	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	10.00	CYCLOBENZAPR TAB 10MG	2/3/25	Y	1	R	GENERIC	5907920	69097084615	N	CVS PHARMACY	TX	30.00	N	18760891730725	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	6.00	BENZONATATE CAP 100MG	2/3/25	Y	1	R	GENERIC	4550198	42806071401	N	FED MART PHCY.	TX	20.00	N	26990738839725	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	3.00	ONDANSETRON TAB 4MG ODT	2/3/25	Y	1	R	GENERIC	4529535	16714020030	N	HEB PHARMACY	TX	10.00	N	16345356690225	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	30.00	AMITRIPTYLIN TAB 10MG	2/3/25	Y	1	R	GENERIC	4543369	16571010501	N	CVS PHARMACY	TX	90.00	N	19139948261425	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	7.00	GABAPENTIN CAP 100MG	2/3/25	Y	1	R	GENERIC	4573196	45963055550	N	WALGREENS	TX	7.00	N	22944842750925	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	2.00	BROM/PSE/DM SYP 2/30/10	2/3/25	Y	1	R	GENERIC	4544361	42192060716	N	HEB PHARMACY	TX	120.00	N	23964132120625	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	5.00	CYCLOBENZAPR TAB 5MG	2/3/25	Y	1	R	GENERIC	4590003	72888001205	N	HEB PHARMACY	TX	30.00	N	37857367849925	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	15.00	NAPROXEN TAB 500MG	2/3/25	Y	1	R	GENERIC	4590003	68462019005	N	HEB PHARMACY	TX	30.00	N	37857367849925	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	7.00	SMZ/TMP DS TAB 800-160	2/3/25	Y	1	R	GENERIC	5906598	65862042005	N	WALGREENS	TX	14.00	N	24516889528525	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	30.00	LEVETIRACETA TAB 500MG	2/3/25	Y	1	R	GENERIC	5912541	31722053705	N	WALGREENS	TX	180.00	N	28893933854425	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	15.00	FLUOCINONIDE SOL 0.05%	2/3/25	Y	1	R	GENERIC	0323624	51672127302	N	WALGREENS	AZ	20.00	N	27273784283325	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	90.00	METFORMIN TAB 1000MG	2/3/25	Y	1	R	GENERIC	4501311	65862001005	N	CVS PHARMACY	TX	180.00	N	21179050455525	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	5.00	BUT/APAP/CAF TAB	2/3/25	Y	1	R	GENERIC	4520272	00527169505	N	HEB PHARMACY	TX	30.00	N	33862885063525	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	30.00	HYDROXYZINE SYP 10MG/5ML	2/3/25	Y	1	R	GENERIC	4529496	00121103416	N	WALGREENS	TX	450.00	N	16582298868925	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	9.00	PREDNISONE TAB 20MG	2/3/25	Y	1	R	GENERIC	4553409	60219170801	N	CVS PHARMACY	TX	18.00	N	20040898152525	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	23.00	HYDROXYZ PAM CAP 25MG	2/3/25	Y	1	R	GENERIC	4507488	00115180301	N	CVS PHARMACY	TX	90.00	N	16067908179425	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	28.00	DROS/ETH EST TAB LEVOMEFO	2/3/25	Y	1	R	GENERIC	4520272	68180089473	N	HEB PHARMACY	TX	28.00	N	35046374467225	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	3.00	BROM/PSE/DM SYP	2/3/25	Y	1	R	GENERIC	4516540	71930002643	N	HEB PHARMACY	TX	120.00	N	21812728630725	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	5.00	OSELTAMIVIR CAP 75MG	2/3/25	Y	1	R	GENERIC	4544361	64380079901	N	HEB PHARMACY	TX	10.00	N	23964132120625	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	30.00	METHYLPRED TAB 8MG	2/3/25	Y	1	R	GENERIC	4544791	68382091711	N	HEB PHARMACY	TX	90.00	N	31072445593825	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	30.00	QUETIAPINE TAB 300MG	2/3/25	Y	1	R	GENERIC	4529535	67877024760	N	HEB PHARMACY	TX	60.00	N	25730729819725	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	