| Document Date: 2011-04-26 15:51:49
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Company GENERIC HYDRAMINE ELIXIR OTC EON LABS / GUAIFENESIN/DEXTROMETHORPHAN HBR PERRIGO CO. / DECONGESTANT PE 10 MG TB OTC ROXANE LABS / TEVA / PHENYLEPHRINE HCL/CHLORPHENIRAMINE MALEATE KYLEMORE PHARMA / / MedicalCondition West Virginia Medicaid Program NDC Listing Preferred Cough / GENERIC KIDKARE COUGH / MG TABLET OTC PSEUDOEPHEDRINE HCL RT25634_WV_Preferred_Cough / TB / Antihistamine - Ethanolamines CLEMASTINE FUMARATE DIPHENHYDRAMINE HCL RT25634_WV_Preferred_Cough / GENERIC TUSSIN DM SYRUP OTC RT25634_WV_Preferred_Cough / GENERIC ALLERGY / / Organization GENERIC TUSSIN DM COUGH SYRUP OTC PHARMACEU ASSOC / / Position Major / ML SYRUP OTC LEADER / General / Q-TUSSIN-DM SYRUP OTC LEADER / MG TABLET OTC LEADER / / Product Antitussive / DELSYM / Decongestant-Anticholinergic / HYDRAMINE / RX / PROMETHAZINE / CHLORPHENIRAMINE MALEATE / Ethanolamines CLEMASTINE FUMARATE DIPHENHYDRAMINE HCL RT25634 / CLEMASTINE FUMARATE / / Region West Virginia / /
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Bureau for Medical Services Approved PDL for West Virginia Medicaid Program NDC Listing Preferred Cough and Cold Products Effective Date: [removed]