RABEprazole Sodium
| Strength: | 10cm (L) |
Medication Description
AcipHex Sprinkle Capsule Sprinkle 10 MG Oral
Medication Features
| Tier | 3 |
| PA Type | No Prior Authorization |
| ST | N |
| QL | Y |
| QL Amount | 60 |
| QL Days | 30 |
RABEprazole Sodium
| Strength: | 10cm (L) |
AcipHex Sprinkle Capsule Sprinkle 10 MG Oral
| Tier | 3 |
| PA Type | No Prior Authorization |
| ST | N |
| QL | Y |
| QL Amount | 60 |
| QL Days | 30 |