Adacel Suspension 5-2-15.5 LF-MCG/0.5 Intramuscular
Tetanus-Diphth-Acell Pertussis
Tier: 3
PA Type: No Prior Authorization
ST: N
Adacel Suspension 5-2-15.5 LF-MCG/0.5 Intramuscular
Tetanus-Diphth-Acell Pertussis
Tier: 3
PA Type: No Prior Authorization
ST: N
Adacel Suspension 5-2-15.5 LF-MCG/0.5 Intramuscular
Tetanus-Diphth-Acell Pertussis
Tier: 3
PA Type: No Prior Authorization
ST: N
Adacel Suspension 5-2-15.5 LF-MCG/0.5 Intramuscular
Tetanus-Diphth-Acell Pertussis
Tier: 3
PA Type: No Prior Authorization
ST: N
Adacel Suspension 5-2-15.5 LF-MCG/0.5 Intramuscular
Tetanus-Diphth-Acell Pertussis
Tier: 3
PA Type: No Prior Authorization
ST: N
Adacel Suspension 5-2-15.5 LF-MCG/0.5 Intramuscular
Tetanus-Diphth-Acell Pertussis
Tier: 3
PA Type: No Prior Authorization
ST: N
Boostrix Suspension 5-2.5-18.5 LF-MCG/0.5 Intramuscular
Tetanus-Diphth-Acell Pertussis
Tier: 3
PA Type: No Prior Authorization
ST: N
Boostrix Suspension 5-2.5-18.5 LF-MCG/0.5 Intramuscular
Tetanus-Diphth-Acell Pertussis
Tier: 3
PA Type: No Prior Authorization
ST: N
Boostrix Suspension 5-2.5-18.5 LF-MCG/0.5 Intramuscular
Tetanus-Diphth-Acell Pertussis
Tier: 3
PA Type: No Prior Authorization
ST: N
Boostrix Suspension 5-2.5-18.5 LF-MCG/0.5 Intramuscular
Tetanus-Diphth-Acell Pertussis
Tier: 3
PA Type: No Prior Authorization
ST: N