All *ANTICOAGULANTS*

ACD Formula A Solution 0.73-2.45-2.2 GM/100ML In Vitro
ACD Formula A Solution 0.73-2.45-2.2 GM/100ML In Vitro

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
ACD Formula A Solution 0.73-2.45-2.2 GM/100ML In Vitro
ACD Formula A Solution 0.73-2.45-2.2 GM/100ML In Vitro

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
ACD Formula B Solution 440-1.47-1.32 In Vitro
ACD Formula B Solution 440-1.47-1.32 In Vitro

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
ACD-A noClot-50 Solution 0.73-2.45-2.2 GM/100ML In Vitro
ACD-A noClot-50 Solution 0.73-2.45-2.2 GM/100ML In Vitro

Anticoagulant Cit Dext Soln A

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Angiomax Solution Reconstituted 250 MG Intravenous
Angiomax Solution Reconstituted 250 MG Intravenous

Bivalirudin Trifluoroacetate

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Angiomax Solution Reconstituted 250 MG Intravenous
Angiomax Solution Reconstituted 250 MG Intravenous

Bivalirudin Trifluoroacetate

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Anticoagulant Cit Dext Soln A Solution 0.8-2.45-2.2 GM/100ML In Vitro
Anticoagulant Cit Dext Soln A Solution 0.8-2.45-2.2 GM/100ML In Vitro

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Anticoagulant Compound Solution In Vitro
Anticoagulant Compound Solution In Vitro

Anticoag Cit Phos Dex Soln

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Anticoagulant Sodium Citrate Solution 4 GM/100ML In Vitro
Anticoagulant Sodium Citrate Solution 4 GM/100ML In Vitro

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Anticoagulant Sodium Citrate Solution 4 GM/100ML In Vitro
Anticoagulant Sodium Citrate Solution 4 GM/100ML In Vitro

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Anticoagulant Sodium Citrate Solution 4 GM/100ML In Vitro
Anticoagulant Sodium Citrate Solution 4 GM/100ML In Vitro

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Argatroban in Sodium Chloride Solution 125-0.9 MG/125ML-% Intravenous
Argatroban in Sodium Chloride Solution 125-0.9 MG/125ML-% Intravenous

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N