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Dextrose Monohydrate - Dextrose Monohydrate injection, Solution
Central California Alliance for Health
Central California Alliance for Health Coverage for Dextrose Monohydrate - Dextrose Monohydrate injection, Solution
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3
Commercial
1
Managed Medicaid
1
Medicare
1
Commercial
Commercial - HMO
PA Required
No Step Therapy
No Quantity Limit
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Managed Medicaid
Managed Medicaid - HMO - Medicaid
PA Required
No Step Therapy
No Quantity Limit
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Medicare
Medicare - Medicare Advantage Part D
No PA
No Step Therapy
No Quantity Limit
See Details
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