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