Displaying 201 - 250 of 21179 records found. Return to search page.
Search results: Formulary Drugs
Brand Name/Generic Name NDC PDL Class FFS Clinical Prior Auth Required PDL Prior Auth Required Programs
ACYCLOVIR 200 MG CAPSULE
acyclovir
00904578961 ANTIVIRALS: ORAL No No Medicaid, CHIP, CSHCN, KHC, HTW
ACYCLOVIR 200 MG CAPSULE
acyclovir
23155014601 ANTIVIRALS: ORAL No No Medicaid, CHIP, CSHCN, HTW
ACYCLOVIR 200 MG CAPSULE
acyclovir
60505004206 ANTIVIRALS: ORAL No No Medicaid, CHIP, CSHCN, KHC, HTW
ACYCLOVIR 200 MG CAPSULE
acyclovir
61442011101 ANTIVIRALS: ORAL No No Medicaid, CHIP, CSHCN, HTW
ACYCLOVIR 200 MG CAPSULE
acyclovir
61442011105 ANTIVIRALS: ORAL No No Medicaid, CHIP, CSHCN, HTW
ACYCLOVIR 200 MG CAPSULE
acyclovir
69076014601 ANTIVIRALS: ORAL No No Medicaid, CHIP, CSHCN, HTW
ACYCLOVIR 200 MG CAPSULE
acyclovir
75834012401 ANTIVIRALS: ORAL No No Medicaid, CHIP, CSHCN, HTW
ACYCLOVIR 200 MG CAPSULE
acyclovir
23155022901 ANTIVIRALS: ORAL No No Medicaid, CHIP, CSHCN
ACYCLOVIR 200 MG CAPSULE
acyclovir
23155022905 ANTIVIRALS: ORAL No No Medicaid, CHIP, CSHCN
ACYCLOVIR 200 MG/5 ML SUSP
acyclovir
00472008216 ANTIVIRALS: ORAL No No Medicaid, CHIP, CSHCN, KHC
ACYCLOVIR 200 MG/5 ML SUSP
acyclovir
40085084296 ANTIVIRALS: ORAL No No Medicaid, CHIP, CSHCN
ACYCLOVIR 200 MG/5 ML SUSP
acyclovir
50383081016 ANTIVIRALS: ORAL No No Medicaid, CHIP, CSHCN
ACYCLOVIR 400 MG TABLET
acyclovir
00093894301 ANTIVIRALS: ORAL No No Medicaid, CHIP, CSHCN, KHC, HTW
ACYCLOVIR 400 MG TABLET
acyclovir
00093894305 ANTIVIRALS: ORAL No No Medicaid, CHIP, CSHCN, KHC, HTW
ACYCLOVIR 400 MG TABLET
acyclovir
00904579061 ANTIVIRALS: ORAL No No Medicaid, CHIP, CSHCN, HTW
ACYCLOVIR 400 MG TABLET
acyclovir
23155022701 ANTIVIRALS: ORAL No No Medicaid, CHIP, CSHCN, HTW
ACYCLOVIR 400 MG TABLET
acyclovir
23155022705 ANTIVIRALS: ORAL No No Medicaid, CHIP, CSHCN, HTW
ACYCLOVIR 400 MG TABLET
acyclovir
31722077701 ANTIVIRALS: ORAL No No Medicaid, CHIP, CSHCN, KHC, HTW
ACYCLOVIR 400 MG TABLET
acyclovir
31722077705 ANTIVIRALS: ORAL No No Medicaid, CHIP, CSHCN, KHC, HTW
ACYCLOVIR 400 MG TABLET
acyclovir
60505530601 ANTIVIRALS: ORAL No No Medicaid, CHIP, CSHCN, KHC, HTW
ACYCLOVIR 400 MG TABLET
acyclovir
60505530608 ANTIVIRALS: ORAL No No Medicaid, CHIP, CSHCN, KHC, HTW
ACYCLOVIR 400 MG TABLET
acyclovir
61442011201 ANTIVIRALS: ORAL No No Medicaid, CHIP, CSHCN, HTW
ACYCLOVIR 400 MG TABLET
acyclovir
61442011205 ANTIVIRALS: ORAL No No Medicaid, CHIP, CSHCN, KHC, HTW
ACYCLOVIR 400 MG TABLET
