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medical staff–approved therapeutic interchanges - Pharmacy
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UnitedHealthcare & Affiliated Companies - UnitedHealthcareOnline
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PDL_Phys_Bk.pdf

2017 Preferred Drug List - Ambetter from Sunshine Health
mg) generic. 0. FAL Female - 55 to 79 yrs old. MAL Male - 45 to 79 yrs old aspirin tab delayed release ..... 120 mg generic. 1. MDD 2 per day loratadine & pseudoephedrine tab sr 24hr 10-. 240 mg generic. 1 ..... NOROXIN. BRAND. 3 ofloxacin.
2017_fl_formulary.PDF

2012 Formulary Print document - Geisinger Health Plan
Oct 1, 2016 ... ... the use of a contracted specialty pharmacy vendor for purchase. .... Aspirin Products – Low dose (81 mg) aspirin products for females and .... AVINZA cpmp 24hr: 45mg, 75mg, 90mg,. 120mg. 4. PA. BUTRANS ..... NOROXIN.
marketplace_formulary1.pdf

preferred drug list - Health Republic Insurance of New Jersey
Jan 1, 2015 ... carbonyl iron susp 15 mg/1.25ml (elemental iron) generic. 0 ..... XENICAL CAP 120 MG. BRAND. 3 ...... NOROXIN TAB 400 MG. BRAND. 3.
2015-hrinj-formulary

Ambetter 2016 (test)
nicotine (patch 24hr 7 mg/24hr, patch 24hr 21 mg/24hr .... 120 mg generic. 1. QL. 60 / 30 DAYS fexofenadine-pseudoephedrine tab sr 24hr 180- ...... NOROXIN.
IL-FORMULARY-AMBETTER_2016_FINAL.PDF

The Most Spectacular Sights & Sounds of - Stockyard Institute
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Project Cycology - Stockyard Institute
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Drug Formulary - MyPrime
chew tab 250 mg. 1 amoxicillin (trihydrate) cap 250 mg. 1 ..... NOROXIN - norfloxacin tab 400 mg. 4 ofloxacin tab 200 ... pyrazinamide tab 50-120-300 mg. 4. • •.
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Four-Tier Prescription Member Guide - Blue Cross and Blue Shield
Generally, you will pay the least out of pocket when you buy value drugs - or drugs that are in Tier ..... NOROXIN ..... LATUDA ORAL TABLET 120 MG, 20 MG, 40.
2015_4Tier_Formulary.pdf

Providence Health Insurance Marketplace Formulary
Visit the Consumer Reports Best-Buy Drug website for more information regarding safe and effective ..... gentamicin in nacl, iso-osm 120mg/0.1l ..... NOROXIN.
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Covered Drugs - HealthSpan
network pharmacy where you purchase your drugs, and your drug's cost-sharing tier on our formulary. Please refer to .... HYSINGLA ER ORAL TABLET,ORAL. ONLY,EXT.REL.24 HR 100 MG, 120 MG, 80. MG. 5. NM ..... NOROXIN. 4 ofloxacin ...
HIC_15282.001_Comprehensive_(Cost).pdf

View Drug Formulary - Apex-HealthSolutions.com
90mg, 120mg. (Avinza). 2 ... 1.2mg, 50mg-2mg, 60mg-2.4mg, 80mg-. 3.2mg. 3. QL: 60 in 30 days. ESGIC. 3. ESGIC-PLUS. 3 ..... NOROXIN. 3. Sulfonamides.
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Antimicrobial Prophylaxis in Adults - Mayo Clinic Proceedings
on Antimicrobial Therapy will be available for purchase from our Web site .... nonpregnant women13-15. Trimethoprim. 100 mg. Norfloxacin. 200 mg. Ciprofloxacin. 125 mg ...... be started 90 to 120 minutes before surgical incision be-.
AB PROFILACTICOS.pdf

HSA Preferred Drug List - Medica
PA, QL: 120 in 30 days fentanyl. (Duragesic). 1. QL: 10 in 30 ..... NOROXIN. 3. Sulfonamides .... Drug List). REVLIMID capsule: 2.5mg, 5mg, 15mg,. 20mg, 25mg .
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SWHP ACA Compliant Formulary - Scott & White Health Plan
may still purchase the medication for the full price. What drugs are not .... Form. Strength. Pref. Coverage Details. Comment. PROMETHAZINE HCL. TABS. 12.5 MG. T1 ..... NOROXIN. TABS. 400MG. T3 ..... 120MCG/0.5ML. T4. PEG-INTRON ...
exchange-members-pharmacy-information

List of Covered Drugs - Cigna
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823099_f_2014_PDP_Formulary_Comp_Secure_v10_508.pdf

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