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City National Provider / / Company AAP / Wilson / Applicable Verbal SA / / Facility Atrioventricular canal / / / IndustryTerm prevention of serious lower respiratory tract disease / / MedicalCondition bronchopulmonary dysplasia / Cerebral Palsy / Chronic Lung Disease2 / congestive heart failure / congenital heart disease / persistent pulmonary hypertension/primary pulmonary hypertension / Myoclonus / Spina bifida / Newborn seizures / Cardiomyopathy / CHD / anomalous pulmonary venous return C. Pulmonary Hypertension / disease / severe pulmonary hypertension2 / chronic pulmonary heart disease / serious lower respiratory tract disease / congenital abnormalities / Primary pulmonary hypertension / mal seizures / Acute cor pulmonale / Patent ductus arteriosus / bronchitis / Spinocerebellar disease / tracheal stenosis / Chronic / Infantile paralysis / cyanotic heart disease / Aortic stenosis / pulmonary hypertension / Ventricular septal defect / endocardial cushion defect / pulmonary fibrosis / chronic corticosteroid therapy / Macroglossia / Tricuspid atresia / bronchiolitis / Persistent fetal circulation / neuromuscular disease / Lung Disease / hemodynamically significant Congenital Heart Disease / Generalized Convulsive epilepsy / Congenital bronchiectasis / Infantile spinal muscular atrophy / muscular atrophy / Epilepsy / Other diseases / indicated disease / Infantile seizures II / Congential Heart Diseases / Tetralogy of Fallot / illness / Atrial septal defect / severe pulmonary hypertension / croup / wheezing / asthma / / MusicGroup Yes / / Organization Virginia Department of Medical Assistance Services Synagis / Committee on Infectious Diseases / Virginia Medicaid Agency / FDA / Administration of Synagis / VIRGINIA DEPARTMENT of MEDICAL ASSISTANCE SERIVCES SYNAGIS / American Academy of Pediatrics / / Person VIRGINIA MEDICAID / / / Position RES CRIBER INFORMATION Physician / Pharmacist / Medical Director / Physician / / Product Synagis / / ProgrammingLanguage J / / ProvinceOrState Georgia / / URL http / SocialTag 
VIRGINIA MEDICAID’s S YNAGIS ® SERVICE AUTHORIZATION COMMONWEALTH of VIRGINIA Season: October 1 through March 31