All *AMINOGLYCOSIDES*

Amikacin Sulfate Solution 1 GM/4ML Injection
Amikacin Sulfate Solution 1 GM/4ML Injection

Tier: 1
PA Type: No Prior Authorization
ST: N
Amikacin Sulfate Solution 1 GM/4ML Injection
Amikacin Sulfate Solution 1 GM/4ML Injection

Tier: 1
PA Type: No Prior Authorization
ST: N
Amikacin Sulfate Solution 1 GM/4ML Injection
Amikacin Sulfate Solution 1 GM/4ML Injection

Tier: 1
PA Type: No Prior Authorization
ST: N
Amikacin Sulfate Solution 1 GM/4ML Injection
Amikacin Sulfate Solution 1 GM/4ML Injection

Tier: 1
PA Type: No Prior Authorization
ST: N
Amikacin Sulfate Solution 1 GM/4ML Injection
Amikacin Sulfate Solution 1 GM/4ML Injection

Tier: 1
PA Type: No Prior Authorization
ST: N
Amikacin Sulfate Solution 1 GM/4ML Injection
Amikacin Sulfate Solution 1 GM/4ML Injection

Tier: 1
PA Type: No Prior Authorization
ST: N
Amikacin Sulfate Solution 1 GM/4ML Injection
Amikacin Sulfate Solution 1 GM/4ML Injection

Tier: 1
PA Type: No Prior Authorization
ST: N
Amikacin Sulfate Solution 1 GM/4ML Injection
Amikacin Sulfate Solution 1 GM/4ML Injection

Tier: 1
PA Type: No Prior Authorization
ST: N
Amikacin Sulfate Solution 1 GM/4ML Injection
Amikacin Sulfate Solution 1 GM/4ML Injection

Tier: 1
PA Type: No Prior Authorization
ST: N
Amikacin Sulfate Solution 1 GM/4ML Injection
Amikacin Sulfate Solution 1 GM/4ML Injection

Tier: 1
PA Type: No Prior Authorization
ST: N
Amikacin Sulfate Solution 1 GM/4ML Injection
Amikacin Sulfate Solution 1 GM/4ML Injection

Tier: 1
PA Type: No Prior Authorization
ST: N
Amikacin Sulfate Solution 500 MG/2ML Injection
Amikacin Sulfate Solution 500 MG/2ML Injection

Tier: 1
PA Type: No Prior Authorization
ST: N