ANTIEMETIC/ANTIVERTIGO AGENTS | Vendor Drug Program

Brand Name/Generic Name	NDC/Manufacturer	FFS Clinical Prior Auth Required	PDL Prior Auth Required	Programs
MECLIZINE 12.5 MG TABLET meclizine HCl	16571066050 RISING PHARM	Yes	No	Medicaid CHIP CSHCN
MECLIZINE 12.5 MG TABLET meclizine HCl	42806001201 EPIC PHARMA LLC	Yes	No	Medicaid CHIP CSHCN
MECLIZINE 12.5 MG TABLET meclizine HCl	42806001210 EPIC PHARMA LLC	Yes	No	Medicaid CHIP CSHCN
MECLIZINE 12.5 MG TABLET meclizine HCl	00904651661 MAJOR PHARMACEU	Yes	No	Medicaid CHIP CSHCN KHC
MECLIZINE 12.5 MG TABLET meclizine HCl	68001052800 BLUEPOINT LABOR	Yes	No	Medicaid CSHCN
MECLIZINE 12.5 MG TABLET meclizine HCl	65162044110 AMNEAL PHARMACE	Yes	No	Medicaid CHIP CSHCN KHC
MECLIZINE 12.5 MG TABLET meclizine HCl	65162044111 AMNEAL PHARMACE	Yes	No	Medicaid CHIP CSHCN KHC
MECLIZINE 12.5 MG TABLET meclizine HCl	70710116100 ZYDUS PHARMACEU	Yes	No	Medicaid CHIP CSHCN
MECLIZINE 25 MG TABLET meclizine HCl	65162044210 AMNEAL PHARMACE	Yes	No	Medicaid CHIP CSHCN KHC
MECLIZINE 25 MG TABLET meclizine HCl	59746012106 JUBILANT CADIST	Yes	No	Medicaid CHIP CSHCN