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Ampicillin Sodium - Ampicillin Sodium injection, Powder, For Solution
Kaiser Foundation Health Plan of Hawaii
Kaiser Foundation Health Plan of Hawaii Coverage for Ampicillin Sodium - Ampicillin Sodium injection, Powder, For Solution
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4
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2
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1
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1
Commercial
Commercial - HMO
No PA
No Step Therapy
No Quantity Limit
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Commercial - Other Insurer
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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Managed Medicaid
Managed Medicaid - HMO - Medicaid
No PA
No Step Therapy
No Quantity Limit
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