Anthem Blue Cross (HMO, PPO, EPO)
Dexcom G4 Platinum Receiver (
blood-glucose meter,continuous
)
Medical Supplies and Durable Medical Equipment : Medical Supplies and Durable Medical Equipment
Quantity Limit: 30 day supply per 1 fill(s).
Prior Authorization: PA_APPLIES
Quantity Limit: 1 kit per 365 day(s).
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