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MAXIMUM QUANTITY LIMITS (TABLE 1)
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Document Date: 2010-07-07 15:46:31

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MedicalTreatment

chemo / /

Organization

PDL PA / Call Center / /

Person

Virginia Medicaid / /

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Product

Subutex / Lidocaine / Granisetron / Zomig / Naloxone / Actiq / Suboxone / Emend / Sumatriptan / Lidoderm / Imitrex / Zofran / Duragesic / Fentanyl / Anzemet / Axert / Kytril / Relpax / Maxalt / Amerge / Zomig-ZMT / Frova / Naloxone Buprenorphine 102 / Maxalt-MLT / Ondansetron / /

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