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Acyclovir - Acyclovir tablet
Rocky Mountain Health Plans
Rocky Mountain Health Plans Coverage for Acyclovir - Acyclovir tablet
All
2
Health Exchange
1
Managed Medicaid
1
Health Exchange
Health Exchange - HMO - Health Insurance Exchange
No PA
No Step Therapy
No Quantity Limit
See Details
Managed Medicaid
Managed Medicaid - HMO - Medicaid
No PA
No Step Therapy
Quantity Limit
See Details
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