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Synagis RSV Prevention 169 KB |
#30120 |
2023/11/07 |
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Hyaluronic Acid Derivatives 43.5 KB |
#30130 |
2023/10/16 |
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Narcotics 46.5 KB |
#20510 |
2023/10/16 |
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Buprenorphine Extended Release 40.5 KB |
#20200 |
2023/10/16 |
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Botulinum 48 KB |
#10210 |
2023/10/16 |
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Hepatitis C Treatment 301.12 KB |
#10700 |
2022/06/28 |
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Antipsychotics 65.5 KB |
#10130 |
2022/02/09 |
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Suboxone/Buprenorphine 195.44 KB |
#20100 |
2021/07/19 |
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Antibacterial Antibiotics 51 KB |
#30820 |
2020/09/23 |
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PA Submission Instructions 180.78 KB |
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2020/02/25 |
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WIC MaineCare PA Form 166.17 KB |
All children under five are required to complete the PA form for medical necessity |
2019/12/18 |
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Proton Pump Inhibitors 40.5 KB |
# 20720 |
2019/05/24 |
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Brand Drugs 54 KB |
#10220 |
2019/02/07 |
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Granulocyte Colony Stimulating Factor 34.5 KB |
#20520 |
2019/01/17 |
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Opiate Limits 61 KB |
#10300 |
2017/03/17 |
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MS Agents 83 KB |
#20430 |
2017/01/19 |
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Provigil 42 KB |
#20710 |
2015/11/20 |
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Subjective Global Assessment (SGA) 69 KB |
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2014/09/02 |
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Antifungals 38 KB |
#10120 |
2014/04/21 |
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Sedative Hypnotics 32 KB |
#30110 |
2014/04/21 |
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Growth Hormone 40 KB |
#10710 |
2014/01/16 |
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Psoriasis Biologicals 31.5 KB |
#20910 |
2014/01/16 |
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Rheumatoid/Crohns 31 KB |
#20900 |
2014/01/16 |
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Acute Migraine 51.5 KB |
#10110 |
2013/07/25 |
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EPO 46 KB |
#10520 |
2013/07/25 |
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Platelet Aggregation Inhibitors 47.5 KB |
#20715 |
2013/06/21 |
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Drug Drug Interaction 33 KB |
#10400 |
2011/08/22 |
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Dose Consolidation 35 KB |
#10420 |
2011/03/01 |
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Med Watch Form 124.51 KB |
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2009/05/08 |
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Non Sedating Antihistimines 35.5 KB |
#20530 |
2009/05/08 |
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Miscellaneous Non Preferred 34 KB |
#20420 |
2008/09/29 |
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Multi Antipsychotic - Clinical PA 34.5 KB |
#20440 |
2008/09/29 |
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Sensipar 33 KB |
#30115 |
2008/09/29 |
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Syringe Filling 31 KB |
#30140 |
2008/09/29 |