30.00	NORTRIPTYLIN CAP 10MG	2/3/25	Y	1	R	GENERIC	4545604	00093081001	N	CVS PHARMACY	TX	30.00	N	27319627211225	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	B	N	0	30.00	DESCOVY TAB 200/25MG	2/3/25	Y	2	S	SSB	3137141	61958200201	N	CAREMARK SPECIALTY PHARMACY	NJ	30.00	Y	22046926348625	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	84.00	LARIN FE TAB 1/20	2/3/25	Y	1	R	GENERIC	4570683	16714040604	N	HEB PHARMACY	TX	84.00	N	18648792459825	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	30.00	ATOMOXETINE CAP 25MG	2/3/25	Y	1	R	GENERIC	5934953	16714075701	N	HEB PHARMACY	TX	30.00	N	26753166843825	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	16.00	ALBUTEROL AER HFA	2/3/25	Y	1	R	GENERIC	4553409	69097014260	N	CVS PHARMACY	TX	6.70	N	20040898152525	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	30.00	KETOCONAZOLE SHA 2%	2/3/25	Y	1	R	GENERIC	4582385	45802046564	N	HEB PHARMACY	TX	120.00	N	24089567794225	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	7.00	CEPHALEXIN CAP 500MG	2/3/25	Y	1	R	GENERIC	4573196	00093314705	N	WALGREENS	TX	28.00	N	22944842750925	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	2.00	BROM/PSE/DM SYP	2/3/25	Y	1	R	GENERIC	4594506	71930002643	N	HEB PHARMACY	TX	120.00	N	24066519302425	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	18.00	RIZATRIPTAN TAB 10MG ODT	2/3/25	Y	1	R	GENERIC	4577803	33342009441	N	WALMART PHARMACY	TX	9.00	N	21448999948825	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	30.00	ESZOPICLONE TAB 3MG	2/3/25	Y	1	R	GENERIC	5908554	68462038401	N	HEB PHARMACY	TX	30.00	N	14374352289725	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	30.00	BUDES/FORMOT AER 80-4.5	2/3/25	Y	1	R	GENERIC	5943192	00310737220	N	HEB PHARMACY	TX	10.20	N	15255537210925	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	10.00	BENZONATATE CAP 100MG	2/3/25	Y	1	R	GENERIC	5916626	42806071405	N	HEB PHARMACY	TX	30.00	N	17744082613425	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	10.00	BENZONATATE CAP 100MG	2/3/25	Y	1	R	GENERIC	4532203	64380071207	N	CVS PHARMACY	TX	30.00	N	14173874316725	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	90.00	SERTRALINE TAB 100MG	2/3/25	Y	1	M	GENERIC	1486516	68180035309	N	CAREMARK PRESCRIPTION SVC-CHI	IL	135.00	N	26131912208025	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	21.00	ELINEST TAB	2/3/25	Y	1	R	GENERIC	4513532	16714036504	N	HEB PHARMACY	TX	28.00	N	24738637673425	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	90.00	VALSARTAN TAB 40MG	2/3/25	Y	1	R	GENERIC	5915698	43547036703	N	HEB PHARMACY	TX	90.00	N	16189332318925	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	5.00	OSELTAMIVIR CAP 75MG	2/3/25	Y	1	R	GENERIC	4548713	64380079901	N	HEB PHARMACY	TX	10.00	N	24720180339225	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	1.00	SODIUM/POTAS SOL MAGNESIU	2/3/25	Y	1	R	GENERIC	4545604	43386070083	N	CVS PHARMACY	TX	354.00	N	18727874489425	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	30.00	ATOMOXETINE CAP 40MG	2/3/25	Y	1	R	GENERIC	5934953	16714075801	N	HEB PHARMACY	TX	30.00	N	26753166843825	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	30.00	IBUPROFEN TAB 600MG	2/3/25	Y	1	R	GENERIC	4550198	65162046550	N	FED MART PHCY.	