Standard Health Pals Formulary
Tobramycin 80 mg / 2 ml Vial for Infusion (Generic for Nebcin)
Coverage Level – 100%
Copay – $0
Limitations – No more than 30 days’ supply; Maximum 25 vials in 30 days.
Restrictions – Health Pals Mail Order Pharmacy Network
Comments – Generic for Nebcin