All *VITAMINS*

Aminobenzoate Potassium Packet 2 GM Oral
Aminobenzoate Potassium Packet 2 GM Oral

Tier: 3
PA Type: No Prior Authorization
ST: N
Aquasol A Solution 15 MG/ML Intramuscular
Aquasol A Solution 15 MG/ML Intramuscular

Vitamin A

Tier: 3
PA Type: No Prior Authorization
ST: N
Aquasol A Solution 15 MG/ML Intramuscular
Aquasol A Solution 15 MG/ML Intramuscular

Vitamin A

Tier: 3
PA Type: No Prior Authorization
ST: N
Aquasol A Solution 50000 UNIT/ML Intramuscular
Aquasol A Solution 50000 UNIT/ML Intramuscular

Vitamin A

Tier: 3
PA Type: No Prior Authorization
ST: N
Ascor Solution 25000 MG/50ML Intravenous
Ascor Solution 25000 MG/50ML Intravenous

Ascorbic Acid

Tier: 3
PA Type: No Prior Authorization
ST: N
Ascor Solution 25000 MG/50ML Intravenous
Ascor Solution 25000 MG/50ML Intravenous

Ascorbic Acid

Tier: 3
PA Type: No Prior Authorization
ST: N
Ascorbic Acid Solution 15000 MG/30ML Intravenous
Ascorbic Acid Solution 15000 MG/30ML Intravenous

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Ascorbic Acid Solution 15000 MG/30ML Intravenous
Ascorbic Acid Solution 15000 MG/30ML Intravenous

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Ascorbic Acid Solution 500 MG/ML Injection
Ascorbic Acid Solution 500 MG/ML Injection

Tier: 1
PA Type: No Prior Authorization
ST: N
Ascorbic Acid Solution 500 MG/ML Injection
Ascorbic Acid Solution 500 MG/ML Injection

Tier: 1
PA Type: No Prior Authorization
ST: N
Ascorbic Acid Solution 500 MG/ML Injection
Ascorbic Acid Solution 500 MG/ML Injection

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Ascorbic Acid Solution 500 MG/ML Injection
Ascorbic Acid Solution 500 MG/ML Injection

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