All *TETRACYCLINES*

Acticlate Tablet 150 MG Oral
Acticlate Tablet 150 MG Oral

Doxycycline Hyclate

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Acticlate Tablet 75 MG Oral
Acticlate Tablet 75 MG Oral

Doxycycline Hyclate

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Adoxa Pak 1/100 TABLET 100 MG Oral
Adoxa Pak 1/100 TABLET 100 MG Oral

Doxycycline Monohydrate

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Adoxa Pak 1/150 TABLET 150 MG Oral
Adoxa Pak 1/150 TABLET 150 MG Oral

Doxycycline Monohydrate

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Adoxa Pak 2/100 TABLET 100 MG Oral
Adoxa Pak 2/100 TABLET 100 MG Oral

Doxycycline Monohydrate

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Adoxa TABLET 100 MG Oral
Adoxa TABLET 100 MG Oral

Doxycycline Monohydrate

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Adoxa TABLET 100 MG Oral
Adoxa TABLET 100 MG Oral

Doxycycline Monohydrate

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Adoxa TABLET 50 MG Oral
Adoxa TABLET 50 MG Oral

Doxycycline Monohydrate

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Adoxa TABLET 75 MG Oral
Adoxa TABLET 75 MG Oral

Doxycycline Monohydrate

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Adoxa TABLET 75 MG Oral
Adoxa TABLET 75 MG Oral

Doxycycline Monohydrate

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Avidoxy DK KIT 100 MG COMBINATION
Avidoxy DK KIT 100 MG COMBINATION

Doxycycline-Suncreen-Sal Acid

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Avidoxy TABLET 100 MG Oral
Avidoxy TABLET 100 MG Oral

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N