Anthem Blue Cross (HMO, PPO, EPO)
Dexcom G4 Plat Ped 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).
Step Therapy: ST_APPLIES
Minimum Age: 12 Years; Maximum Age: N.A.;
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