Provider
P40-16 New Drug-Related Prior Authorization Criteria with Quantity Limit for Lidocaine Transdermal
Program effective Date: Aug 03, 2016
Program effective Date: Aug 03, 2016
Program effective Date: Dec 05, 2016
Program effective Date: Dec 05, 2016
Program effective Date: Nov 22, 2016
Program effective Date: Aug 03, 2016
Program effective Date: May 18, 2017
Program effective Date: May 08, 2017
Program effective Date: Feb 26, 2016
Program effective Date: Aug 01, 2016
Program effective Date: May 03, 2017