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PDL Status Values

Y = preferred
N = non-preferred. Non-preferred drugs listed as N but without clinical drug use criteria are subject to the Non-Preferred Drugs in Select PDL Classes prior authorization criteria. New drugs will be listed as N until reviewed by the P&T Committee and are subject to the New Drug Policy.
V = voluntary non-preferred. Non-preferred mental health drugs are listed as V and prior authorization is not required.
Null (i.e. blank) = indicates the class or specific drug has not been reviewed for PDL placement.

To request a Prior Authorization, please use this form.

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NDC Brand Name Generic Name Form Strength PDL
Status		 Rebate Current Drug Use Criteria
00254906858 CHLORAL HYDRATE chloral hydrate SYRUP 500 mg/5 mL Y PA Document
80491782503 QUVIVIQ daridorexant HCl TABLET 25 mg N Y PA Document
80491785003 QUVIVIQ daridorexant HCl TABLET 50 mg N Y PA Document
70000058401 SLEEP AID diphenhydramine HCl CAPSULE 25 mg N Y PA Document
46122069572 NIGHTTIME SLEEP AID diphenhydramine HCl CAPSULE 50 mg N Y PA Document
46122077564 NIGHTTIME SLEEP AID diphenhydramine HCl CAPSULE 50 mg N Y PA Document
62011041601 NIGHTTIME SLEEP AID diphenhydramine HCl CAPSULE 50 mg N Y PA Document
70000052701 SLEEP AID diphenhydramine HCl CAPSULE 50 mg N Y PA Document
70677115101 SLEEP AID diphenhydramine HCl CAPSULE 50 mg N Y PA Document
83324015132 SLEEP AID diphenhydramine HCl CAPSULE 50 mg N Y PA Document
70000061601 SLEEP-AID diphenhydramine HCl CAPSULE 50 mg N Y PA Document
83324001506 EZZ NITE SLEEP AID diphenhydramine HCl LIQUID 50 mg/30 mL N Y PA Document
46122075429 SLEEP AID diphenhydramine HCl LIQUID 50 mg/30 mL N Y PA Document
70000017401 SLEEP AID diphenhydramine HCl LIQUID 50 mg/30 mL N Y PA Document
70000017402 SLEEP AID diphenhydramine HCl LIQUID 50 mg/30 mL N Y PA Document
00113018640 SLEEP TIME diphenhydramine HCl LIQUID 50 mg/30 mL N Y PA Document
70677112801 NIGHTTIME SLEEP AID diphenhydramine HCl TABLET 25 mg N Y PA Document
83324011032 NIGHTTIME SLEEP AID diphenhydramine HCl TABLET 25 mg N Y PA Document
83324011301 REST SIMPLY diphenhydramine HCl TABLET 25 mg N Y PA Document
00113043162 SLEEP AID diphenhydramine HCl TABLET 25 mg N Y PA Document
46122065162 SLEEP AID diphenhydramine HCl TABLET 25 mg N Y PA Document
46122065178 SLEEP AID diphenhydramine HCl TABLET 25 mg N Y PA Document
00904427451 SLEEP TABS diphenhydramine HCl TABLET 25 mg N Y PA Document
00228331503 DOXEPIN HCL doxepin HCl TABLET 3 mg N Y PA Document
27241028030 DOXEPIN HCL doxepin HCl TABLET 3 mg N Y PA Document
59651084430 DOXEPIN HCL doxepin HCl TABLET 3 mg N Y PA Document
64380020301 DOXEPIN HCL doxepin HCl TABLET 3 mg N Y PA Document
72205005230 DOXEPIN HCL doxepin HCl TABLET 3 mg N Y PA Document
72578018106 DOXEPIN HCL doxepin HCl TABLET 3 mg N Y PA Document
72603022201 DOXEPIN HCL doxepin HCl TABLET 3 mg N Y PA Document
72819016103 DOXEPIN HCL doxepin HCl TABLET 3 mg N Y PA Document
00228331603 DOXEPIN HCL doxepin HCl TABLET 6 mg N Y PA Document
27241028130 DOXEPIN HCL doxepin HCl TABLET 6 mg N Y PA Document
59651084530 DOXEPIN HCL doxepin HCl TABLET 6 mg N Y PA Document
64380020401 DOXEPIN HCL doxepin HCl TABLET 6 mg N Y PA Document
