| 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, 2013 |
Word
|
None | English |
| F-00433 | Prior Authorization / Preferred Drug List (PA/PDL) for Proton Pump Inhibitor (PPI) Orally Disintegrating Tablets | July 1, 2013 |
PDF
|
None | English |
| F-00433 | Completion Instructions | July 1, 2015 |
PDF
|
None | English |
Last Revised: September 23, 2019