TX	20.00	N	26990738839725	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	B	N	1	28.00	MOUNJARO INJ 10MG/0.5	2/3/25	Y	2	R	SSB	4528418	00002147180	N	HEB PHARMACY	TX	2.00	N	19421544754225	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	90.00	METFORMIN TAB 500MG	2/3/25	Y	1	R	GENERIC	4544791	23155084110	N	HEB PHARMACY	TX	180.00	N	16263241467225	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	30.00	CLOBETASOL SOL 0.05%	2/3/25	Y	1	R	GENERIC	4579162	51672129303	N	HEB PHARMACY	TX	50.00	N	40986926191525	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	90.00	FLUOXETINE CAP 20MG	2/3/25	Y	1	R	GENERIC	4508024	50111064801	N	CVS PHARMACY	TX	90.00	N	17136621183925	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	10.00	AMOX/K CLAV TAB 875-125	2/3/25	Y	1	R	GENERIC	4516540	81964022114	N	HEB PHARMACY	TX	20.00	N	22314538630225	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	30.00	TRETINOIN CRE 0.025%	2/3/25	Y	1	R	GENERIC	4579162	51672140700	N	HEB PHARMACY	TX	20.00	N	40986926191525	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	90.00	FLUCONAZOLE TAB 100MG	2/3/25	Y	1	R	GENERIC	4533178	70710113803	N	WALMART PHARMACY	TX	90.00	N	25474259669425	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	90.00	AMLODIPINE TAB 2.5MG	2/3/25	Y	1	R	GENERIC	4537746	29300039605	N	WALGREENS	TX	90.00	N	29057473656625	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	30.00	CLINDAMYCIN LOT 1%	2/3/25	Y	1	R	GENERIC	5916892	21922003601	N	CLARX BIG COUNTRY DERMATOLOGY	TX	60.00	N	18056669933025	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	B	N	0	1.00	ELLA TAB 30MG	2/3/25	N	3	R	SSB	4520272	73302045601	N	HEB PHARMACY	TX	1.00	N	33862885063525	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	30.00	AZELASTINE SPR 0.1%	2/3/25	Y	1	R	GENERIC	4520258	60505083305	N	HEB PHARMACY	TX	30.00	N	16803906118625	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	30.00	TRAZODONE TAB 50MG	2/3/25	Y	1	R	GENERIC	4513532	68382080505	N	HEB PHARMACY	TX	30.00	N	23699336854425	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	30.00	PREGABALIN CAP 75MG	2/3/25	Y	1	R	GENERIC	4588781	69238131209	N	WALGREENS	TX	60.00	N	36347393795025	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	30.00	PROPRANOLOL TAB 10MG	2/3/25	Y	1	R	GENERIC	5908554	69238207701	N	HEB PHARMACY	TX	30.00	N	29574291164825	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	84.00	VITAMIN D CAP 1.25MG	2/3/25	Y	1	R	GENERIC	4554007	42806054701	N	CVS PHARMACY	TX	12.00	N	20146935599525	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	90.00	PROPRANOLOL TAB 40MG	2/3/25	Y	1	R	GENERIC	5909215	69238207901	N	LYNN'S PHARMACY HEWITT	TX	180.00	N	35087578446525	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	7.00	VALACYCLOVIR TAB 1GM	2/3/25	Y	1	R	GENERIC	4516540	31722070530	N	HEB PHARMACY	TX	21.00	N	21812728630725	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	B	N	0	30.00	JUBLIA SOL 10%	2/3/25	N	3	R	SSB	5923859	00187540004	N	SYMPHONY PHARMACY	TX	4.00	N	26992738839725	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	84.00	ESTARYLLA TAB 0.25-35	2/3/25	Y	1	R	GENERIC	4906888	70700011985	N	RUBENSTEIN MEM HLTH CTR PHCY	WA	84.00	N	39044272330925	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	3.00	TRAMADOL HCL TAB 50MG	2/3/25	Y	1	R	GENERIC	4573196	60219234801	N	WALGREENS	TX	15.00	N	22944842750925	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	90.00	VALACYCLOVIR TAB 500MG	2/3/25	Y	1	R	GENERIC	4551330	65862044890	N	WALGREENS	TX	90.00	N	25447627021125	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	30.00	HYDROCO/APAP TAB 7.5-325	2/3/25	Y	1	R	GENERIC	4553144	00406012405	N	WALGREENS	TX	90.00	N	29263312417725	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	