- QL (30 per Rx);
- Quantity Limit: 2 tablets per 1 day(s).
- PA Applies
- Assisted Reproductive Technology (ART):
Age Requirement: >= 18
Duration: 30 Day(s)
Specialist Required: Yes
Documented Diagnosis: Yes
Medical Test Required: No
Specialist Type(s): Reproductive Specialist
Reauthorization Required: Yes
Duration of Reauthorization: = 30 day(s)
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