MACROLIDES/KETOLIDES | Vendor Drug Program

Brand Name/Generic Name	NDC/Manufacturer	FFS Clinical Prior Auth Required	PDL Prior Auth Required	Programs
AZITHROMYCIN 1 GM PWD PACKET azithromycin	59762305101 GREENSTONE LLC.	No	No	Medicaid CHIP CSHCN HTW
AZITHROMYCIN 1 GM PWD PACKET azithromycin	59762305102 GREENSTONE LLC.	No	No	Medicaid CHIP CSHCN HTW
AZITHROMYCIN 100 MG/5 ML SUSP azithromycin	00093202723 TEVA USA	No	No	Medicaid CHIP CSHCN KHC
AZITHROMYCIN 100 MG/5 ML SUSP azithromycin	70710145701 ZYDUS PHARMACEU	No	No	Medicaid CHIP CSHCN
AZITHROMYCIN 100 MG/5 ML SUSP azithromycin	59651000715 AUROBINDO PHARM	No	No	Medicaid CHIP CSHCN
AZITHROMYCIN 100 MG/5 ML SUSP azithromycin	59762311001 GREENSTONE LLC.	No	No	Medicaid CHIP CSHCN
AZITHROMYCIN 100 MG/5 ML SUSP azithromycin	42806014731 EPIC PHARMA LLC	No	No	Medicaid CHIP CSHCN
AZITHROMYCIN 200 MG/5 ML SUSP azithromycin	00093202631 TEVA USA	No	No	Medicaid CHIP CSHCN KHC
AZITHROMYCIN 200 MG/5 ML SUSP azithromycin	42806014932 EPIC PHARMA LLC	No	No	Medicaid CHIP CSHCN
AZITHROMYCIN 200 MG/5 ML SUSP azithromycin	42806015033 EPIC PHARMA LLC	No	No	Medicaid CHIP CSHCN