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Ampicillin And Sulbactam - Ampicillin Sodium And Sulbactam Sodium injection, Powder, For Solution
Harvard Pilgrim Health Care
Harvard Pilgrim Health Care Coverage for Ampicillin And Sulbactam - Ampicillin Sodium And Sulbactam Sodium injection, Powder, For Solution
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4
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3
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Commercial
Commercial - HMO
No PA
No Step Therapy
No Quantity Limit
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Commercial - PPO
No PA
No Step Therapy
No Quantity Limit
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Commercial - Point of Service
No PA
No Step Therapy
No Quantity Limit
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Health Exchange
Health Exchange - HMO - Health Insurance Exchange
No PA
No Step Therapy
No Quantity Limit
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