Standard Health Pals Formulary
Lamivudine 150 mg / 300 mg Zidovudine
Coverage Level – 100%
Copay – $0
Limitations – No more than 90 days’ supply
Restrictions – Health Pals Mail Order Pharmacy Network
Comments – Generic for Combivir
Coverage Level – 100%
Copay – $0
Limitations – No more than 90 days’ supply
Restrictions – Health Pals Mail Order Pharmacy Network
Comments – Generic for Combivir
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