| Document Date: 2010-12-03 12:26:04
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Company ML LIQUID OTC WATSON LABS / MG CAPSULE Rx PLIVA INC / Rx CYPRESS PHARM / MG CAPSULE Rx PERRIGO CO. / GENERIC HYDRAMINE ELIXIR OTC EON LABS / PHENYLEPHRINE HCL/CHLORPHENIRAMINE MALEATE CYPRESS PHARM / GUAIFENESIN/DEXTROMETHORPHAN HBR PERRIGO CO. / MG TABLET Rx CYPRESS PHARM / QUALITEST PHENYLEPHRINE HCL/PYRILAMINE MALEATE/CHLORPHENIRAMINE LARKEN LABS / DECONGESTANT PE 10 MG TB OTC ROXANE LABS / GENERIC TUSSIN DM SYRUP OTC CYPRESS PHARM / MG TABLET Rx PLIVA INC / Rx WATSON LABS / TEVA / / MedicalCondition West Virginia Medicaid Program NDC Listing Preferred Cough / OTC Systemic Sympathomimetic Decongestants PHENYLEPHRINE HCL PSEUDOEPHEDRINE HCL RT25634_WV_Preferred_Cough / TB / Narcotic Antitussive-1st Generation Antihistamine Combinations CODEINE/PROMETHAZINE HCL RT25634_WV_Preferred_Cough / Antihistamine - Ethanolamines CLEMASTINE FUMARATE DIPHENHYDRAMINE HCL RT25634_WV_Preferred_Cough / GENERIC KIDCARE COUGH / GENERIC ALLERGY / / Organization GENERIC TUSSIN DM COUGH SYRUP OTC PHARMACEU ASSOC / / Position GENERIC Q-TUSSIN-DM SYRUP OTC LEADER / Major / General / SYRUP OTC LEADER / / Product Antitussive / BENZONATATE / PYRILAMINE MALEATE / PROMETHAZINE VC / Ethanolamines DIPHENHYDRAMINE HCL BARR 00555 / Decongestant-Anticholinergic / HYDRAMINE / RX / PROMETHAZINE / GENERIC DURADRYL TABLET / CHLORPHENIRAMINE MALEATE / Ethanolamines CLEMASTINE FUMARATE DIPHENHYDRAMINE HCL RT25634 / Alkylamines CHLORPHENIRAMINE MALEATE CHLORPHENIRAMINE TANNATE / 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]