| Document Date: 2014-08-29 15:22:41
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City Therapy / / Company Salicylates ADULT ASA / HP / / Currency PEN / / MedicalCondition ADHD / Attention-Deficit/Hyperactivity Disorder / / Organization PA PA PA PA / PA PA PA / / Person ARIA SOL / / Product CELEBREX / HUMIRA / ORENCIA / METHYLIN / oxaprozin / dextroamphetamine sulfate / acetaminophen / KINERET / RITALIN LA / fentanyl citrate / diflunisal / morphine sulfate / meclofenamate sodium / tobramycin sulfate / NEO-FRADIN / leflunomide / ENBREL / ketoprofen / sulindac / ibuprofen / modafinil / amikacin sulfate / VYVANSE / DILAUDID-HP / kanamycin sulfate / tolmetin sodium / butalbital / NALFON / STRATTERA / DAYTRANA / Tier Requirements / etodolac / meloxicam / gentamicin / diclofenac sodium / streptomycin sulfate / diclofenac potassium / fenoprofen calcium / INDOCIN / ketorolac tromethamine / gentamicin sulfate / fentanyl / flurbiprofen / ARCALYST / paromomycin sulfate / NUVIGIL / naproxen / piroxicam / nabumetone / methadose / neomycin sulfate / indomethacin / KADIAN / misoprostol / levorphanol tartrate / FOCALIN XR / FENTORA / naproxen sodium / tobramycin / / Technology alpha / Antibodies / /
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EXCHANGES_CVSC Template Legacy SP eff[removed]Drug Name Drug Tier Requirements/Limits ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS