Search Results: Formulary Drugs

Displaying 1 - 2 of 2 records found. Return to search page.
Brand Name/Generic Name/Package Size NDC/Manufacturer PDL Class FFS Clinical Prior Auth Required PDL Prior Auth Required Programs
ENEMEEZ MINI ENEMA
docusate sodium
5 ML
17433987603
ALLIANCE LABS,
No No Medicaid CSHCN
ENEMEEZ PLUS MINI ENEMA
docusate sodium/benzocaine
5 ML
17433987703
ALLIANCE LABS,
No No Medicaid CSHCN