30.00	AMPHET/DEXTR TAB 20MG	2/3/25	Y	1	R	GENERIC	4500321	00555097302	N	HEB PHARMACY	TX	30.00	N	26003501848625	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	5.00	OSELTAMIVIR CAP 75MG	2/3/25	Y	1	R	GENERIC	5934799	72205004411	N	CVS PHARMACY	TX	10.00	N	25931285450925	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	10.00	METHOCARBAM TAB 500MG	2/3/25	Y	1	R	GENERIC	4558687	69584061150	N	HEB PHARMACY	TX	40.00	N	14281318417625	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	30.00	PROPRANOLOL TAB 10MG	2/3/25	Y	1	R	GENERIC	4513532	69238207701	N	HEB PHARMACY	TX	90.00	N	23699336854425	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	90.00	METOPROL SUC TAB 25MG ER	2/3/25	Y	1	R	GENERIC	4569010	50742061510	N	HEB PHARMACY	TX	180.00	N	26752766843825	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	14.00	BENZONATATE CAP 100MG	2/3/25	Y	1	R	GENERIC	4516540	42806071405	N	HEB PHARMACY	TX	42.00	N	21812728630725	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	5.00	IBUPROFEN TAB 800MG	2/3/25	Y	1	R	GENERIC	4529496	64380080707	N	WALGREENS	TX	16.00	N	14221040511025	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	30.00	AMPHET/DEXTR TAB 20MG	2/3/25	Y	1	R	GENERIC	5900774	00406889301	N	WALGREENS	TX	60.00	N	16984978929325	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	6.00	METHYLPRED TAB 4MG	2/3/25	Y	1	R	GENERIC	4590003	59746000103	N	HEB PHARMACY	TX	21.00	N	37857367849925	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	30.00	FLUOXETINE CAP 10MG	2/3/25	Y	1	R	GENERIC	4582587	23155002801	N	38TH ST PHARMACY INC	TX	30.00	N	15974973811025	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	4.00	PREDNISONE TAB 20MG	2/3/25	Y	1	R	GENERIC	4532203	60219170801	N	CVS PHARMACY	TX	5.00	N	14173874316725	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	7.00	BENZONATATE CAP 100MG	2/3/25	Y	1	R	GENERIC	4548713	42806071405	N	HEB PHARMACY	TX	21.00	N	24720180339225	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	5.00	AZITHROMYCIN TAB 250MG	2/3/25	Y	1	R	GENERIC	4544361	65862064163	N	HEB PHARMACY	TX	6.00	N	23964132120625	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	5.00	AZITHROMYCIN TAB 250MG	2/3/25	Y	1	R	GENERIC	4567662	65862064163	N	HEB PHARMACY	TX	6.00	N	20149135599525	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	B	N	0	2.00	BAQSIMI TWO POW 3MG/DOSE	2/3/25	Y	2	R	SSB	5915624	00548835202	N	CVS PHARMACY	TX	2.00	N	22433015969725	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	30.00	ATOMOXETINE CAP 60MG	2/3/25	Y	1	R	GENERIC	4500650	31722071830	N	WALGREENS	TX	30.00	N	26545154211225	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	5.00	TRAMADOL HCL TAB 50MG	2/3/25	Y	1	R	GENERIC	4516540	29300035510	N	HEB PHARMACY	TX	20.00	N	21812728630725	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	B	N	0	28.00	OZEMPIC INJ 4MG/3ML	2/3/25	Y	2	R	SSB	4528418	00169413013	N	HEB PHARMACY	TX	3.00	N	18483954799025	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	90.00	ATORVASTATIN TAB 10MG	2/3/25	Y	1	R	GENERIC	4597235	00093505698	N	WALMART PHARMACY	TX	90.00	N	16984288099025	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	30.00	HYDROXYZ HCL TAB 25MG	2/3/25	Y	1	R	GENERIC	5908554	16714008211	N	HEB PHARMACY	TX	90.00	N	29574291164825	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	2.00	PROMETHAZINE SUP 12.5MG	2/3/25	Y	1	R	GENERIC	4529535	31722004031	N	HEB PHARMACY	TX	6.00	N	16345356690225	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	