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Number(s): 01-15-33, 02-15-25, 03-15-25, 08-15-31, 09-15-31, 11-15-24, 14-15-26, 24-15-26, 27-15-25, 30-15-24, 31-15-32, 32-15-25, 33-15-30
Issue Date: 11/13/2015
Effective Date: 10/26/2015
Subject: Prior Authorization of Lipotropics, Other - Pharmacy Service
Program Office(s): Office of Medical Assistance Programs
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