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
Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
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
Anticoagulant Cit Dext Soln A
Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Angiomax Solution Reconstituted 250 MG Intravenous
Bivalirudin Trifluoroacetate
Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
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
Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
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
Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Anticoagulant Sodium Citrate Solution 4 GM/100ML In Vitro
Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N