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Acyclovir - Acyclovir ointment
Wellpoint
Wellpoint Coverage for Acyclovir - Acyclovir ointment
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4
Health Exchange
3
Managed Medicaid
1
Health Exchange
Health Exchange - HMO - Health Insurance Exchange
No PA
No Step Therapy
Quantity Limit
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Health Exchange - POS - Health Insurance Exchange
No PA
No Step Therapy
Quantity Limit
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Health Exchange - PPO - Health Insurance Exchange
No PA
No Step Therapy
Quantity Limit
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Managed Medicaid
Managed Medicaid - HMO - Medicaid
PA Required
No Step Therapy
Quantity Limit
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