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Gentamicin Sulfate - Gentamicin Sulfate solution/ Drops
Wellpoint
Wellpoint Coverage for Gentamicin Sulfate - Gentamicin Sulfate solution/ Drops
All
4
Health Exchange
3
Managed Medicaid
1
Health Exchange
Health Exchange - HMO - Health Insurance Exchange
No PA
No Step Therapy
Quantity Limit
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Health Exchange - POS - Health Insurance Exchange
No PA
No Step Therapy
Quantity Limit
See Details
Health Exchange - PPO - Health Insurance Exchange
No PA
No Step Therapy
Quantity Limit
See Details
Managed Medicaid
Managed Medicaid - HMO - Medicaid
No PA
No Step Therapy
Quantity Limit
See Details
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