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Retail pharmacy (31-day supply)

Member for

7 years 4 months

Submitted by Site Factory admin on Wed, 01/13/2021 - 00:11

Service Benefit Category Id

10738

Newborn hearing screening tests

Member for

7 years 4 months

Submitted by Site Factory admin on Wed, 01/13/2021 - 00:11

Service Benefit Category Id

10739

Audiologist or multi-specialty provider group services

Member for

7 years 4 months

Submitted by Site Factory admin on Wed, 01/13/2021 - 00:11

Service Benefit Category Id

10740

Tier 1 covered drugs

Member for

7 years 4 months

Submitted by Site Factory admin on Wed, 01/13/2021 - 00:11

Service Benefit Category Id

10741

Specialty pharmacy

Member for

7 years 4 months

Submitted by Site Factory admin on Wed, 01/13/2021 - 00:11

Service Benefit Category Id

10742

Tier 2 and Tier 3 covered drugs

Member for

7 years 4 months

Submitted by Site Factory admin on Wed, 01/13/2021 - 00:11

Service Benefit Category Id

10743

Basic Benefits Tier

Member for

7 years 4 months

Submitted by Site Factory admin on Wed, 01/13/2021 - 00:11

Service Benefit Category Id

10744

Removal of teeth impacted in bone

Member for

7 years 4 months

Submitted by Site Factory admin on Wed, 01/13/2021 - 00:11

Service Benefit Category Id

10745

Basic Benefits Tier

Member for

7 years 4 months

Submitted by Site Factory admin on Wed, 01/13/2021 - 00:11

Service Benefit Category Id

10746

Basic Benefits Tier

Member for

7 years 4 months

Submitted by Site Factory admin on Wed, 01/13/2021 - 00:11

Service Benefit Category Id

10747