ANALGESICS: NARCOTICS SHORT | Vendor Drug Program

Brand Name/Generic Name	NDC/Manufacturer	FFS Clinical Prior Auth Required	PDL Prior Auth Required	Programs
ACETAMINOPHEN-COD #4 TABLET acetaminophen with codeine	13107006099 AUROBINDO PHARM	Yes	No	Medicaid CHIP CSHCN KHC
ENDOCET 10-325 MG TABLET oxycodone HCl/acetaminophen	60951071270 QUALITEST/PAR P	Yes	No	Medicaid CHIP
ENDOCET 5-325 MG TABLET oxycodone HCl/acetaminophen	60951060270 QUALITEST/PAR P	Yes	No	Medicaid CHIP CSHCN KHC
ENDOCET 5-325 MG TABLET oxycodone HCl/acetaminophen	60951060285 QUALITEST/PAR P	Yes	No	Medicaid CHIP CSHCN KHC
ENDOCET 7.5-325 MG TABLET oxycodone HCl/acetaminophen	60951070070 QUALITEST/PAR P	Yes	No	Medicaid CHIP
HYDROCODONE-ACETAMIN 10-300 MG hydrocodone/acetaminophen	10702019401 KVK-TECH, INC.	Yes	No	Medicaid CHIP CSHCN
HYDROCODONE-ACETAMIN 10-300 MG hydrocodone/acetaminophen	13107021301 AUROBINDO PHARM	Yes	No	Medicaid CHIP CSHCN KHC
HYDROCODONE-ACETAMIN 10-300 MG hydrocodone/acetaminophen	13107021305 AUROBINDO PHARM	Yes	No	Medicaid CHIP CSHCN KHC
HYDROCODONE-ACETAMIN 10-300 MG hydrocodone/acetaminophen	27808011601 TRIS PHARMA INC	Yes	No	Medicaid CHIP CSHCN
HYDROCODONE-ACETAMIN 10-300 MG hydrocodone/acetaminophen	27808011602 TRIS PHARMA INC	Yes	No	Medicaid CHIP CSHCN