ANTIFUNGALS: ORAL | Vendor Drug Program

Brand Name/Generic Name	NDC/Manufacturer	FFS Clinical Prior Auth Required	PDL Prior Auth Required	Programs
CLOTRIMAZOLE 10 MG TROCHE clotrimazole	00054814622 WEST-WARD/HIKMA	No	No	Medicaid CHIP CSHCN KHC
CLOTRIMAZOLE 10 MG TROCHE clotrimazole	00054414622 WEST-WARD/HIKMA	No	No	Medicaid CHIP CSHCN KHC
CLOTRIMAZOLE 10 MG TROCHE clotrimazole	00054414623 ROXANE/WEST-WAR	No	No	Medicaid CHIP CSHCN KHC
CLOTRIMAZOLE 10 MG TROCHE clotrimazole	00574010714 PERRIGO/PADAGIS	No	No	Medicaid CHIP CSHCN KHC
CLOTRIMAZOLE 10 MG TROCHE clotrimazole	00574010770 PADAGIS	No	No	Medicaid CHIP CSHCN KHC
FLUCONAZOLE 10 MG/ML SUSP fluconazole	59762502901 GREENSTONE LLC.	No	No	Medicaid CHIP
FLUCONAZOLE 10 MG/ML SUSP fluconazole	57237014935 RISING PHARM	No	No	Medicaid CHIP CSHCN
FLUCONAZOLE 10 MG/ML SUSP fluconazole	16714069501 NORTHSTAR RX LL	No	No	Medicaid CHIP CSHCN
FLUCONAZOLE 100 MG TABLET fluconazole	68462010230 GLENMARK PHARMA	No	No	Medicaid CHIP CSHCN
FLUCONAZOLE 100 MG TABLET fluconazole	59762501601 GREENSTONE LLC.	No	No	Medicaid CHIP CSHCN