Displaying 251 - 300 of 5958 records found.

Items in this class
Brand Name/Generic Name NDC code Clinical Prior Auth Required PDL Prior Auth Required
AMMONIUM LACTATE 12% LOTION
ammonium lactate
51672130009 No No
AMMONIUM LACTATE 12% LOTION
ammonium lactate
45802041926 No No
AMMONIUM LACTATE 12% LOTION
ammonium lactate
45802041954 No No
AMPHOTERICIN B 50 MG VIAL
amphotericin B
39822105505 No No
AMPICILLIN 1 GM VIAL
ampicillin sodium
00781340495 No No
AMPICILLIN 1 GM VIAL
ampicillin sodium
63323038910 No No
AMPICILLIN 1 GM VIAL
ampicillin sodium
44567010210 No No
AMPICILLIN 1 GM VIAL
ampicillin sodium
00781926195 No No
AMPICILLIN 10 GM VIAL
ampicillin sodium
00781340995 No No
AMPICILLIN 10 GM VIAL
ampicillin sodium
44567010410 No No
AMPICILLIN 125 MG VIAL
ampicillin sodium
00781340095 No No
AMPICILLIN 2 GM VIAL
ampicillin sodium
00781340895 No No
AMPICILLIN 2 GM VIAL
ampicillin sodium
44567010310 No No
AMPICILLIN 2 GM VIAL
ampicillin sodium
00781927395 No No
AMPICILLIN 250 MG VIAL
ampicillin sodium
00781340295 No No
AMPICILLIN 250 MG VIAL
ampicillin sodium
00781924295 No No
AMPICILLIN 500 MG VIAL
ampicillin sodium
63323038810 No No
AMPICILLIN 500 MG VIAL
ampicillin sodium
00781340795 No No
AMPICILLIN 500 MG VIAL
ampicillin sodium
44567010110 No No
AMPICILLIN 500 MG VIAL
ampicillin sodium
00781925095 No No
AMPICILLIN-SULBACTAM 1.5 GM VL
ampicillin sodium/sulbactam Na
44567021010 No No
AMPICILLIN-SULBACTAM 15 GM VL
ampicillin sodium/sulbactam Na
44567021201 No No
AMPICILLIN-SULBACTAM 3 GM VIAL
ampicillin sodium/sulbactam Na
44567021110 No No
AMPICILLIN-SULBACTAM 3 GM VIAL
ampicillin sodium/sulbactam Na
00781303395 No No
AMPYRA ER 10 MG TABLET
dalfampridine
10144042760 No No
ANADROL-50 TABLET
oxymetholone
68220005510 No No
ANAGRELIDE HCL 0.5 MG CAPSULE
anagrelide HCl
13668045301 No No
ANAGRELIDE HCL 0.5 MG CAPSULE
anagrelide HCl
00172524160 No No
ANAGRELIDE HCL 1 MG CAPSULE
anagrelide HCl
13668046201 No No
ANAGRELIDE HCL 1 MG CAPSULE
anagrelide HCl
00172524060 No No
ANASPAZ 0.125 MG TABLET ODT
hyoscyamine sulfate
00225029515 No No
ANASPAZ 0.125 MG TABLET ODT
hyoscyamine sulfate
00225029520 No No
ANASTROZOLE 1 MG TABLET
anastrozole
00378603405 No No
ANASTROZOLE 1 MG TABLET
anastrozole
00378603477 No No
ANASTROZOLE 1 MG TABLET
anastrozole
16571042103 No No
ANASTROZOLE 1 MG TABLET
anastrozole
16729003510 No No
ANASTROZOLE 1 MG TABLET
anastrozole
16729003515 No No
ANASTROZOLE 1 MG TABLET
anastrozole
16729003516 No No
ANASTROZOLE 1 MG TABLET
anastrozole
62756025013 No No
ANASTROZOLE 1 MG TABLET
anastrozole
62756025083 No No
ANASTROZOLE 1 MG TABLET
anastrozole
51991062010 No No
ANASTROZOLE 1 MG TABLET
anastrozole
51991062033 No No
ANASTROZOLE 1 MG TABLET
anastrozole
68001015504 No No
ANASTROZOLE 1 MG TABLET
anastrozole
68001015508 No No
ANASTROZOLE 1 MG TABLET
anastrozole
00904619546 No No
ANASTROZOLE 1 MG TABLET
anastrozole
68382020906 No No
ANASTROZOLE 1 MG TABLET
anastrozole
68382020910 No No
ANASTROZOLE 1 MG TABLET
anastrozole
00093753656 No No
ANDROXY 10 MG TABLET
fluoxymesterone
00832008600 No No
ANGELIQ 0.5 MG-1 MG TABLET
drospirenone/estradiol
50419048303 No No