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Theophylline - Theophylline tablet, Extended Release
Special Agents Mutual Benefit Association (SAMBA) (MCO)
Special Agents Mutual Benefit Association (SAMBA) (MCO) Coverage for Theophylline - Theophylline tablet, Extended Release
All
1
Commercial
1
Commercial
Commercial - Other Insurer
No PA
No Step Therapy
No Quantity Limit
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