B	N	0	28.00	MOUNJARO INJ 10MG/0.5	2/3/25	Y	2	R	SSB	5930397	00002147180	N	NORTH CENTRAL PHARMACY	TX	2.00	N	24734637673425	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	B	N	0	84.00	SKYRIZI PEN INJ 150MG/ML	2/3/25	Y	2	S	SSB	3958898	00074210001	N	CVS SPECIALTY	PA	1.00	Y	34014567899725	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	30.00	ESCITALOPRAM TAB 10MG	2/3/25	Y	1	R	GENERIC	4513532	13668013610	N	HEB PHARMACY	TX	30.00	N	23699336854425	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	B	N	0	30.00	PLENVU SOL	2/3/25	N	3	R	SSB	4541985	65649040001	N	CVS PHARMACY	TX	3.00	N	35562832851425	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	30.00	MELOXICAM TAB 15MG	2/3/25	Y	1	R	GENERIC	5930210	29300012510	N	HEB PHARMACY	TX	30.00	N	40737073871925	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	B	N	0	28.00	TRULICITY INJ 1.5/0.5	2/3/25	Y	2	R	SSB	4528418	00002143480	N	HEB PHARMACY	TX	2.00	N	17065492605925	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	B	N	0	28.00	MOUNJARO INJ 5MG/0.5	2/3/25	Y	2	R	SSB	5934799	00002149580	N	CVS PHARMACY	TX	2.00	N	17393346687525	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	43.00	IPRATROPIUM SPR 0.03%	2/3/25	Y	1	R	GENERIC	4554362	24208039830	N	WALGREENS	TX	30.00	N	19881218529325	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	30.00	AMPHET/DEXTR CAP 25MG ER	2/3/25	Y	1	R	GENERIC	4535146	31722018901	N	WALGREENS	TX	30.00	N	35171868799525	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	17.00	ALBUTEROL AER HFA	2/3/25	Y	1	R	GENERIC	4545161	69097014260	N	CVS PHARMACY	TX	6.70	N	35609781069925	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	30.00	QUETIAPINE TAB 50MG	2/4/25	Y	1	R	GENERIC	5930397	65862049001	N	NORTH CENTRAL PHARMACY	TX	60.00	N	14544749439825	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	90.00	LUBIPROSTONE CAP 24MCG	2/4/25	Y	1	R	GENERIC	4590940	00254302902	N	WALGREENS	TX	180.00	N	18423185426725	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	30.00	CETIRIZINE SOL 1MG/ML	2/4/25	Y	1	R	GENERIC	4584567	51672407008	N	CVS PHARMACY	TX	150.00	N	28518625241425	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	90.00	PANTOPRAZOLE TAB 40MG	2/4/25	Y	1	R	GENERIC	4566658	13668042905	N	HEB PHARMACY	TX	90.00	N	25469259669425	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	90.00	LISINOP/HCTZ TAB 10-12.5	2/4/25	Y	1	R	GENERIC	5943192	43547042050	N	HEB PHARMACY	TX	90.00	N	13915958833625	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	B	N	0	30.00	DESCOVY TAB 200/25MG	2/4/25	Y	2	S	SSB	3137141	61958200201	N	CAREMARK SPECIALTY PHARMACY	NJ	30.00	Y	36386558635725	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	14.00	CLONAZEP ODT TAB 0.25MG	2/4/25	Y	1	R	GENERIC	4553144	49884030702	N	WALGREENS	TX	14.00	N	14872935683125	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	15.00	CLONAZEPAM TAB 0.5MG	2/4/25	Y	1	R	GENERIC	4545604	72888015205	N	CVS PHARMACY	TX	15.00	N	27319627211225	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	16.00	ALBUTEROL AER HFA	2/4/25	Y	1	R	GENERIC	4547468	00054074287	N	WALGREENS	TX	6.70	N	19200410053325	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	7.00	METRONIDAZOL TAB 500MG	2/4/25	Y	1	R	GENERIC	4500650	50111033402	N	WALGREENS	TX	14.00	N	35935818898125	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	90.00	DULOXETINE CAP 30MG DR	2/4/25	Y	1	R	GENERIC	5916690	27241009810	N	SANDERS DRUG STORE	TX	90.00	N	14366064217625	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	