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Number(s): 01-17-35, 02-17-30, 03-17-30, 08-17-37, 09-17-34, 11-17-30, 14-17-31, 24-17-31, 27-17-32, 30-17-31, 31-17-36, 32-17-30, 33-17-35
Issue Date: 12/14/2017
Effective Date: 01/08/2018
Subject: Prior Authorization of Antibiotics, GI and Related Agents - Pharmacy Services
Program Office(s): Office of Medical Assistance Programs
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