Provider
P58-17 New Drug-Related Prior Authorization with Quantity Limit Criteria: Topical Doxepin
Program effective Date: Oct 24, 2017
Program effective Date: Oct 24, 2017
Program effective Date: Nov 01, 2018
Program effective Date: Jun 28, 2018
Program effective Date: Oct 01, 2018
Program effective Date: Jun 01, 2018
Program effective Date: Aug 01, 2018
Program effective Date: Dec 05, 2017
Program effective Date: Jul 02, 2018
Program effective Date: Dec 12, 2017