Fillable vermont prior authorization for vivitrol form

Description
Department of Vermont Health Access 312 Hurricane Lane, Suite 201 Williston, Vermont 05495 Agency of Human Services VIVITROL Prior Authorization Request Form Vermont Medicaid has established criteria for prior authorization of Vivitrol (naltrexone for IM extended release suspension). These criteria are based on concerns about safety. In order for beneficiaries to receive coverage for Vivitrol, it will be necessary...
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vermont prior authorization for vivitrol
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