72205005330 DOXEPIN HCL doxepin HCl TABLET 6 mg N Y PA Document
72578018206 DOXEPIN HCL doxepin HCl TABLET 6 mg N Y PA Document
72603022301 DOXEPIN HCL doxepin HCl TABLET 6 mg N Y PA Document
72819016203 DOXEPIN HCL doxepin HCl TABLET 6 mg N Y PA Document
46122078815 NIGHTTIME SLEEP AID doxylamine succinate TABLET 25 mg N Y PA Document
00113040264 SLEEP AID doxylamine succinate TABLET 25 mg N Y PA Document
00113044164 SLEEP AID doxylamine succinate TABLET 25 mg N Y PA Document
00113044173 SLEEP AID doxylamine succinate TABLET 25 mg N Y PA Document
24385044164 SLEEP AID doxylamine succinate TABLET 25 mg N Y PA Document
46122076351 SLEEP AID doxylamine succinate TABLET 25 mg N Y PA Document
70000056701 SLEEP AID doxylamine succinate TABLET 25 mg N Y PA Document
70677006801 SLEEP AID doxylamine succinate TABLET 25 mg N Y PA Document
70677112901 SLEEP AID doxylamine succinate TABLET 25 mg N Y PA Document
00113403262 SLEEP AID ULTRA doxylamine succinate TABLET 25 mg N Y PA Document
00113403267 SLEEP AID ULTRA doxylamine succinate TABLET 25 mg N Y PA Document
00591074401 ESTAZOLAM estazolam TABLET 1 mg N Y PA Document
70954048010 ESTAZOLAM estazolam TABLET 1 mg N Y PA Document
75907002801 ESTAZOLAM estazolam TABLET 1 mg N Y PA Document
00591074501 ESTAZOLAM estazolam TABLET 2 mg N Y PA Document
70954048110 ESTAZOLAM estazolam TABLET 2 mg N Y PA Document
75907002901 ESTAZOLAM estazolam TABLET 2 mg N Y PA Document
00093553756 ESZOPICLONE eszopiclone TABLET 1 mg N Y PA Document
00378527001 ESZOPICLONE eszopiclone TABLET 1 mg N Y PA Document
31722085501 ESZOPICLONE eszopiclone TABLET 1 mg N Y PA Document
31722085530 ESZOPICLONE eszopiclone TABLET 1 mg N Y PA Document
33342029907 ESZOPICLONE eszopiclone TABLET 1 mg N Y PA Document
55111062930 ESZOPICLONE eszopiclone TABLET 1 mg N Y PA Document
65862096701 ESZOPICLONE eszopiclone TABLET 1 mg N Y PA Document
65862096730 ESZOPICLONE eszopiclone TABLET 1 mg N Y PA Document
68462038201 ESZOPICLONE eszopiclone TABLET 1 mg N Y PA Document
69452034713 ESZOPICLONE eszopiclone TABLET 1 mg N Y PA Document
00093553801 ESZOPICLONE eszopiclone TABLET 2 mg N Y PA Document
00378527101 ESZOPICLONE eszopiclone TABLET 2 mg N Y PA Document
31722085601 ESZOPICLONE eszopiclone TABLET 2 mg N Y PA Document
31722085630 ESZOPICLONE eszopiclone TABLET 2 mg N Y PA Document
33342030011 ESZOPICLONE eszopiclone TABLET 2 mg N Y PA Document
55111061901 ESZOPICLONE eszopiclone TABLET 2 mg N Y PA Document
65862096801 ESZOPICLONE eszopiclone TABLET 2 mg N Y PA Document
65862096830 ESZOPICLONE eszopiclone TABLET 2 mg N Y PA Document
68462038301 ESZOPICLONE eszopiclone TABLET 2 mg N Y PA Document
69452034820 ESZOPICLONE eszopiclone TABLET 2 mg N Y PA Document
00093553901 ESZOPICLONE eszopiclone TABLET 3 mg N Y PA Document
00378527201 ESZOPICLONE eszopiclone TABLET 3 mg N Y PA Document
31722085701 ESZOPICLONE eszopiclone TABLET 3 mg N Y PA Document
31722085730 ESZOPICLONE eszopiclone TABLET 3 mg N Y PA Document
33342030111 ESZOPICLONE eszopiclone TABLET 3 mg N Y PA Document
55111061701 ESZOPICLONE eszopiclone TABLET 3 mg N Y PA Document
65862096901 ESZOPICLONE eszopiclone TABLET 3 mg N Y PA Document
65862096930 ESZOPICLONE eszopiclone TABLET 3 mg N Y PA Document
