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Ascomp With Codeine - Butalbital, Aspirin, Caffeine And Codeine Phosphate capsule
Asuris Northwest Health
Asuris Northwest Health Coverage for Ascomp With Codeine - Butalbital, Aspirin, Caffeine And Codeine Phosphate capsule
All
1
Commercial
1
Commercial
Commercial - PPO
PA Required
No Step Therapy
No Quantity Limit
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