Benzalkonium Chloride Solution 50 % External
Tier: 3
PA Type: No Prior Authorization
ST: N
Benzalkonium Chloride Solution 50 % External
Tier: 3
PA Type: No Prior Authorization
ST: N
Benzalkonium Chloride Solution External
Tier: 3
PA Type: No Prior Authorization
ST: N
Benzalkonium Chloride Solution External
Tier: 3
PA Type: No Prior Authorization
ST: N
Benzalkonium Chloride Solution External
Tier: 3
PA Type: No Prior Authorization
ST: N
Benzalkonium Chloride Solution External
Tier: 3
PA Type: No Prior Authorization
ST: N
Chlorhexidine Gluconate Solution 20 %
Tier: 3
PA Type: No Prior Authorization
ST: N
Chlorhexidine Gluconate Solution 20 %
Tier: 3
PA Type: No Prior Authorization
ST: N
Chlorhexidine Gluconate Solution 20 %
Tier: 3
PA Type: No Prior Authorization
ST: N
Chlorhexidine Gluconate Solution 20 %
Tier: 3
PA Type: No Prior Authorization
ST: N
Chlorhexidine Gluconate Solution 20 %
Tier: 3
PA Type: No Prior Authorization
ST: N
Chlorhexidine Gluconate Solution 20 %
Tier: 3
PA Type: No Prior Authorization
ST: N
