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Dextrose Monohydrate - Dextrose Monohydrate injection, Solution
Providence Health Plan
Providence Health Plan Coverage for Dextrose Monohydrate - Dextrose Monohydrate injection, Solution
All
6
Commercial
3
Health Exchange
1
Managed Medicaid
1
Medicare
1
Commercial
Commercial - HMO
No PA
No Step Therapy
No Quantity Limit
See Details
Commercial - Employer
No PA
No Step Therapy
No Quantity Limit
See Details
Commercial - PPO
No PA
No Step Therapy
No Quantity Limit
See Details
Health Exchange
Health Exchange - PPO - Health Insurance Exchange
No PA
No Step Therapy
No Quantity Limit
See Details
Managed Medicaid
Managed Medicaid - HMO - Medicaid
PA Required
No Step Therapy
No Quantity Limit
See Details
Medicare
Medicare - Medicare Advantage Part D
No PA
No Step Therapy
No Quantity Limit
See Details