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Number(s): 01-16-17, 09-16-16, 27-16-15, 02-16-15, 11-16-15, 30-16-15, 03-16-15, 14-16-15, 31-16-18, 08-16-16, 24-16-16, 32-16-14, 33-16-15
Issue Date: 06/13/2016
Effective Date: 06/13/2016
Subject: Prior Authorization of Provenge (sipuleucel-T) - Pharmacy Service
Program Office(s): Office of Medical Assistance Programs
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