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Sulfadiazine - Sulfadiazine tablet
Capital Health Plan (MCO)
Capital Health Plan (MCO) Coverage for Sulfadiazine - Sulfadiazine tablet
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4
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2
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1
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1
Commercial
Commercial - Other Insurer
No PA
No Step Therapy
No Quantity Limit
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Commercial - HMO
No PA
No Step Therapy
No Quantity Limit
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Health Exchange
Health Exchange - HMO - Health Insurance Exchange
No PA
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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