JADENU SPRKL GRA 360MG NF 2 Formulary Enhancement N/A JADENU SPRKL GRA 90MG NF 2 Formulary Enhancement N/A LIDOCAINE INJ 0.5% NF 1 Formulary Enhancement N/A Lynparza TAB 100 MG NF 2 + PA2 + LA Formulary Enhancement N/A Lynparza TAB 150 MG NF 2 + PA2 + LA Formulary Enhancement N/A Mavyret TAB 100-40 MG NF 2 + PA1 Formulary Enhancement N/A MEROPENEM INJ 1GM NF 1 Formulary Enhancement N/A MOXIFLOXACIN SOL 0.5% NF 1 Formulary Enhancement N/A Nerlynx TAB 40 MG NF 2 + PA2 + LA Formulary Enhancement N/A 1 + QL Ondansetron HCl TAB 4 MG 1 + QL 90 + BD Formulary Enhancement N/A 60 + BD 1 + QL Ondansetron HCl TAB 8 MG 1 + QL 90 + BD Formulary Enhancement N/A 60 + BD Ondansetron TAB DISPERSIBLE 4 1 + QL 1 + QL 90 + BD Formulary Enhancement N/A MG 60 + BD Ondansetron TAB DISPERSIBLE 8 1 + QL 1 + QL 90 + BD Formulary Enhancement N/A MG 60 + BD ORFADIN CAP 20MG NF 2 Formulary Enhancement N/A Radicava SOL 30 MG/100ML IV NF 2 + PA1 Formulary Enhancement N/A 2 + QL 120 + SYNDROS SOL 5MG/ML NF Formulary Enhancement N/A BD Vigabatrin PACK 500 MG NF 2 + LA Formulary Enhancement N/A Vyxeos SUSP RECON 100-44 MG IV NF 2 + PA2 Formulary Enhancement N/A XATMEP SOL 2.5MG/ML NF 2 + BD Formulary Enhancement N/A Zytiga TAB 500 MG NF 2 + PA2 Formulary Enhancement N/A EFFECTIVE 03/01/2018
JADENU SPRKL GRA 360MG NF 2 Formulary Enhancement N/A JADENU SPRKL GRA 90MG NF 2 Formulary Enhancement N/A LIDOCAINE INJ 0.5% NF 1 Formulary Enhancement N/A Lynparza TAB 100 MG NF 2 + PA2 + LA Formulary Enhancement N/A Lynparza TAB 150 MG NF 2 + PA2 + LA Formulary Enhancement N/A Mavyret TAB 100-40 MG NF 2 + PA1 Formulary Enhancement N/A MEROPENEM INJ 1GM NF 1 Formulary Enhancement N/A MOXIFLOXACIN SOL 0.5% NF 1 Formulary Enhancement N/A Nerlynx TAB 40 MG NF 2 + PA2 + LA Formulary Enhancement N/A Ondansetron HCl TAB 4 MG 1 + QL 60 + BD 1 + QL 90 + BD Formulary Enhancement N/A Ondansetron HCl TAB 8 MG 1 + QL 60 + BD 1 + QL 90 + BD Formulary Enhancement N/A Ondansetron TAB DISPERSIBLE 4 MG 1 + QL 60 + BD 1 + QL 90 + BD Formulary Enhancement N/A Ondansetron TAB DISPERSIBLE 8 MG 1 + QL 60 + BD 1 + QL 90 + BD Formulary Enhancement N/A ORFADIN CAP 20MG NF 2 Formulary Enhancement N/A Radicava SOL 30 MG/100ML IV NF 2 + PA1 Formulary Enhancement N/A SYNDROS SOL 5MG/ML NF 2 + QL 120 + BD Formulary Enhancement N/A Vigabatrin PACK 500 MG NF 2 + LA Formulary Enhancement N/A Vyxeos SUSP RECON 100-44 MG IV NF 2 + PA2 Formulary Enhancement N/A XATMEP SOL 2.5MG/ML NF 2 + BD Formulary Enhancement N/A Zytiga TAB 500 MG NF 2 + PA2 Formulary Enhancement N/A EFFECTIVE 03/01/2018
AgeWell-MMP_2018_Addendum_Eff_07012018.docx