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Number(s): 01-16-24, 02-16-21, 03-16-21, 08-16-22, 09-16-22, 11-16-21, 14-16-22, 24-16-24, 27-16-22, 30-16-21, 31-16-26, 32-16-20, 33-16-21
Issue Date: 07/08/2016
Effective Date: 07/11/2016
Subject: Prior Authorization of Lipotropics, Other - Pharmacy Services
Program Office(s): Office of Medical Assistance Programs
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