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AVMED 4 TIER AND 5 TIER FORMULARY QUANTITY LIMIT TABLE Generic Name Brand Name Quantity Limit Description Comments ABACAVIR SOLN 20 MG/ML ZIAGEN 900ml every 30 days 1 HMSA QUEST Integration Managed Medicaid Formulary LEGEND AL Age Limit OTC Over the Counter PA Prior Authorization QL Quantity Limit...
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