A screenshot of a form titled "mentor (fentanyl citrate) buccal tablet CII". The form is titled "formula Results - By Drug" and has a full prescribing information including boxed warning. At the top of the form there is a heading that reads "mentor is covered for 74% of the lives in New Jersey for all plans at Tiers 1-7". Below the heading there are three fields - Horizon 2-Tier (bluegrass BlueShield New Jersey) warp Medicare Rx Preferred VA National formula and Oxford Advantage (NJ). The fields are arranged in a grid-like format with each field representing a different type of medication. The first field is labeled "Horizon 2-Tier" and shows the number of medications available in each category. The second field has a list of restrictions the third field has restrictions and the fourth field has options to copy copy and print. The fifth field has an option to copy and print the medication the sixth field has the option to print it the seventh field has print it and print it. The eighth field has two options - "VA National Formula" and "Oxford Advantage". Overall the form appears to be a form that provides information about the medication and its benefits.
Description 
Type
Category
-
Date
2012
Collection
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