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Dextroamphetamine SulfateĀ - Dextroamphetamine SulfateĀ tablet
Special Agents Mutual Benefit Association (SAMBA) (MCO)
Special Agents Mutual Benefit Association (SAMBA) (MCO) Coverage for Dextroamphetamine SulfateĀ - Dextroamphetamine SulfateĀ tablet
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1
Commercial
1
Commercial
Commercial - Other Insurer
PA Required
No Step Therapy
No Quantity Limit
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