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Fee-for-Service counties (mostly rural, low population density): Alpine, Amador, Calaveras, Colusa, Del Norte, Glenn, Inyo, Lassen, Mariposa, Modoc, Mono, Plumas, Sierra, Siskiyou, Trinity, Tuolumne Fee-for-Service members use the statewide Medi-Cal Rx formulary
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US$ 23.23