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Biology / Immune system / Entry inhibitors / Organofluorides / CCR5 / HIV / Maraviroc / Medicaid / Pfizer / Chemokine receptors / HIV/AIDS / Chemistry


Kansas Medical Assistance Program P O Box 3571 Topeka, KS[removed]Provider[removed]Beneficiary[removed]
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Document Date: 2013-01-01 09:43:57


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City

Beneficiary Medicaid / Topeka / /

Company

Pfizer / /

Facility

Pharmacy Medicaid ID# / Pharmacy Name / /

MedicalCondition

HIV / /

Organization

Prior Authorization Unit / /

/

Position

Physician / Yes_______ No_______ Prescribing Physician / HIV Specialist / /

Product

Selzentry / /

ProvinceOrState

Kansas / /

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