Displaying 1 - 50 of 71 records found.

Items in this class
Brand Name/Generic Name NDC code Clinical Prior Auth Required PDL Prior Auth Required
DIFICID 200 MG TABLET
fidaxomicin
52015008001 No Yes
FIRVANQ 25 MG/ML SOLUTION
vancomycin HCl
65628020405 No No
FIRVANQ 25 MG/ML SOLUTION
vancomycin HCl
65628020510 No No
FIRVANQ 50 MG/ML SOLUTION
vancomycin HCl
65628020605 No No
FIRVANQ 50 MG/ML SOLUTION
vancomycin HCl
65628020810 No No
FLAGYL 250 MG TABLET
metronidazole
00025183131 No Yes
FLAGYL 375 CAPSULE
metronidazole
00025194250 No Yes
FLAGYL 500 MG TABLET
metronidazole
00025182131 No Yes
METRONIDAZOLE 250 MG TABLET
metronidazole
29300022605 No No
METRONIDAZOLE 250 MG TABLET
metronidazole
29300022652 No No
METRONIDAZOLE 250 MG TABLET
metronidazole
72578000701 No No
METRONIDAZOLE 250 MG TABLET
metronidazole
72578000705 No No
METRONIDAZOLE 250 MG TABLET
metronidazole
72578000721 No No
METRONIDAZOLE 250 MG TABLET
metronidazole
68001022903 No No
METRONIDAZOLE 250 MG TABLET
metronidazole
50111033301 No No
METRONIDAZOLE 250 MG TABLET
metronidazole
68001036400 No No
METRONIDAZOLE 250 MG TABLET
metronidazole
50111033302 No No
METRONIDAZOLE 250 MG TABLET
metronidazole
68001036413 No No
METRONIDAZOLE 250 MG TABLET
metronidazole
50111033306 No No
METRONIDAZOLE 250 MG TABLET
metronidazole
69292020750 No No
METRONIDAZOLE 250 MG TABLET
metronidazole
62332001631 No No
METRONIDAZOLE 250 MG TABLET
metronidazole
62332001671 No No
METRONIDAZOLE 250 MG TABLET
metronidazole
00904145361 No No
METRONIDAZOLE 250 MG TABLET
metronidazole
23155065101 No No
METRONIDAZOLE 250 MG TABLET
metronidazole
23155065105 No No
METRONIDAZOLE 250 MG TABLET
metronidazole
29300022601 No No
METRONIDAZOLE 375 MG CAPSULE
metronidazole
62332001850 No Yes
METRONIDAZOLE 500 MG TABLET
metronidazole
29300022701 No No
METRONIDAZOLE 500 MG TABLET
metronidazole
29300022705 No No
METRONIDAZOLE 500 MG TABLET
metronidazole
29300022746 No No
METRONIDAZOLE 500 MG TABLET
metronidazole
72578000801 No No
METRONIDAZOLE 500 MG TABLET
metronidazole
72578000805 No No
METRONIDAZOLE 500 MG TABLET
metronidazole
72578000818 No No
METRONIDAZOLE 500 MG TABLET
metronidazole
68001036500 No No
METRONIDAZOLE 500 MG TABLET
metronidazole
50111033401 No No
METRONIDAZOLE 500 MG TABLET
metronidazole
68001036503 No No
METRONIDAZOLE 500 MG TABLET
metronidazole
50111033402 No No
METRONIDAZOLE 500 MG TABLET
metronidazole
69292020650 No No
METRONIDAZOLE 500 MG TABLET
metronidazole
69292020850 No No
METRONIDAZOLE 500 MG TABLET
metronidazole
62332001731 No No
METRONIDAZOLE 500 MG TABLET
metronidazole
62332001771 No No
NEOMYCIN 500 MG TABLET
neomycin sulfate
50383056510 No No
NEOMYCIN 500 MG TABLET
neomycin sulfate
00093117701 No No
PAROMOMYCIN 250 MG CAPSULE
paromomycin sulfate
57664017508 No Yes
PAROMOMYCIN 250 MG CAPSULE
paromomycin sulfate
23155003801 No Yes
TINIDAZOLE 250 MG TABLET
tinidazole
64980042602 No No
TINIDAZOLE 250 MG TABLET
tinidazole
42799020701 No No
TINIDAZOLE 250 MG TABLET
tinidazole
43386055004 No No
TINIDAZOLE 250 MG TABLET
tinidazole
00054034716 No No
TINIDAZOLE 500 MG TABLET
tinidazole
64980042712 No No