ANALGESICS: NARCOTICS SHORT
Brand Name/Generic Name | NDC/Manufacturer | FFS Clinical Prior Auth Required | PDL Prior Auth Required | Programs |
---|---|---|---|---|
ACETAMINOP-CODEINE 120-12 MG/5 acetaminophen with codeine |
50383007916 HI-TECH/AKORN C |
Yes | No | Medicaid CHIP CSHCN |
ACETAMINOP-CODEINE 120-12 MG/5 acetaminophen with codeine |
00121050404 PHARM ASSOC INC |
Yes | No | Medicaid CHIP CSHCN KHC |
ACETAMINOP-CODEINE 120-12 MG/5 acetaminophen with codeine |
00121050416 PHARM ASSOC INC |
Yes | No | Medicaid CHIP CSHCN KHC |
ACETAMINOP-CODEINE 120-12 MG/5 acetaminophen with codeine |
60432024516 MORTON GROVE PH |
Yes | No | Medicaid CHIP CSHCN KHC |
ACETAMINOPHEN-COD #2 TABLET acetaminophen with codeine |
13107005801 AUROBINDO PHARM |
Yes | No | Medicaid CHIP CSHCN KHC |
ACETAMINOPHEN-COD #2 TABLET acetaminophen with codeine |
00406048301 MALLINCKRODT PH |
Yes | No | Medicaid CHIP CSHCN KHC |
ACETAMINOPHEN-COD #2 TABLET acetaminophen with codeine |
71930005412 EYWA PHARMA INC |
Yes | No | Medicaid CHIP CSHCN |
ACETAMINOPHEN-COD #2 TABLET acetaminophen with codeine |
71930005452 EYWA PHARMA INC |
Yes | No | Medicaid CHIP CSHCN |
ACETAMINOPHEN-COD #2 TABLET acetaminophen with codeine |
00603233721 QUALITEST/PAR P |
Yes | No | Medicaid CHIP CSHCN KHC |
ACETAMINOPHEN-COD #3 TABLET acetaminophen with codeine |
00603233832 QUALITEST/PAR P |
Yes | No | Medicaid CHIP CSHCN KHC |