Displaying 1 - 50 of 88 records found.

Items in this class
Brand Name/Generic Name NDC code Clinical Prior Auth Required PDL Prior Auth Required
ACETAMINOPHEN CONGST-PAIN CPLT
phenylephrine HCl/acetaminophn
00904676024 No Yes
ALA-HIST IR 2 MG TABLET
dexbrompheniramine maleate
50991078360 Yes No
ALA-HIST PE 2-10 MG TABLET
dexbrompheniramin/phenylephrin
50991078260 Yes No
ALA-HIST PE 2-10 MG TABLET
dexbrompheniramin/phenylephrin
50991078290 Yes No
ALLERGY MULTI-SYMPTOM CAPLET
phenylephrine/acetaminophn/cpm
70000021101 Yes Yes
APRODINE TABLET
triprolidine/pseudoephedrine
00904025024 Yes No
APRODINE TABLET
triprolidine/pseudoephedrine
00904025059 Yes No
CHEST CONGEST RLF 400 MG TAB
guaifenesin
70000045201 Yes No
CHILD COLD-ALLERGY LIQUID
brompheniramine/phenylephrine
70000018801 Yes No
CHILD MUCINEX CHEST 100 MG PKT
guaifenesin
63824025412 Yes No
CHILD MUCINEX NIGHT TIME LIQ
diphenhyd/phenyleph/acetaminop
63824060064 Yes No
COUGH SYRUP 200 MG/10 ML
guaifenesin
00536109597 Yes No
DECONEX IR 385-10 MG TABLET
guaifenesin/phenylephrine HCl
50991073690 Yes No
DEXBROMPHENIR-PHENYLEPH 2-10MG
dexbrompheniramin/phenylephrin
69367019760 Yes Yes
DIMAPHEN ELIXIR
brompheniramine/phenylephrine
00904646220 Yes No
DOXYLAMINE-PHENYLEPH 7.5-10 MG
doxylamine/phenylephrine HCl
69367019901 Yes Yes
ED A-HIST LIQUID
chlorpheniramine/phenylephrine
00485015516 Yes No
ED BRON GP LIQUID
guaifenesin/phenylephrine HCl
00485020816 Yes No
ED-A-HIST 4 MG-10 MG TABLET
chlorpheniramine/phenylephrine
00485025401 Yes No
ED-A-HIST PSE TABLET
triprolidine/pseudoephedrine
00485021001 Yes Yes
GUAIFENESIN 100 MG/5 ML SYRUP
guaifenesin
00536082585 Yes No
GUAIFENESIN-PSE 375-60 MG TAB
guaifenesin/pseudoephedrne HCl
42195028110 No Yes
GUAIFENESIN-PSE ER 1200-120 MG
guaifenesin/pseudoephedrne HCl
55111079924 Yes No
GUAIFENESIN-PSE ER 600-60 MG
guaifenesin/pseudoephedrne HCl
45802023068 Yes No
GUAIFENESIN-PSE ER 600-60 MG
guaifenesin/pseudoephedrne HCl
45802023089 Yes No
HISTEX-PE SYRUP
phenylephrine HCl/triprolidine
28595080316 Yes No
LODRANE D CAPSULE
brompheniramin/pseudoephedrine
00095086006 Yes Yes
LOHIST-D LIQUID
chlorpheniramine/pseudoephed
68047012016 Yes Yes
MAPAP SINUS CAPLET
phenylephrine HCl/acetaminophn
00904578324 No Yes
MUCINEX D ER 1,200-120 MG TAB
guaifenesin/pseudoephedrne HCl
63824004124 Yes No
MUCINEX D ER 600-60 MG TABLET
guaifenesin/pseudoephedrne HCl
63824005718 Yes No
MUCINEX D ER 600-60 MG TABLET
guaifenesin/pseudoephedrne HCl
63824005736 Yes No
MUCINEX ER 1,200 MG TABLET
guaifenesin
63824002335 Yes No
MUCINEX ER 1,200 MG TABLET
guaifenesin
63824002336 Yes No
MUCINEX ER 1,200 MG TABLET
guaifenesin
63824002346 Yes No
MUCINEX ER 600 MG TABLET
guaifenesin
63824000832 Yes No
MUCINEX ER 600 MG TABLET
guaifenesin
63824000834 Yes No
MUCINEX ER 600 MG TABLET
guaifenesin
63824000850 Yes No
MUCINEX FAST-MAX COLD-SINUS TB
guaifen/phenyleph/acetaminophn
63824019020 No No
MUCINEX FAST-MAX NITE COLD-FLU
diphenhyd/phenyleph/acetaminop
63824050066 Yes Yes
MUCUS RELIEF 400 MG TABLET
guaifenesin
00904623252 Yes No
MUCUS RELIEF 400 MG TABLET
guaifenesin
00904681546 Yes No
MUCUS RELIEF 400 MG TABLET
guaifenesin
00904681552 Yes No
MUCUS RELIEF D ER 600-60 MG TB
guaifenesin/pseudoephedrne HCl
00536120521 Yes Yes
MUCUS RELIEF D ER 600-60 MG TB
guaifenesin/pseudoephedrne HCl
00536120536 Yes Yes
MUCUS RELIEF ER 1,200 MG TAB
guaifenesin
70000047901 Yes No
MUCUS RELIEF ER 1,200 MG TAB
guaifenesin
70000047902 Yes No
MUCUS RELIEF ER 600 MG TABLET
guaifenesin
00904671839 Yes No
MUCUS RELIEF ER 600 MG TABLET
guaifenesin
00904698640 Yes No
MUCUS RELIEF ER 600 MG TABLET
guaifenesin
00536116361 Yes No