Prior Authorization Drug Attachment for Modafinil and Nuvigil

Assigned Number Titlesort descending Version Date Publication Type Other Location Language
F-00079 Effective for use before 07/01/2018: Prior Authorization Drug Attachment for Modafinil and Nuvigil January 1, 2018
Word
English
F-00079 Effective for use before 07/01/2018: Prior Authorization Drug Attachment for Modafinil and Nuvigil January 1, 2018
PDF
English
F-00079 Effective for use before 07/01/2018: Prior Authorization Drug Attachment for Modafinil and Nuvigil Instructions January 1, 2018
PDF
English
F-00079 Effective for use on and after 07/01/2018: Prior Authorization Drug Attachment for Modafinil and Nuvigil July 1, 2018
Word
English
F-00079 Effective for use on and after 07/01/2018: Prior Authorization Drug Attachment for Modafinil and Nuvigil July 1, 2018
PDF
English
F-00079 Effective for use on and after 07/01/2018: Prior Authorization Drug Attachment for Modafinil and Nuvigil Instructions July 1, 2018
PDF
English
Last Revised: June 15, 2018