All *ANTISEPTICS & DISINFECTANTS*

Benzalkonium Chloride Solution 50 % External
Benzalkonium Chloride Solution 50 % External

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

Tier: 3
PA Type: No Prior Authorization
ST: N
Benzalkonium Chloride Solution External
Benzalkonium Chloride Solution External

Tier: 3
PA Type: No Prior Authorization
ST: N
Benzalkonium Chloride Solution External
Benzalkonium Chloride Solution External

Tier: 3
PA Type: No Prior Authorization
ST: N
Benzalkonium Chloride Solution External
Benzalkonium Chloride Solution External

Tier: 3
PA Type: No Prior Authorization
ST: N
Benzalkonium Chloride Solution External
Benzalkonium Chloride Solution External

Tier: 3
PA Type: No Prior Authorization
ST: N
Chlorhexidine Gluconate Solution 20 %
Chlorhexidine Gluconate Solution 20 %

Tier: 3
PA Type: No Prior Authorization
ST: N
Chlorhexidine Gluconate Solution 20 %
Chlorhexidine Gluconate Solution 20 %

Tier: 3
PA Type: No Prior Authorization
ST: N
Chlorhexidine Gluconate Solution 20 %
Chlorhexidine Gluconate Solution 20 %

Tier: 3
PA Type: No Prior Authorization
ST: N
Chlorhexidine Gluconate Solution 20 %
Chlorhexidine Gluconate Solution 20 %

Tier: 3
PA Type: No Prior Authorization
ST: N
Chlorhexidine Gluconate Solution 20 %
Chlorhexidine Gluconate Solution 20 %

Tier: 3
PA Type: No Prior Authorization
ST: N
Chlorhexidine Gluconate Solution 20 %
Chlorhexidine Gluconate Solution 20 %

Tier: 3
PA Type: No Prior Authorization
ST: N