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Employee Employee plus one Employee plus family |
$25
per pay period $60 per pay period $75 per pay period |
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Employee Employee plus one Employee plus family |
Free $10 per pay period $15 per pay period |
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Namebrand Generic Non-Formulary Mail in Program |
$25
co-pay $10 co-pay $40 co-Pay 2x co-pay |
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Employee
only Employee only Employee only Employee only |
Free Free Free 7% |
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©2008
Memorial Medical Center
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