ActHIB SOLUTION RECONSTITUTED Intramuscular
Haemophilus B Polysac Conj Vac
Tier: 3
PA Type: No Prior Authorization
ST: N
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
Influenza Virus Vacc Split PF
Tier: 3
PA Type: No Prior Authorization
ST: N
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
Influenza Virus Vacc Split PF
Tier: 3
PA Type: No Prior Authorization
ST: N
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
Influenza Virus Vacc Split PF
Tier: 3
PA Type: No Prior Authorization
ST: N
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
Influenza Vac Split Quad
Tier: 3
PA Type: No Prior Authorization
ST: N
Afluria Quadrivalent Suspension Intramuscular
Influenza Vac Split Quad
Tier: 3
PA Type: No Prior Authorization
ST: N