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Lmd In Dextrose - Dextran 40 injection, Solution
CalOptima (MCO)
CalOptima (MCO) Coverage for Lmd In Dextrose - Dextran 40 injection, Solution
All
2
Managed Medicaid
1
Medicare
1
Managed Medicaid
Managed Medicaid - HMO - Medicaid
PA Required
No Step Therapy
No Quantity Limit
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Medicare
Medicare - Medicare Advantage Part D
No PA
No Step Therapy
No Quantity Limit
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