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Synagis (palivizumab)

MedStar Family Choice follows the American Academy of Pediatrics 2014 guidelines for Synagis (palivizumab) administration (see link below). 

Requests for Synagis (palivizumab) require a completed 2016-2017 Synagis® Seasonal Respiratory Syncytial Virus Enrollment Form (see link below). Please fax completed forms to MFC at 202-243-5496.

If you have questions for MFC, call 855-210-6203.

Click here for the American Academy of Pediatrics 2014 Synagis (palivizumab) Guidelines.

Click here for the Synagis (palivizumab) Prior Authorization Form.

Information current as of: 01/06/17