Hypoglycemics, Insulins - Soliqua and Xultophy Form

Office of the Deputy Secretary for Administration

This government document is issued by Office of the Deputy Secretary for Administration for use in Pennsylvania

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File Details: PDF (133 KB)
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Source
https://www.dhs.pa.gov/providers/Pharmacy-Services/Documents/Fax%20Forms%20SW%20PDL/Hypoglycemics,%20Insulins%20-%20Soliqua%20and%20Xultophy%20(NEW)%20PEAP%20form%2001-01-20.pdf

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