Zenchent FE TAB CHEWABLE 0.4-35 1 NF CMS Required Deletion N/A MG-MCG Zenpep CAPSULE DELAYED RELEASE PARTICLES NF 2 Formulary Enhancement N/A UNIT Oral EFFECTIVE 04/01/2018 Altavera TABLET 0.15-30 MG-MCG NF 1 Formulary Enhancement N/A ORAL Alunbrig TABLET 180 MG Oral NF 2 + PA2 Formulary Enhancement N/A Alunbrig TABLET 90 MG Oral NF 2 + PA2 Formulary Enhancement N/A Alunbrig Tablet Therapy Pack 90 & 180 NF 2 + PA2 Formulary Enhancement N/A MG Oral Atazanavir Sulfate CAPSULE 150 MG NF 1 Formulary Enhancement N/A Oral Atazanavir Sulfate CAPSULE 200 MG NF 1 Formulary Enhancement N/A Oral Atazanavir Sulfate CAPSULE 300 MG NF 1 Formulary Enhancement N/A Oral Calcipotriene CREAM 0.005 % NF 1 Formulary Enhancement N/A EXTERNAL Calcipotriene OINTMENT 0.005 % NF 1 Formulary Enhancement N/A EXTERNAL Carvedilol Phosphate ER CAPSULE EXTENDED RELEASE 24 HOUR 10 NF 1 Formulary Enhancement N/A MG Oral Carvedilol Phosphate ER CAPSULE EXTENDED RELEASE 24 HOUR 20 NF 1 Formulary Enhancement N/A MG Oral
Zenchent FE TAB CHEWABLE 0.4-35 MG-MCG 1 NF CMS Required Deletion N/A Zenpep CAPSULE DELAYED RELEASE PARTICLES UNIT Oral NF 2 Formulary Enhancement N/A EFFECTIVE 04/01/2018 Altavera TABLET 0.15-30 MG-MCG ORAL NF 1 Formulary Enhancement N/A Alunbrig TABLET 180 MG Oral NF 2 + PA2 Formulary Enhancement N/A Alunbrig TABLET 90 MG Oral NF 2 + PA2 Formulary Enhancement N/A Alunbrig Tablet Therapy Pack 90 & 180 MG Oral NF 2 + PA2 Formulary Enhancement N/A Atazanavir Sulfate CAPSULE 150 MG Oral NF 1 Formulary Enhancement N/A Atazanavir Sulfate CAPSULE 200 MG Oral NF 1 Formulary Enhancement N/A Atazanavir Sulfate CAPSULE 300 MG Oral NF 1 Formulary Enhancement N/A Calcipotriene CREAM 0.005 % EXTERNAL NF 1 Formulary Enhancement N/A Calcipotriene OINTMENT 0.005 % EXTERNAL NF 1 Formulary Enhancement N/A Carvedilol Phosphate ER CAPSULE EXTENDED RELEASE 24 HOUR 10 MG Oral NF 1 Formulary Enhancement N/A Carvedilol Phosphate ER CAPSULE EXTENDED RELEASE 24 HOUR 20 MG Oral NF 1 Formulary Enhancement N/A
AgeWell-MMP_2018_Addendum_Eff_07012018.docx