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Search results with tag "Sodium ascorbate"

Patient Assistance Program (PAP) Application

Patient Assistance Program (PAP) Application

forms.benefitscheckup.org

o ®MoviPrep (PEG 3350, sodium sulfate, sodium chloride, potassium chloride, sodium ascorbate and ascorbic acid for oral solution) Directions: o ®Uceris (budesonide) 2 mg rectal foam Directions: 1 treatment (4 canisters) Prescriber’s Signature Required Below: Substitution Permitted Dispense As Written o o

  Sodium, Chloride, Potassium, Sodium chloride, Sulfate, Potassium chloride, Ascorbate, Sodium sulfate, Sodium ascorbate

Kentucky Medicaid Pharmacy Preferred Drug List

Kentucky Medicaid Pharmacy Preferred Drug List

kyportal.magellanmedicaid.com

PEG-3350, sodium sulfate, sodium chloride, potassium chloride, sodium ascorbate and ascorbic acid for oral solution (generic for MoviPrep®) Plenvu® powder packets Suprep® Sutab® Trilyte® GI Motility Agents Amitiza® CC, AE, QL Linzess® CC, AE, QL Movantik® CC, AE, QL alosetronCC Lotronex®CC ,AE, QL lubiprostone AE, QL Motegrity™AE, QL

  Drug, Preferred, Lists, Sodium, Chloride, Potassium, Sodium chloride, Preferred drug list, Sulfate, Potassium chloride, Ascorbate, Sodium sulfate, Sodium ascorbate

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Sodium sulfate, sodium chloride, potassium chloride, sodium ascorbate, Preferred Drug List