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Levorphanol Tartrate - Levorphanol Tartrate tablet
Cook Children's Health Plan (CCHP)
Cook Children's Health Plan (CCHP) Coverage for Levorphanol Tartrate - Levorphanol Tartrate tablet
All
1
Managed Medicaid
1
Managed Medicaid
Managed Medicaid - HMO - Medicaid
PA Required
No Step Therapy
No Quantity Limit
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