acyclovir
63739068210 ANTIVIRALS: ORAL No No Medicaid, CHIP, CSHCN, HTW
ACYCLOVIR 400 MG TABLET
acyclovir
68382079101 ANTIVIRALS: ORAL No No Medicaid, CHIP, CSHCN, HTW
ACYCLOVIR 400 MG TABLET
acyclovir
68382079105 ANTIVIRALS: ORAL No No Medicaid, CHIP, CSHCN, HTW
ACYCLOVIR 5% OINTMENT
acyclovir
00168082515 ANTIVIRALS: TOPICAL No No Medicaid, CHIP, CSHCN
ACYCLOVIR 5% OINTMENT
acyclovir
00168082530 ANTIVIRALS: TOPICAL No No Medicaid, CHIP, CSHCN
ACYCLOVIR 5% OINTMENT
acyclovir
00378870006 ANTIVIRALS: TOPICAL No No Medicaid, CHIP, CSHCN
ACYCLOVIR 5% OINTMENT
acyclovir
00591115930 ANTIVIRALS: TOPICAL No No Medicaid, CHIP, CSHCN
ACYCLOVIR 5% OINTMENT
acyclovir
51079055068 ANTIVIRALS: TOPICAL No No Medicaid, CHIP, CSHCN
ACYCLOVIR 5% OINTMENT
acyclovir
51672136001 ANTIVIRALS: TOPICAL No No Medicaid, CHIP, CSHCN
ACYCLOVIR 5% OINTMENT
acyclovir
51672136002 ANTIVIRALS: TOPICAL No No Medicaid, CHIP, CSHCN
ACYCLOVIR 5% OINTMENT
acyclovir
63646030015 ANTIVIRALS: TOPICAL No No Medicaid, CHIP, CSHCN
ACYCLOVIR 5% OINTMENT
acyclovir
63646030030 ANTIVIRALS: TOPICAL No No Medicaid, CHIP, CSHCN
ACYCLOVIR 5% OINTMENT
acyclovir
65162083594 ANTIVIRALS: TOPICAL No No Medicaid, CHIP, CSHCN
ACYCLOVIR 5% OINTMENT
acyclovir
65162083596 ANTIVIRALS: TOPICAL No No Medicaid, CHIP, CSHCN
ACYCLOVIR 5% OINTMENT
acyclovir
68462074617 ANTIVIRALS: TOPICAL No No Medicaid, CHIP, CSHCN
ACYCLOVIR 5% OINTMENT
acyclovir
68462074635 ANTIVIRALS: TOPICAL No No Medicaid, CHIP, CSHCN
ACYCLOVIR 5% OINTMENT
acyclovir
00713063015 ANTIVIRALS: TOPICAL No No Medicaid, CHIP, CSHCN
ACYCLOVIR 5% OINTMENT
acyclovir
00713063031 ANTIVIRALS: TOPICAL No No Medicaid, CHIP, CSHCN
ACYCLOVIR 5% OINTMENT
acyclovir
16714066801 ANTIVIRALS: TOPICAL No No Medicaid, CHIP, CSHCN
ACYCLOVIR 5% OINTMENT
acyclovir
16714066802 ANTIVIRALS: TOPICAL No No Medicaid, CHIP, CSHCN
ACYCLOVIR 800 MG TABLET
acyclovir
00093894701 ANTIVIRALS: ORAL No No Medicaid, CHIP, CSHCN, KHC
ACYCLOVIR 800 MG TABLET
acyclovir
00093894705 ANTIVIRALS: ORAL No No Medicaid, CHIP, CSHCN, KHC
ACYCLOVIR 800 MG TABLET
acyclovir
23155022801 ANTIVIRALS: ORAL No No Medicaid, CHIP, CSHCN
ACYCLOVIR 800 MG TABLET
acyclovir
23155022805 ANTIVIRALS: ORAL No No Medicaid, CHIP, CSHCN
ACYCLOVIR 800 MG TABLET
acyclovir
31722077801 ANTIVIRALS: ORAL No No Medicaid, CHIP, CSHCN, KHC
ACYCLOVIR 800 MG TABLET
acyclovir
31722077805 ANTIVIRALS: ORAL No No Medicaid, CHIP, CSHCN, KHC
ACYCLOVIR 800 MG TABLET
acyclovir
60505530701 ANTIVIRALS: ORAL No No Medicaid, CHIP, CSHCN, KHC