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Ampicillin And Sulbactam - Ampicillin And Sulbactam injection, Powder, For Solution
Blue Cross and Blue Shield of Vermont
Blue Cross and Blue Shield of Vermont Coverage for Ampicillin And Sulbactam - Ampicillin And Sulbactam injection, Powder, For Solution
All
4
Commercial
3
Health Exchange
1
Commercial
Commercial - HMO
No PA
No Step Therapy
Quantity Limit
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Commercial - PPO
No PA
No Step Therapy
Quantity Limit
See Details
Commercial - Point of Service
No PA
No Step Therapy
Quantity Limit
See Details
Health Exchange
Health Exchange - PPO - Health Insurance Exchange
No PA
No Step Therapy
Quantity Limit
See Details
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