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Number(s): 01-18-27, 09-18-28, 27-18-27, 33-18-27, 02-18-22, 11-18-22, 30-18-22, 03-18-23, 14-18-23, 31-18-28, 08-18-30, 24-18-24, 32-18-22
Issue Date: 12/12/2018
Effective Date: 12/17/2018
Subject: Prior Authorization of Antimigraine Agents, Other – Pharmacy Services
Program Office(s): Office of Medical Assistance Programs
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