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Number(s): 01-15-38, 09-15-36, 27-15-30, 02-15-30, 11-15-29, 30-15-29, 03-15-30, 14-15-31, 31-15-37, 08-15-36, 24-15-31, 32-15-30, 33-15-35
Issue Date: 11/30/2015
Effective Date: 12/01/2015
Subject: Prior Authorization of Alpha-1 Proteinase Inhibitors - Pharmacy Service
Program Office(s): Office of Medical Assistance Programs
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