All *VACCINES*

ActHIB SOLUTION RECONSTITUTED Intramuscular
ActHIB SOLUTION RECONSTITUTED Intramuscular

Haemophilus B Polysac Conj Vac

Tier: 3
PA Type: No Prior Authorization
ST: N
ActHIB SOLUTION RECONSTITUTED Intramuscular
ActHIB SOLUTION RECONSTITUTED Intramuscular

Haemophilus B Polysac Conj Vac

Tier: 3
PA Type: No Prior Authorization
ST: N
Afluria Preservative Free Suspension Prefilled Syringe 0.5 ML Intramuscular
Afluria Preservative Free Suspension Prefilled Syringe 0.5 ML Intramuscular

Influenza Virus Vacc Split PF

Tier: 3
PA Type: No Prior Authorization
ST: N
Afluria Preservative Free Suspension Prefilled Syringe 0.5 ML Intramuscular
Afluria Preservative Free Suspension Prefilled Syringe 0.5 ML Intramuscular

Influenza Virus Vacc Split PF

Tier: 3
PA Type: No Prior Authorization
ST: N
Afluria Preservative Free Suspension Prefilled Syringe 0.5 ML Intramuscular
Afluria Preservative Free Suspension Prefilled Syringe 0.5 ML Intramuscular

Influenza Virus Vacc Split PF

Tier: 3
PA Type: No Prior Authorization
ST: N
Afluria Preservative Free Suspension Prefilled Syringe 0.5 ML Intramuscular
Afluria Preservative Free Suspension Prefilled Syringe 0.5 ML Intramuscular

Influenza Virus Vacc Split PF

Tier: 3
PA Type: No Prior Authorization
ST: N
Afluria Preservative Free Suspension Prefilled Syringe 0.5 ML Intramuscular
Afluria Preservative Free Suspension Prefilled Syringe 0.5 ML Intramuscular

Influenza Virus Vacc Split PF

Tier: 3
PA Type: No Prior Authorization
ST: N
Afluria Preservative Free Suspension Prefilled Syringe 0.5 ML Intramuscular
Afluria Preservative Free Suspension Prefilled Syringe 0.5 ML Intramuscular

Influenza Virus Vacc Split PF

Tier: 3
PA Type: No Prior Authorization
ST: N
Afluria Quadrivalent Suspension Intramuscular
Afluria Quadrivalent Suspension Intramuscular

Influenza Vac Split Quad

Tier: 3
PA Type: No Prior Authorization
ST: N
Afluria Quadrivalent Suspension Intramuscular
Afluria Quadrivalent Suspension Intramuscular

Influenza Vac Split Quad

Tier: 3
PA Type: No Prior Authorization
ST: N
Afluria Quadrivalent Suspension Intramuscular
Afluria Quadrivalent Suspension Intramuscular

Influenza Vac Split Quad

Tier: 3
PA Type: No Prior Authorization
ST: N
Afluria Quadrivalent Suspension Intramuscular
Afluria Quadrivalent Suspension Intramuscular

Influenza Vac Split Quad

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