| Assigned Number |
Title |
Version Date | Publication Type | Other Location | Language |
|---|---|---|---|---|---|
| F-00433 | Prior Authorization/Preferred Drug List (PA/PDL) for Proton Pump Inhibitor (PPI) Orally Disintegrating Tablets | July 1, 2022 |
Word
|
None | English |
| F-00433 | Prior Authorization/Preferred Drug List (PA/PDL) for Proton Pump Inhibitor (PPI) Orally Disintegrating Tablets | July 1, 2022 |
PDF
|
None | English |
| F-00433 | Prior Authorization/Preferred Drug List (PA/PDL) for Proton Pump Inhibitor (PPI) Orally Disintegrating Tablets Instructions | July 1, 2022 |
PDF
|
None | English |
Last Revised: July 1, 2022
