Active Injection LM-2 Kit 1 & 0.25 % Injection
Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Articadent Dental Solution Cartridge 4 %-1:100000 Injection
Articaine-EPINEPHrine
Tier: 1
PA Type: No Prior Authorization
ST: N
Articadent Dental Solution Cartridge 4 %-1:200000 Injection
Articaine-EPINEPHrine
Tier: 1
PA Type: No Prior Authorization
ST: N
BD Pudendal/Local Tray/1% Lido Kit 1 % Injection
Lidocaine HCl
Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Buffered Lidocaine Solution Prefilled Syringe 0.9-8.4 % Injection
Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Buffered Lidocaine Solution Prefilled Syringe 0.9-8.4 % Injection
Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Buffered Lidocaine Solution Prefilled Syringe 0.9-8.4 % Injection
Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Buffered Lidocaine Solution Prefilled Syringe 0.9-8.4 % Injection
Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Buffered Lidocaine Solution Prefilled Syringe 0.9-8.4 % Injection
Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Buffered Lidocaine Solution Prefilled Syringe 0.9-8.4 % Injection
Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N