Q0177

Hydroxyzine pamoate, 25 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen

Short Description: Hydroxyzine pamoate 25mg

Coverage Code: Special coverage instructions apply

Action Code: No maintenance for this code

Date Added: April 1, 1998

Effective Date: April 1, 1998

Termination Date:

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