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Dextrose Monohydrate - Dextrose Monohydrate injection, Solution
Kaiser Foundation Health Plan of California
Kaiser Foundation Health Plan of California Coverage for Dextrose Monohydrate - Dextrose Monohydrate injection, Solution
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3
Health Exchange
2
Managed Medicaid
1
Health Exchange
Health Exchange - HMO - Health Insurance Exchange
No PA
No Step Therapy
No Quantity Limit
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Health Exchange - HDHP - Health Insurance Exchange
No PA
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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