ANTIFUNGALS: ORAL
Brand Name/Generic Name | NDC/Manufacturer | FFS Clinical Prior Auth Required | PDL Prior Auth Required | Programs |
---|---|---|---|---|
CLOTRIMAZOLE 10 MG TROCHE clotrimazole |
00574010714 PERRIGO/PADAGIS |
No | No | Medicaid CHIP CSHCN KHC |
CLOTRIMAZOLE 10 MG TROCHE clotrimazole |
00574010770 PERRIGO/PADAGIS |
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 |
00054814622 WEST-WARD/HIKMA |
No | No | Medicaid CHIP CSHCN KHC |
FLUCONAZOLE 10 MG/ML SUSP fluconazole |
57237014935 RISING PHARM |
No | No | Medicaid CHIP CSHCN |
FLUCONAZOLE 10 MG/ML SUSP fluconazole |
59762502901 GREENSTONE LLC. |
No | No | Medicaid CHIP |
FLUCONAZOLE 10 MG/ML SUSP fluconazole |
16714069501 NORTHSTAR RX LL |
No | No | Medicaid CHIP CSHCN |
FLUCONAZOLE 100 MG TABLET fluconazole |
59762501601 GREENSTONE LLC. |
No | No | Medicaid CHIP CSHCN |
FLUCONAZOLE 100 MG TABLET fluconazole |
67405060203 HARRIS PHARM |
No | No | Medicaid CHIP CSHCN |