30.00	EPINEPHRINE INJ 0.3MG	2/4/25	Y	1	R	GENERIC	4544361	00115169449	N	HEB PHARMACY	TX	2.00	N	34644348424625	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	30.00	CARBAMAZEPIN TAB 200MG	2/4/25	Y	1	R	GENERIC	4542622	69452031232	N	WALGREENS	TX	60.00	N	27672982852525	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	30.00	METFORMIN TAB 500MG	2/4/25	Y	1	R	GENERIC	4528418	23155084110	N	HEB PHARMACY	TX	120.00	N	17065492605925	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	30.00	SCOPOLAMINE DIS 1MG/3DAY	2/4/25	Y	1	R	GENERIC	5900964	50742050504	N	WALGREENS	TX	10.00	N	36264636587725	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	B	N	0	30.00	DEXCOM G7 MIS SENSOR	2/4/25	Y	2	R	SSB	5930210	08627007701	N	HEB PHARMACY	TX	3.00	N	25380684085425	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	90.00	ESTRADIOL CRE 0.01%	2/4/25	Y	1	R	GENERIC	5930397	00093354143	N	NORTH CENTRAL PHARMACY	TX	42.50	N	26435011755225	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	1.00	FLUOROURACIL CRE 5%	2/4/25	Y	1	R	GENERIC	4568222	51672411806	N	WALGREENS	TX	40.00	N	26855178195425	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	30.00	FLUTIC/SALME AER 100/50	2/4/25	Y	1	R	GENERIC	4544791	00054032656	N	HEB PHARMACY	TX	60.00	N	26849175366625	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	B	N	0	28.00	OZEMPIC INJ 8MG/3ML	2/4/25	Y	2	R	SSB	4501311	00169477212	N	CVS PHARMACY	TX	3.00	N	21179050455525	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	90.00	PROGESTERONE CAP 100MG	2/4/25	Y	1	R	GENERIC	4569565	70700016201	N	WALGREENS	TX	90.00	N	15491218788325	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	45.00	CARVEDILOL TAB 3.125MG	2/4/25	Y	1	R	GENERIC	4544791	65862014205	N	HEB PHARMACY	TX	90.00	N	24325998467125	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	5.00	AZITHROMYCIN TAB 250MG	2/4/25	Y	1	R	GENERIC	5910559	50111078751	N	WALMART PHARMACY	TX	6.00	N	20773115900325	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	90.00	PREDNISONE TAB 5MG	2/4/25	Y	1	R	GENERIC	4566658	70954005820	N	HEB PHARMACY	TX	90.00	N	14971463219225	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	30.00	LITHIUM CARB CAP 300MG	2/4/25	Y	1	R	GENERIC	5930397	68462022101	N	NORTH CENTRAL PHARMACY	TX	60.00	N	14544749439825	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	5.00	OSELTAMIVIR CAP 75MG	2/4/25	Y	1	R	GENERIC	4547468	72205004411	N	WALGREENS	TX	10.00	N	19200410053325	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	21.00	PREDNISONE TAB 20MG	2/4/25	Y	1	R	GENERIC	5930210	64380078507	N	HEB PHARMACY	TX	42.00	N	19628572820325	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	30.00	NYSTATIN CRE 100000	2/4/25	Y	1	R	GENERIC	4508632	00713067831	N	HEB PHARMACY	TX	30.00	N	28164255705625	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	10.00	AMOX/K CLAV TAB 875-125	2/4/25	Y	1	R	GENERIC	4528418	81964022114	N	HEB PHARMACY	TX	20.00	N	28810434448025	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	B	N	0	28.00	ORILISSA TAB 200MG	2/4/25	Y	2	R	SSB	5930450	00074003956	N	CVS PHARMACY	TX	56.00	N	14365063808025	N
7704	AETNA-CVSH FORMULARY	97013764	TRAVIS COUNTY HEALTHCARE DISTRICT - CENT	00181116	G	N	0	90.00	LISINOP/HCTZ TAB 20-25MG	2/4/25	Y	1	R	GENERIC	5905306	43547042210	N	RANDALLS PHARMACY	TX	90.00	N	13842740952625	N

This is the start of the file's text. The full file is on GovTribe.

File details come from the government source that posted it. Updated Apr 27, 2026.