Displaying 1 - 50 of 121 records found.

Items in this class
Brand Name/Generic Name NDC code Clinical Prior Auth Required PDL Prior Auth Required
AMOXICILLIN 125 MG TAB CHEW
amoxicillin
00093226701 No No
AMOXICILLIN 125 MG/5 ML SUSP
amoxicillin
65862070601 No No
AMOXICILLIN 125 MG/5 ML SUSP
amoxicillin
65862070655 No No
AMOXICILLIN 125 MG/5 ML SUSP
amoxicillin
65862070680 No No
AMOXICILLIN 125 MG/5 ML SUSP
amoxicillin
00781603946 No No
AMOXICILLIN 125 MG/5 ML SUSP
amoxicillin
00781603955 No No
AMOXICILLIN 125 MG/5 ML SUSP
amoxicillin
00781603958 No No
AMOXICILLIN 125 MG/5 ML SUSP
amoxicillin
00143988801 No No
AMOXICILLIN 125 MG/5 ML SUSP
amoxicillin
00143988815 No No
AMOXICILLIN 125 MG/5 ML SUSP
amoxicillin
00143988880 No No
AMOXICILLIN 200 MG/5 ML SUSP
amoxicillin
65862007001 No No
AMOXICILLIN 200 MG/5 ML SUSP
amoxicillin
65862007050 No No
AMOXICILLIN 200 MG/5 ML SUSP
amoxicillin
65862007075 No No
AMOXICILLIN 200 MG/5 ML SUSP
amoxicillin
00093416073 No No
AMOXICILLIN 200 MG/5 ML SUSP
amoxicillin
00093416076 No No
AMOXICILLIN 200 MG/5 ML SUSP
amoxicillin
00143988601 No No
AMOXICILLIN 200 MG/5 ML SUSP
amoxicillin
00093416078 No No
AMOXICILLIN 200 MG/5 ML SUSP
amoxicillin
00143988650 No No
AMOXICILLIN 200 MG/5 ML SUSP
amoxicillin
00143988675 No No
AMOXICILLIN 200 MG/5 ML SUSP
amoxicillin
57237003201 No No
AMOXICILLIN 200 MG/5 ML SUSP
amoxicillin
57237003275 No No
AMOXICILLIN 200 MG/5 ML SUSP
amoxicillin
00781615646 No No
AMOXICILLIN 200 MG/5 ML SUSP
amoxicillin
00781615652 No No
AMOXICILLIN 200 MG/5 ML SUSP
amoxicillin
00781615657 No No
AMOXICILLIN 250 MG CAPSULE
amoxicillin
16714029801 No No
AMOXICILLIN 250 MG CAPSULE
amoxicillin
16714029802 No No
AMOXICILLIN 250 MG CAPSULE
amoxicillin
00781202001 No No
AMOXICILLIN 250 MG CAPSULE
amoxicillin
00781202005 No No
AMOXICILLIN 250 MG CAPSULE
amoxicillin
00093310701 No No
AMOXICILLIN 250 MG CAPSULE
amoxicillin
00781202076 No No
AMOXICILLIN 250 MG CAPSULE
amoxicillin
00093310705 No No
AMOXICILLIN 250 MG CAPSULE
amoxicillin
57237003001 No No
AMOXICILLIN 250 MG CAPSULE
amoxicillin
57237003005 No No
AMOXICILLIN 250 MG CAPSULE
amoxicillin
65862001601 No No
AMOXICILLIN 250 MG CAPSULE
amoxicillin
65862001605 No No
AMOXICILLIN 250 MG TAB CHEW
amoxicillin
00093226801 No No
AMOXICILLIN 250 MG/5 ML SUSP
amoxicillin
00143988901 No No
AMOXICILLIN 250 MG/5 ML SUSP
amoxicillin
00143988915 No No
AMOXICILLIN 250 MG/5 ML SUSP
amoxicillin
00143988980 No No
AMOXICILLIN 250 MG/5 ML SUSP
amoxicillin
65862070701 No No
AMOXICILLIN 250 MG/5 ML SUSP
amoxicillin
65862070755 No No
AMOXICILLIN 250 MG/5 ML SUSP
amoxicillin
65862070780 No No
AMOXICILLIN 250 MG/5 ML SUSP
amoxicillin
00093415573 No No
AMOXICILLIN 250 MG/5 ML SUSP
amoxicillin
00093415579 No No
AMOXICILLIN 250 MG/5 ML SUSP
amoxicillin
00093415580 No No
AMOXICILLIN 250 MG/5 ML SUSP
amoxicillin
00781604146 No No
AMOXICILLIN 250 MG/5 ML SUSP
amoxicillin
00781604155 No No
AMOXICILLIN 250 MG/5 ML SUSP
amoxicillin
00781604158 No No
AMOXICILLIN 400 MG/5 ML SUSP
amoxicillin
00781615752 No No
AMOXICILLIN 400 MG/5 ML SUSP
amoxicillin
00781615757 No No