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Dextroamphetamine SulfateĀ - Dextroamphetamine SulfateĀ tablet
Community Health Plan of Imperial Valley (MCO)
Community Health Plan of Imperial Valley (MCO) Coverage for Dextroamphetamine SulfateĀ - Dextroamphetamine SulfateĀ tablet
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2
Managed Medicaid
1
Medicare
1
Managed Medicaid
Managed Medicaid - HMO - Medicaid
No PA
No Step Therapy
Quantity Limit
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Medicare
Medicare - Medicare Advantage Part D
No PA
No Step Therapy
No Quantity Limit
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