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Limited Coverage Drugs - Dipyridamole-acetylsalicylic acid
| Generic Name / Strength / Form |
| Dipyridamole-acetylsalicylic acid |
| Criteria |
Approval Period |
| For secondary prevention of cerebrovascular occlusion and embolization in patients who have experienced recurrent TIA or stroke while receiving ASA alone. |
Indefinite |
Practitioner Exemptions
Special Notes
Special Authority Request Forms
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