68462038401 ESZOPICLONE eszopiclone TABLET 3 mg N Y PA Document
69452034920 ESZOPICLONE eszopiclone TABLET 3 mg N Y PA Document
00143336725 FLURAZEPAM HCL flurazepam HCl CAPSULE 15 mg N Y PA Document
00143336750 FLURAZEPAM HCL flurazepam HCl CAPSULE 15 mg N Y PA Document
62135073630 FLURAZEPAM HCL flurazepam HCl CAPSULE 15 mg N Y PA Document
62135073690 FLURAZEPAM HCL flurazepam HCl CAPSULE 15 mg N Y PA Document
00143337025 FLURAZEPAM HCL flurazepam HCl CAPSULE 30 mg N Y PA Document
00143337050 FLURAZEPAM HCL flurazepam HCl CAPSULE 30 mg N Y PA Document
62135073730 FLURAZEPAM HCL flurazepam HCl CAPSULE 30 mg N Y PA Document
62135073790 FLURAZEPAM HCL flurazepam HCl CAPSULE 30 mg N Y PA Document
62856041030 DAYVIGO lemborexant TABLET 10 mg N Y PA Document
62856040530 DAYVIGO lemborexant TABLET 5 mg N Y PA Document
00536139708 MELATONIN melatonin TAB RAPDIS 10 mg N Y PA Document
00904740861 MELATONIN melatonin TAB RAPDIS 10 mg N Y PA Document
50268055211 MELATONIN melatonin TAB RAPDIS 5 mg N Y PA Document
50268055215 MELATONIN melatonin TAB RAPDIS 5 mg N Y PA Document
16571087201 MELATONIN melatonin TABLET 3 mg Y Y PA Document
16571087290 MELATONIN melatonin TABLET 3 mg Y Y PA Document
50268052411 MELATONIN melatonin TABLET 3 mg Y Y PA Document
50268052415 MELATONIN melatonin TABLET 3 mg Y Y PA Document
51645078806 MELATONIN melatonin TABLET 3 mg Y Y PA Document
68094011059 MELATONIN melatonin TABLET 3 mg Y Y PA Document
68094011061 MELATONIN melatonin TABLET 3 mg Y Y PA Document
16571087301 MELATONIN melatonin TABLET 5 mg Y Y PA Document
50268053311 MELATONIN melatonin TABLET 5 mg Y Y PA Document
50268053315 MELATONIN melatonin TABLET 5 mg Y Y PA Document
45861000006 SINTRALYNE-PM melatonin/GABA/herbal no.183 CAPSULE 5 mg-20 mg-460 mg Y PA Document
67618011460 SLOWMAG MG CALM-SLEEP melatonin/magnesium citrate TABLET DR 1 mg-71.5 mg Y PA Document
16571073012 MELATONIN-VITAMIN B6 melatonin/pyridoxine HCl (B6) TABLET 5 mg-10 mg Y PA Document
60687057640 MIDAZOLAM HCL midazolam HCl SYRUP 10 mg/5 mL (2 mg/mL) N Y PA Document
60687057646 MIDAZOLAM HCL midazolam HCl SYRUP 10 mg/5 mL (2 mg/mL) N Y PA Document
60687057686 MIDAZOLAM HCL midazolam HCl SYRUP 10 mg/5 mL (2 mg/mL) N Y PA Document
68094076459 MIDAZOLAM HCL midazolam HCl SYRUP 10 mg/5 mL (2 mg/mL) N Y PA Document
68094076462 MIDAZOLAM HCL midazolam HCl SYRUP 10 mg/5 mL (2 mg/mL) N Y PA Document
00054356699 MIDAZOLAM HCL midazolam HCl SYRUP 2 mg/mL N Y PA Document
00574015004 MIDAZOLAM HCL midazolam HCl SYRUP 2 mg/mL N Y PA Document
60687057603 MIDAZOLAM HCL midazolam HCl SYRUP 5 mg/2.5 mL N Y PA Document
60687057604 MIDAZOLAM HCL midazolam HCl SYRUP 5 mg/2.5 mL N Y PA Document
60687057610 MIDAZOLAM HCL midazolam HCl SYRUP 5 mg/2.5 mL N Y PA Document
68094076259 MIDAZOLAM HCL midazolam HCl SYRUP 5 mg/2.5 mL N Y PA Document
68094076262 MIDAZOLAM HCL midazolam HCl SYRUP 5 mg/2.5 mL N Y PA Document
61825016510 DORAL quazepam TABLET 15 mg N Y PA Document
61825016530 DORAL quazepam TABLET 15 mg N Y PA Document
71993026510 QUAZEPAM quazepam TABLET 15 mg N Y PA Document
71993026530 QUAZEPAM quazepam TABLET 15 mg N Y PA Document
00591219101 RAMELTEON ramelteon TABLET 8 mg Y Y PA Document
00591219130 RAMELTEON ramelteon TABLET 8 mg Y Y PA Document
00832125011 RAMELTEON ramelteon TABLET 8 mg Y Y PA Document
