Displaying 1 - 5 of 5 records found.

Items in this class
Brand Name/Generic Name NDC code Clinical Prior Auth Required PDL Prior Auth Required
ACETIC ACID 2% EAR SOLUTION
acetic acid
50383088915 No No
ACETIC ACID 2% EAR SOLUTION
acetic acid
60432074115 No No
HYDROCORTISON-ACETIC ACID SOLN
hydrocortisone/acetic acid
45963041261 No Yes
HYDROCORTISON-ACETIC ACID SOLN
hydrocortisone/acetic acid
50383090110 No Yes
PINNACAINE 20% OTIC DROPS
benzocaine
68047005715 No Yes