All *MACROLIDES*

Azithromycin Packet 1 GM Oral
Azithromycin Packet 1 GM Oral

Tier: 3
PA Type: No Prior Authorization
ST: Y
Azithromycin Packet 1 GM Oral
Azithromycin Packet 1 GM Oral

Tier: 3
PA Type: No Prior Authorization
ST: Y
Azithromycin Solution Reconstituted 500 MG Intravenous
Azithromycin Solution Reconstituted 500 MG Intravenous

Tier: 1
PA Type: No Prior Authorization
ST: N
Azithromycin Solution Reconstituted 500 MG Intravenous
Azithromycin Solution Reconstituted 500 MG Intravenous

Tier: 1
PA Type: No Prior Authorization
ST: N
Azithromycin Solution Reconstituted 500 MG Intravenous
Azithromycin Solution Reconstituted 500 MG Intravenous

Tier: 1
PA Type: No Prior Authorization
ST: N
Azithromycin Solution Reconstituted 500 MG Intravenous
Azithromycin Solution Reconstituted 500 MG Intravenous

Tier: 1
PA Type: No Prior Authorization
ST: N
Azithromycin Solution Reconstituted 500 MG Intravenous
Azithromycin Solution Reconstituted 500 MG Intravenous

Tier: 1
PA Type: No Prior Authorization
ST: N
Azithromycin Solution Reconstituted 500 MG Intravenous
Azithromycin Solution Reconstituted 500 MG Intravenous

Tier: 1
PA Type: No Prior Authorization
ST: N
Azithromycin Solution Reconstituted 500 MG Intravenous
Azithromycin Solution Reconstituted 500 MG Intravenous

Tier: 1
PA Type: No Prior Authorization
ST: N
Azithromycin Solution Reconstituted 500 MG Intravenous
Azithromycin Solution Reconstituted 500 MG Intravenous

Tier: 1
PA Type: No Prior Authorization
ST: N
Azithromycin Solution Reconstituted 500 MG Intravenous
Azithromycin Solution Reconstituted 500 MG Intravenous

Tier: 1
PA Type: No Prior Authorization
ST: N
Azithromycin Solution Reconstituted 500 MG Intravenous
Azithromycin Solution Reconstituted 500 MG Intravenous

Tier: 1
PA Type: No Prior Authorization
ST: N