Description - DE Medical Assistance Program

Q2009 FOSPHENYTOIN INJ PE 5 $0.00
Q2010 GLATIRAMER ACETATE, PER DOSE O $0.00
Q2011 HEMIN, PER 1 MG O $0.00
Q2012 PEGADEMASE BOVINE, 25 IU O $0.00
Q2013 PENTASTARCH 10% SOLUTION O $0.00
Q2014 SERMORELIN ACETATE, 0.5 MG O $0.00
Q2015 SOMATREM, 5 MG O $0.00
Q2016 SOMATROPIN, 1 MG O $0.00
Q2017 TENIPOSIDE, 50 MG 5 $0.00
Q2018 UROFOLLITROPIN, 75 IU O $0.00
Q2019 BASILIXIMAB O $0.00
Q2020 HISTRELIN ACETATE O $0.00
Q2021 LEPIRUDIN O $0.00
Q2022 VONWILLEBRANDFACTRCMPLXPERIU O $0.00
Q2023 XYNTHA, INJ O $0.00
Q2024 BEVACIZUMAB INJECTION O $0.00
Q3000 RUBIDIUM RB 82 O $0.00
Q3001 BRACHYTHERAPY RADIOELEMENTS 5 $0.00
Q3002 GALLIUM GA 67 O $0.00
Q3003 TECHNETIUM TC99M BICISATE O $0.00
Q3004 XENON XE 133 O $0.00
Q3005 TECHNETIUM TC99M MERTIATIDE O $0.00
Q3006 TECHNETIUM TC99M GLUCEPATATE O $0.00
Q3007 SODIUM PHOSPHATE P32 O $0.00
Q3008 INDIUM 111-IN PENTETREOTIDE O $0.00
Q3009 TECHNETIUM TC99M OXIDRONATE O $0.00
Q3010 TECHNETIUM TC99MLABELEDRBCS O $0.00
Q3011 CHROMIC PHOSPHATE P32 O $0.00
Q3012 CYANOCOBALAMIN COBALT CO57 O $0.00
Q3014 TELEHEALTH FACILITY FEE 9 $0.00
Q3017 ALS ASSESSMENT 9 $0.00
Q3019 ALS EMER TRANS NO ALS SERV O $0.00
Q3020 ALS NONEMER TRANS NO ALS SER O $0.00
Q3021 PED HEPATITIS B VACCINE INJ O $0.00
Q3022 HEPATITIS B VACCINE ADULT DS O $0.00
Q3023 INJECTION HEPATITIS BVACCINE O $0.00
Q3025 IM INJ INTERFERON BETA 1-A 5 $0.00
Q3026 SUBC INJ INTERFERON BETA-1A 5 $0.00
Q3031 COLLAGEN SKIN TEST 9 $0.00
Q4001 CAST SUP BODY CAST PLASTER 9 $0.00
Q4002 CAST SUP BODY CAST FIBERGLAS 9 $0.00
Q4003 CAST SUP SHOULDER CAST PLSTR 9 $0.00
Q4004 CAST SUP SHOULDER CAST FBRGL 9 $0.00
Q4005 CAST SUP LONG ARM ADULT PLST 9 $0.00
Q4006 CAST SUP LONG ARM ADULT FBRG 9 $0.00
Q4007 CAST SUP LONG ARM PED PLSTER 9 $0.00
Q4008 CAST SUP LONG ARM PED FBRGLS 9 $0.00
Q4009 CAST SUP SHT ARM ADULT PLSTR 9 $0.00
Q4010 CAST SUP SHT ARM ADULT FBRGL 9 $0.00