Prior Authorization / Preferred Drug List (PA/PDL) for Proton Pump Inhibitor (PPI) Orally Disintegrating Tablets

Assigned Number Titlesort descending Version Date Publication Type Other Location Language
F-00433 Completion Instructions (PDF, 36 KB) July 1, 2015
PDF
English
F-00433 Prior Authorization / Preferred Drug List (PA/PDL) for Proton Pump Inhibitor (PPI) Orally Disintegrating Tablets July 1, 2013
Word
English
F-00433 Prior Authorization / Preferred Drug List (PA/PDL) for Proton Pump Inhibitor (PPI) Orally Disintegrating Tablets (PDF, 1.3 MB) July 1, 2013
PDF
English
Last Revised: December 1, 2015