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Ampicillin And Sulbactam - Ampicillin And Sulbactam injection, Powder, For Solution
Community Health Options (MCO)
Community Health Options (MCO) Coverage for Ampicillin And Sulbactam - Ampicillin And Sulbactam injection, Powder, For Solution
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4
Commercial
2
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2
Commercial
Commercial - PPO
No PA
No Step Therapy
No Quantity Limit
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Commercial - HMO
No PA
No Step Therapy
No Quantity Limit
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Health Exchange
Health Exchange - PPO - Health Insurance Exchange
No PA
No Step Therapy
No Quantity Limit
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Health Exchange - HMO - Health Insurance Exchange
No PA
No Step Therapy
No Quantity Limit
See Details
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