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Diphenoxylate Hydrochloride And Atropine Sulfate - Diphenoxylate Hydrochloride And Atropine Sulfate tablet
First Medical Health Plan
First Medical Health Plan Coverage for Diphenoxylate Hydrochloride And Atropine Sulfate - Diphenoxylate Hydrochloride And Atropine Sulfate tablet
All
2
Commercial
1
Managed Medicaid
1
Commercial
Commercial - PPO
No PA
No Step Therapy
No Quantity Limit
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Managed Medicaid
Managed Medicaid - HMO - Medicaid
PA Required
No Step Therapy
No Quantity Limit
See Details
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