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Number(s): 01-15-35, 02-15-27, 03-15-27, 08-15-33, 09-15-33, 11-15-26, 14-15-28, 24-15-28, 27-15-27, 30-15-26, 31-15-34, 32-15-27, 33-15-32
Issue Date: 11/13/2015
Effective Date: 10/26/2015
Subject: Prior Authorization of GI Motility, Chronic Agents - Pharmacy Service
Program Office(s): Office of Medical Assistance Programs
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