Wisconsin Medicaid Provider Type: 26 Pharmacies

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2007 Archived Data Tables

December 2007 Data Tables Brand Medically Necessary Drugs That Require Prior Authorization PDF (52 KB) Excel (35 KB) Legend Drug Maximum Allowed Cost List PDF (433 KB) Excel (537 KB)
November 2007 Data Tables Brand Medically Necessary Drugs That Require Prior Authorization PDF (52 KB) Excel (35 KB) Legend Drug Maximum Allowed Cost List PDF (433 KB) Excel (537 KB)
October 2007 Data Tables Brand Medically Necessary Drugs That Require Prior Authorization PDF (52 KB) Excel (35 KB) Legend Drug Maximum Allowed Cost List PDF (433 KB) Excel (537 KB)
September 2007 Data Tables Brand Medically Necessary Drugs That Require Prior Authorization PDF (52 KB) Excel (35 KB) Legend Drug Maximum Allowed Cost List PDF (433 KB) Excel (537 KB)
August 2007 Data Tables Brand Medically Necessary Drugs That Require Prior Authorization PDF (24 KB) Excel (34 KB) Legend Drug Maximum Allowed Cost List PDF (439 KB) Excel (547 KB)
July 2007 Data Tables Brand Medically Necessary Drugs That Require Prior Authorization PDF (24 KB) Excel (34 KB) Legend Drug Maximum Allowed Cost List PDF (439 KB) Excel (547 KB)
June 2007 Data Tables Brand Medically Necessary Drugs That Require Prior Authorization PDF (26 KB) Excel (34 KB) Legend Drug Maximum Allowed Cost List PDF (437 KB) Excel (544 KB)
May 2007 Data Tables Brand Medically Necessary Drugs That Require Prior Authorization PDF (27 KB) Excel (32 KB) Legend Drug Maximum Allowed Cost List PDF (440 KB) Excel (559 KB)
April 2007 Data Tables Legend Drug Maximum Allowed Cost List PDF (440 KB) Excel (559 KB)
March 2007 Data Tables Brand Medically Necessary Drugs That Require Prior Authorization PDF (27 KB) Excel (32 KB) Legend Drug Maximum Allowed Cost List PDF (440 KB) Excel (559 KB)

February 2007 Data Tables Brand Medically Necessary Drugs That Require Prior Authorization PDF (27 KB) Excel (32 KB) Legend Drug Maximum Allowed Cost List PDF (440 KB) Excel (559 KB)

January 2007 Data Tables Brand Medically Necessary Drugs That Require Prior Authorization PDF (27 KB) Excel (32 KB) Legend Drug Maximum Allowed Cost List PDF (440 KB) Excel (559 KB)

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