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Acyclovir - Acyclovir tablet
Community Health Plan of Imperial Valley (MCO)
Community Health Plan of Imperial Valley (MCO) Coverage for Acyclovir - Acyclovir tablet
All
2
Managed Medicaid
1
Medicare
1
Managed Medicaid
Managed Medicaid - HMO - Medicaid
No PA
No Step Therapy
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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