COUGH AND COLD: COLD | Vendor Drug Program

Brand Name/Generic Name	NDC/Manufacturer	FFS Clinical Prior Auth Required	PDL Prior Auth Required	Programs
ED-A-HIST 4 MG-10 MG TABLET chlorpheniramine/phenylephrine	00485025401 EDWARDS PHARM.	Yes	No	Medicaid CSHCN
GUAIFENESIN ER 600 MG TABLET guaifenesin	70010019905 GRANULES PHARMA	Yes	No	Medicaid CSHCN
GUAIFENESIN-PSE ER 1200-120 MG guaifenesin/pseudoephedrne HCl	55111079924 DR.REDDY'S LAB	Yes	No	Medicaid CSHCN
GUAIFENESIN-PSE ER 600-60 MG guaifenesin/pseudoephedrne HCl	55111079818 DR.REDDY'S LAB	Yes	No	Medicaid CSHCN
GUAIFENESIN-PSE ER 600-60 MG guaifenesin/pseudoephedrne HCl	55111079835 DR.REDDY'S LAB	Yes	No	Medicaid CSHCN
GUAIFENESIN-PSE ER 600-60 MG guaifenesin/pseudoephedrne HCl	55111079836 DR.REDDY'S LAB	Yes	No	Medicaid CSHCN
GUAIFENESIN-PSE ER 600-60 MG guaifenesin/pseudoephedrne HCl	00536133321 RUGBY	Yes	No	Medicaid CSHCN
GUAIFENESIN-PSE ER 600-60 MG guaifenesin/pseudoephedrne HCl	55111079841 DR.REDDY'S LAB	Yes	No	Medicaid CSHCN
GUAIFENESIN-PSE ER 600-60 MG guaifenesin/pseudoephedrne HCl	00536133336 RUGBY	Yes	No	Medicaid CSHCN
MUCUS RELIEF D ER 1,200-120 MG guaifenesin/pseudoephedrne HCl	70000060801 LEADER	Yes	No	Medicaid CSHCN