Standard Health Pals Formulary
Oxacillin 1 gram vial for Injection (Generic for Bactocill)
Coverage Level – 100%
Copay – $0
Limitations – No more than 30 days’ supply
Restrictions – Health Pals Mail Order Pharmacy Network
Comments – This product must be shipped to either a Physician’s Officer or an Infusion Center; Generic for Bactocill