CY2021 Standard MAPD 5T_21333_353_441
Amlodipine Besylate-Valsartan. amlodipine besylate-valsartan oral tablet 10-160 mg, 10-320 mg, 5-160 mg, 5-320 mg. Quantity Limit: 30 EA Per 30 Days. Coverage Details; Amlodipine-Atorvastatin. ... 2.5 mg/0.5ml. Quantity Limit: 7 ML Per 30 Days. fondaparinux sodium subcutaneous solution 5 mg… ................
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