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Disulfiram - Disulfiram tablet
Affinity Health Plan (MCO)
Affinity Health Plan (MCO) Coverage for Disulfiram - Disulfiram tablet
All
2
Health Exchange
1
Managed Medicaid
1
Health Exchange
Health Exchange - HMO - Health Insurance Exchange
No PA
No Step Therapy
Quantity Limit
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Managed Medicaid
Managed Medicaid - HMO - Medicaid
No PA
No Step Therapy
Quantity Limit
See Details
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