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| Brand Name/Generic Name/Package Size | NDC/Manufacturer/Class | PA Required | Programs/Coverage Dates |
|---|---|---|---|
| AMLODIPINE-ATORVAST 5-40 MG amlodipine/atorvastatin 30 EA |
60505348803 APOTEX CORP LIPOTROPICS: STATINS |
FFS Clinical: Yes PDL: Yes |
Medicaid start: 04/21/2021 CHIP start: 04/21/2021 CSHCN start: 04/21/2021 KHC start: 04/21/2021 |
| AMLODIPINE-ATORVAST 5-40 MG amlodipine/atorvastatin 30 EA |
43598031630 DR.REDDY'S LAB LIPOTROPICS: STATINS |
FFS Clinical: Yes PDL: Yes |
Medicaid start: 08/08/2014 Medicaid end: 12/31/2023 CHIP start: 08/08/2014 CHIP end: 12/31/2023 CSHCN start: 08/08/2014 CSHCN end: 12/31/2023 KHC start: 08/08/2014 KHC end: 12/31/2023 |
| AMLODIPINE-ATORVAST 5-40 MG amlodipine/atorvastatin 90 EA |
43598031690 DR.REDDY'S LAB LIPOTROPICS: STATINS |
FFS Clinical: Yes PDL: Yes |
Medicaid start: 09/29/2014 Medicaid end: 12/31/2023 CHIP start: 09/29/2014 CHIP end: 12/31/2023 CSHCN start: 09/29/2014 CSHCN end: 12/31/2023 KHC start: 09/29/2014 KHC end: 12/31/2023 |
| AMLODIPINE-ATORVAST 5-40 MG amlodipine/atorvastatin 30 EA |
66993026830 PRASCO LABS LIPOTROPICS: STATINS |
FFS Clinical: Yes PDL: Yes |
Medicaid start: 10/31/2022 CHIP start: 10/31/2022 CSHCN start: 10/31/2022 |
| AMLODIPINE-ATORVAST 5-40 MG amlodipine/atorvastatin 30 EA |
00378451593 MYLAN LIPOTROPICS: STATINS |
FFS Clinical: Yes PDL: Yes |
Medicaid start: 04/11/2019 CHIP start: 04/11/2019 CSHCN start: 04/11/2019 KHC start: 04/11/2019 |
| AMLODIPINE-ATORVAST 5-80 MG amlodipine/atorvastatin 30 EA |
43598031430 DR.REDDY'S LAB LIPOTROPICS: STATINS |
FFS Clinical: Yes PDL: Yes |
Medicaid start: 08/13/2014 Medicaid end: 12/31/2023 CHIP start: 08/13/2014 CHIP end: 12/31/2023 CSHCN start: 08/13/2014 CSHCN end: 12/31/2023 KHC start: 08/13/2014 KHC end: 12/31/2023 |
| AMLODIPINE-ATORVAST 5-80 MG amlodipine/atorvastatin 30 EA |
60505349203 APOTEX CORP LIPOTROPICS: STATINS |
FFS Clinical: Yes PDL: Yes |
Medicaid start: 04/21/2021 CHIP start: 04/21/2021 CSHCN start: 04/21/2021 KHC start: 04/21/2021 |
| AMLODIPINE-ATORVAST 5-80 MG amlodipine/atorvastatin 30 EA |
66993026930 PRASCO LABS LIPOTROPICS: STATINS |
FFS Clinical: Yes PDL: Yes |
Medicaid start: 10/31/2022 CHIP start: 10/31/2022 CSHCN start: 10/31/2022 |
| AMLODIPINE-OLMESARTAN 10-20 MG amlodipine bes/olmesartan med 30 EA |
42571023630 MICRO LABS USA, ANGIOTENSIN MODULATOR COMBINATIONS |
FFS Clinical: Yes PDL: Yes |
Medicaid start: 01/03/2020 CHIP start: 01/03/2020 CSHCN start: 01/03/2020 |
| AMLODIPINE-OLMESARTAN 10-20 MG amlodipine bes/olmesartan med 30 EA |
13668031230 TORRENT PHARMAC ANGIOTENSIN MODULATOR COMBINATIONS |
FFS Clinical: Yes PDL: Yes |
Medicaid start: 09/27/2017 Medicaid end: 02/28/2024 CHIP start: 09/27/2017 CHIP end: 02/28/2024 CSHCN start: 09/27/2017 CSHCN end: 02/28/2024 |
| AMLODIPINE-OLMESARTAN 10-20 MG amlodipine bes/olmesartan med 90 EA |
42571023690 MICRO LABS USA, ANGIOTENSIN MODULATOR COMBINATIONS |
FFS Clinical: Yes PDL: Yes |
Medicaid start: 12/15/2020 CHIP start: 12/15/2020 CSHCN start: 12/15/2020 |
| AMLODIPINE-OLMESARTAN 10-20 MG amlodipine bes/olmesartan med 90 EA |
13668031290 TORRENT PHARMAC ANGIOTENSIN MODULATOR COMBINATIONS |
FFS Clinical: Yes PDL: Yes |
Medicaid start: 09/27/2017 Medicaid end: 02/28/2024 CHIP start: 09/27/2017 CHIP end: 02/28/2024 CSHCN start: 09/27/2017 CSHCN end: 02/28/2024 |
