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Number(s): 01-16-25, 09-16-23, 27-16-23, 02-16-22, 11-16-22, 30-16-22, 03-16-22, 14-16-23, 31-16-27, 08-16-23, 24-16-25, 32-16-21, 33-16-22
Issue Date: 07/05/2016
Effective Date: 07/11/2016
Subject: Prior Authorization of Tetracyclines - Pharmacy Services
Program Office(s): Office of Medical Assistance Programs
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