ANALGESICS: NARCOTICS SHORT | Vendor Drug Program

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	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
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	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 #3 TABLET acetaminophen with codeine	71930005512 EYWA PHARMA INC	Yes	No	Medicaid CHIP CSHCN
ACETAMINOPHEN-COD #3 TABLET acetaminophen with codeine	71930005552 EYWA PHARMA INC	Yes	No	Medicaid CHIP CSHCN
ACETAMINOPHEN-COD #3 TABLET acetaminophen with codeine	13107005901 AUROBINDO PHARM	Yes	No	Medicaid CHIP CSHCN KHC
ACETAMINOPHEN-COD #3 TABLET acetaminophen with codeine	13107005999 AUROBINDO PHARM	Yes	No	Medicaid CHIP CSHCN KHC