| AMLODIPINE-OLMESARTAN 10-20 MG amlodipine bes/olmesartan med 30 EA |
65862085630 AUROBINDO PHARM ANGIOTENSIN MODULATOR COMBINATIONS |
FFS Clinical: Yes PDL: Yes |
Medicaid start: 09/07/2017 CHIP start: 09/07/2017 CSHCN start: 09/07/2017 |
| AMLODIPINE-OLMESARTAN 10-20 MG amlodipine bes/olmesartan med 30 EA |
68462056730 GLENMARK PHARMA ANGIOTENSIN MODULATOR COMBINATIONS |
FFS Clinical: Yes PDL: Yes |
Medicaid start: 06/15/2020 CHIP start: 06/15/2020 CSHCN start: 06/15/2020 |
| AMLODIPINE-OLMESARTAN 10-20 MG amlodipine bes/olmesartan med 90 EA |
68462056790 GLENMARK PHARMA ANGIOTENSIN MODULATOR COMBINATIONS |
FFS Clinical: Yes PDL: Yes |
Medicaid start: 06/15/2020 CHIP start: 06/15/2020 CSHCN start: 06/15/2020 |
| AMLODIPINE-OLMESARTAN 10-20 MG amlodipine bes/olmesartan med 30 EA |
62332021430 ALEMBIC PHARMAC ANGIOTENSIN MODULATOR COMBINATIONS |
FFS Clinical: Yes PDL: Yes |
Medicaid start: 02/05/2018 CHIP start: 02/05/2018 CSHCN start: 02/05/2018 |
| AMLODIPINE-OLMESARTAN 10-20 MG amlodipine bes/olmesartan med 30 EA |
27241008503 AJANTA PHARMA L ANGIOTENSIN MODULATOR COMBINATIONS |
FFS Clinical: Yes PDL: Yes |
Medicaid start: 02/17/2017 CHIP start: 02/17/2017 CSHCN start: 02/17/2017 |
| AMLODIPINE-OLMESARTAN 10-20 MG amlodipine bes/olmesartan med 30 EA |
57664077383 SUN PHARMACEUTI ANGIOTENSIN MODULATOR COMBINATIONS |
FFS Clinical: Yes PDL: Yes |
Medicaid start: 02/21/2017 Medicaid end: 02/28/2024 CHIP start: 02/21/2017 CHIP end: 02/28/2024 CSHCN start: 02/21/2017 CSHCN end: 02/28/2024 |
| AMLODIPINE-OLMESARTAN 10-20 MG amlodipine bes/olmesartan med 90 EA |
27241008509 AJANTA PHARMA L ANGIOTENSIN MODULATOR COMBINATIONS |
FFS Clinical: Yes PDL: Yes |
Medicaid start: 02/17/2017 CHIP start: 02/17/2017 CSHCN start: 02/17/2017 |
| AMLODIPINE-OLMESARTAN 10-20 MG amlodipine bes/olmesartan med 90 EA |
57664077399 SUN PHARMACEUTI ANGIOTENSIN MODULATOR COMBINATIONS |
FFS Clinical: Yes PDL: Yes |
Medicaid start: 02/21/2017 Medicaid end: 02/28/2024 CHIP start: 02/21/2017 CHIP end: 02/28/2024 CSHCN start: 02/21/2017 CSHCN end: 02/28/2024 |
| AMLODIPINE-OLMESARTAN 10-20 MG amlodipine bes/olmesartan med 30 EA |
33342019207 MACLEODS PHARMA ANGIOTENSIN MODULATOR COMBINATIONS |
FFS Clinical: Yes PDL: Yes |
Medicaid start: 08/16/2017 CHIP start: 08/16/2017 CSHCN start: 08/16/2017 |
| AMLODIPINE-OLMESARTAN 10-20 MG amlodipine bes/olmesartan med 90 EA |
33342019210 MACLEODS PHARMA ANGIOTENSIN MODULATOR COMBINATIONS |
FFS Clinical: Yes PDL: Yes |
Medicaid start: 08/16/2017 CHIP start: 08/16/2017 CSHCN start: 08/16/2017 |
| AMLODIPINE-OLMESARTAN 10-20 MG amlodipine bes/olmesartan med 30 EA |
67877050030 ASCEND LABORATO ANGIOTENSIN MODULATOR COMBINATIONS |
FFS Clinical: Yes PDL: Yes |
Medicaid start: 11/07/2022 CHIP start: 11/07/2022 CSHCN start: 11/07/2022 |
| AMLODIPINE-OLMESARTAN 10-40 MG amlodipine bes/olmesartan med 30 EA |
13668031130 TORRENT PHARMAC ANGIOTENSIN MODULATOR COMBINATIONS |
FFS Clinical: Yes PDL: Yes |
Medicaid start: 09/27/2017 Medicaid end: 02/28/2024 CHIP start: 09/27/2017 CHIP end: 02/28/2024 CSHCN start: 09/27/2017 CSHCN end: 02/28/2024 |
| AMLODIPINE-OLMESARTAN 10-40 MG amlodipine bes/olmesartan med 90 EA |
13668031190 TORRENT PHARMAC ANGIOTENSIN MODULATOR COMBINATIONS |
FFS Clinical: Yes PDL: Yes |
Medicaid start: 09/27/2017 Medicaid end: 02/28/2024 CHIP start: 09/27/2017 CHIP end: 02/28/2024 CSHCN start: 09/27/2017 CSHCN end: 02/28/2024 |