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Microsoft Word - F0HP3O4A_2014 Formulary_HP_3 TIER OpenInc_COMP_G. S_PB. S_NPB. S_08. 15. 13 nbsp; (PDP) Customer Service at the numbers located on the back of your member ID card. Customer Service is available 24 hours a day, 7 days a week. You can also visit us on the Web at www. . Note tTier Requirements/ Limits CLIMARA 3 QL(13 per 90 days) MO CLIMARA PRO 3 QL(13 per 90 days) MO COMBIPATCH 3 MO CRINONE GEL 4 3 MO CRINONE GEL 850 E e. e. s. 400 nbsp; F B43285A - F O RMULA RY RE F ERENC E G UID E 1Q 13_v1_ F B43285A - F O RMULA RY RE F ERENC E G UID E 1Q 13_v1 5/2/13 2:16 PM P age A F B43285A - F O RMULA RY RE F ERENC E G UID E 1Q 13_v1_ F B43285A - free cialis sample F O RMULRY RE F ERENC E G UID E 1Q 13_v1 5/2/13 2:24 PM P age 50 FORMULARY PRODUCTS50 INDEX F B43285A - F O RMULA RY RE F ERENC E G UID E 1Q 13_v150 D. H. E. 45 Microsoft Word - F0NP3O4A_2014 Formulary_NatPref_3 TIER OpenInc_COMP_G. PB. NPB nbsp; (PDP) Customer Service at the numbers located on the back of your member ID card. Customer Service is available 24 hours a day, 7 days a week. You can also visit us on the Web at www. . Note tMO camila 1 MO CENESTIN 3 MO cialis cvs CLIMARA 3 QL(13 per 90 days) MO CLIMARA PRO 2 QL(13 per 90 daysTier Requirements/ Limits CRINONE GEL 4 3 MO CRINONE GEL 850 E e. e. s. 400 nbsp; This document includes a complete list of the drugs (formulary) for our plan and is current as of August 1, 2013. For an updated formulary (drug list), please contact us. Our contact information, along with the19 Cimetidine 50 Cimetidine HCl 50 CimziaCleocin-T 48 Climara68 Clinimix E 2. 75 /DextroseClobetasol Propionate E 52 Clobex 52 ClodermColyte-Flavor Packs 50 Combigan 64 CombiPatch49 Crestor 45 Crinone 57 Crixivan 34 Microsoft Word - F0NP3O4A_2014 Formulary_NatPref_3 TIER OpenInc_COMP_G. PB. NPB nbsp; (PDP) Customer Service at the numbers located on the back of your member ID card. Customer Service is available 24 hours a day, 7 days a week. You can also visit us on the Web at www. . Note tMO camila 1 MO CENESTIN 3 MO CLIMARA 3 QL(13 per 90 days) MO CLIMARA PRO 2 QL(13 per 90 daysTier Requirements/ Limits CRINONE GEL 4 3 MO CRINONE GEL 850 E e. e. s. 400 nbsp; Note to existing members: This formulary has changed since last year. Please review this document to make sure that it still contains the drugs you take. Beneficiaries must use network pharmacies to access theimcg tab 51 cytomel 50 mcg tab . 51 d. h. e. 45 1 mg/ml inj . . 50 d10w/nacl 0. 2 injdyrenium 100 mg cap. 38 dyrenium 50 mg cap 38 e. e. s. 200 mg/5ml gran susp

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Note: Instructions for Plans are provided within italicized text nbsp;

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