Dosage Strength
60 kB
|
#10410
|
2008/09/29
|
|
Dose Consolidation (copy)
101 kB
|
#10420
|
2011/03/01
|
|
Part D Safety Net
61 kB
|
#20740
|
2008/09/29
|
|
Narcotics (copy)
244 kB
|
#20510
|
2010/01/14
|
|
Plavix (copy)
35 kB
|
#20715
|
2010/03/04
|
|
MS Agents (copy)
188 kB
|
#20430
|
2010/03/04
|
|
Acute Migraine (copy)
418 kB
|
#10110
|
2010/03/04
|
|
Acute Migraine (copy)
468 kB
|
#10110
|
2010/04/02
|
|
Neupogen Leukine (copy)
69 kB
|
#20520
|
2010/06/15
|
|
Proton Pump Inhibitors (copy)
118 kB
|
#20720
|
2010/05/11
|
|
Botox - Myobloc (copy)
135 kB
|
#10210
|
2010/07/23
|
|
Cox II Inhibitors (copy)
97 kB
|
#10310
|
2010/08/06
|
|
Synagis (copy)
162 kB
|
#30120
|
2010/10/01
|
|
Proton Pump Inhibitors (copy)
158 kB
|
#20720
|
2010/10/08
|
|
Acute Migraine (copy)
519 kB
|
#10110
|
2010/10/15
|
|
Hyaluronic Acid Derivatives (copy)
162 kB
|
#30130
|
2010/11/05
|
|
MS Agents (copy)
233 kB
|
#20430
|
2010/12/03
|
|
Byetta (copy)
107 kB
|
#10230
|
2010/12/03
|
|
Botox - Myobloc (copy)
228 kB
|
#10210
|
2010/12/03
|
|
Cox II Inhibitors (copy)
133 kB
|
#10310
|
2011/04/20
|
|
Vivitrol (copy)
97 kB
|
#3400
|
2011/04/29
|
|
Proton Pump Inhibitors (copy)
199 kB
|
#20720
|
2011/04/29
|
|
Antipsychotic (copy)
39 kB
|
#10130
|
2011/04/29
|
|
Zyvox
134 kB
|
#30820
|
2008/09/29
|
|
Flumist (copy)
80 kB
|
#10610
|
2011/05/26
|
|
Provigil (copy)
106 kB
|
#20710
|
2011/07/22
|
|
Proton Pump Inhibitors (copy)
241 kB
|
#20720
|
2011/07/22
|
|
Growth Hormone (copy)
203 kB
|
#10710
|
2011/07/22
|
|
Antipsychotic (copy)
78 kB
|
#10130
|
2011/07/22
|
|
Synagis (copy)
207 kB
|
#30120
|
2011/10/03
|
|
WIC MaineCare PA Form (copy)
3 MB
|
All children under five are required to complete the PA form for medical necessity
|
2011/10/04
|
|
Vivitrol (copy)
131 kB
|
#3400
|
2011/10/05
|
