ANXIOLYTICS | Vendor Drug Program

Brand Name/Generic Name	NDC/Manufacturer	FFS Clinical Prior Auth Required	PDL Prior Auth Required	Programs
ALPRAZOLAM 0.25 MG TABLET alprazolam	47335060318 SUN PHARMA GLOB	Yes	No	Medicaid CHIP CSHCN
ALPRAZOLAM 0.25 MG TABLET alprazolam	47335060388 SUN PHARMA GLOB	Yes	No	Medicaid CHIP CSHCN
ALPRAZOLAM 0.25 MG TABLET alprazolam	00228202710 ACTAVIS/TEVA	Yes	No	Medicaid CHIP CSHCN
ALPRAZOLAM 0.25 MG TABLET alprazolam	00228202750 ACTAVIS/TEVA	Yes	No	Medicaid CHIP CSHCN
ALPRAZOLAM 0.25 MG TABLET alprazolam	00228202796 ACTAVIS/TEVA	Yes	No	Medicaid CHIP CSHCN
ALPRAZOLAM 0.25 MG TABLET alprazolam	59762371901 GREENSTONE LLC.	Yes	No	Medicaid CHIP CSHCN
ALPRAZOLAM 0.25 MG TABLET alprazolam	59762371903 GREENSTONE LLC.	Yes	No	Medicaid CHIP CSHCN
ALPRAZOLAM 0.25 MG TABLET alprazolam	00781106101 SANDOZ	Yes	No	Medicaid CHIP CSHCN
ALPRAZOLAM 0.25 MG TABLET alprazolam	59762371904 GREENSTONE LLC.	Yes	No	Medicaid CHIP CSHCN
ALPRAZOLAM 0.25 MG TABLET alprazolam	00781106105 SANDOZ	Yes	No	Medicaid CHIP CSHCN