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Spritam - Levetiracetam tablet, For Suspension
State of New Hampshire (MCO)
State of New Hampshire (MCO) Coverage for Spritam - Levetiracetam tablet, For Suspension
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2
State Medicaid
2
State Medicaid
State Medicaid - State Medicaid
PA Required
Step Therapy
No Quantity Limit
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State Medicaid - AIDS Drug Assistance Program
PA Required
No Step Therapy
No Quantity Limit
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