ANTIDEPRESSANTS: OTHER | Vendor Drug Program

Brand Name/Generic Name	NDC/Manufacturer	FFS Clinical Prior Auth Required	PDL Prior Auth Required	Programs
BUPROPION HCL 100 MG TABLET bupropion HCl	60505015701 APOTEX CORP	No	No	Medicaid CHIP CSHCN HTW KHC
BUPROPION HCL 100 MG TABLET bupropion HCl	68001030900 BLUEPOINT LABOR	No	No	Medicaid CHIP CSHCN
BUPROPION HCL 100 MG TABLET bupropion HCl	23155019201 AVET PHARMACEUT	No	No	Medicaid CHIP CSHCN
BUPROPION HCL 100 MG TABLET bupropion HCl	00904663661 MAJOR PHARMACEU	No	No	Medicaid CHIP CSHCN HTW KHC
BUPROPION HCL 75 MG TABLET bupropion HCl	68001030800 BLUEPOINT LABOR	No	No	Medicaid CHIP CSHCN
BUPROPION HCL 75 MG TABLET bupropion HCl	23155019101 AVET PHARMACEUT	No	No	Medicaid CHIP CSHCN
BUPROPION HCL 75 MG TABLET bupropion HCl	60505015801 APOTEX CORP	No	No	Medicaid CHIP CSHCN HTW KHC
BUPROPION HCL 75 MG TABLET bupropion HCl	00904663561 MAJOR PHARMACEU	No	No	Medicaid CHIP CSHCN HTW KHC
BUPROPION HCL SR 100 MG TABLET bupropion HCl	47335073686 SUN PHARMA GLOB	No	No	Medicaid CHIP CSHCN HTW
BUPROPION HCL SR 100 MG TABLET bupropion HCl	43598075101 DR.REDDY'S LAB	No	No	Medicaid CHIP CSHCN HTW KHC