00832125030 RAMELTEON ramelteon TABLET 8 mg Y Y PA Document
00904749406 RAMELTEON ramelteon TABLET 8 mg Y Y PA Document
42571037501 RAMELTEON ramelteon TABLET 8 mg Y Y PA Document
42571037530 RAMELTEON ramelteon TABLET 8 mg Y Y PA Document
43598074101 RAMELTEON ramelteon TABLET 8 mg Y Y PA Document
43598074130 RAMELTEON ramelteon TABLET 8 mg Y Y PA Document
50268070811 RAMELTEON ramelteon TABLET 8 mg Y Y PA Document
50268070815 RAMELTEON ramelteon TABLET 8 mg Y Y PA Document
52817023510 RAMELTEON ramelteon TABLET 8 mg Y Y PA Document
52817023530 RAMELTEON ramelteon TABLET 8 mg Y Y PA Document
59651050501 RAMELTEON ramelteon TABLET 8 mg Y Y PA Document
59651050530 RAMELTEON ramelteon TABLET 8 mg Y Y PA Document
60687069211 RAMELTEON ramelteon TABLET 8 mg Y Y PA Document
60687069265 RAMELTEON ramelteon TABLET 8 mg Y Y PA Document
69367035601 RAMELTEON ramelteon TABLET 8 mg Y Y PA Document
69367035630 RAMELTEON ramelteon TABLET 8 mg Y Y PA Document
70010002803 RAMELTEON ramelteon TABLET 8 mg Y Y PA Document
70700027205 RAMELTEON ramelteon TABLET 8 mg Y Y PA Document
70700027210 RAMELTEON ramelteon TABLET 8 mg Y Y PA Document
70700027230 RAMELTEON ramelteon TABLET 8 mg Y Y PA Document
70710134401 RAMELTEON ramelteon TABLET 8 mg Y Y PA Document
70710134403 RAMELTEON ramelteon TABLET 8 mg Y Y PA Document
64764080510 ROZEREM ramelteon TABLET 8 mg Y Y PA Document
64764080530 ROZEREM ramelteon TABLET 8 mg Y Y PA Document
00006003310 BELSOMRA suvorexant TABLET 10 mg N Y PA Document
00006003313 BELSOMRA suvorexant TABLET 10 mg N Y PA Document
00006003330 BELSOMRA suvorexant TABLET 10 mg N Y PA Document
00006032510 BELSOMRA suvorexant TABLET 15 mg N Y PA Document
00006032513 BELSOMRA suvorexant TABLET 15 mg N Y PA Document
00006032530 BELSOMRA suvorexant TABLET 15 mg N Y PA Document
00006033510 BELSOMRA suvorexant TABLET 20 mg N Y PA Document
00006033513 BELSOMRA suvorexant TABLET 20 mg N Y PA Document
00006033530 BELSOMRA suvorexant TABLET 20 mg N Y PA Document
00006000510 BELSOMRA suvorexant TABLET 5 mg N Y PA Document
00006000513 BELSOMRA suvorexant TABLET 5 mg N Y PA Document
00006000530 BELSOMRA suvorexant TABLET 5 mg N Y PA Document
43068022001 HETLIOZ tasimelteon CAPSULE 20 mg N Y PA Document
00480449056 TASIMELTEON tasimelteon CAPSULE 20 mg N Y PA Document
60505466503 TASIMELTEON tasimelteon CAPSULE 20 mg N Y PA Document
69238254803 TASIMELTEON tasimelteon CAPSULE 20 mg N Y PA Document
43068030402 HETLIOZ LQ tasimelteon ORAL SUSP 4 mg/mL N Y PA Document
43068030406 HETLIOZ LQ tasimelteon ORAL SUSP 4 mg/mL N Y PA Document
00406991601 RESTORIL temazepam CAPSULE 15 mg N Y PA Document
00228207610 TEMAZEPAM temazepam CAPSULE 15 mg N Y PA Document
00228207650 TEMAZEPAM temazepam CAPSULE 15 mg N Y PA Document
00406996101 TEMAZEPAM temazepam CAPSULE 15 mg N Y PA Document
43547061210 TEMAZEPAM temazepam CAPSULE 15 mg N Y PA Document
43547061250 TEMAZEPAM temazepam CAPSULE 15 mg N Y PA Document
50268077911 TEMAZEPAM temazepam CAPSULE 15 mg N Y PA Document
50268077915 TEMAZEPAM temazepam CAPSULE 15 mg N Y PA Document
62332038031 TEMAZEPAM temazepam CAPSULE 15 mg N Y PA Document
62332038071 TEMAZEPAM temazepam CAPSULE 15 mg N Y PA Document
62584086033 TEMAZEPAM temazepam CAPSULE 15 mg N Y PA Document
67877014601 TEMAZEPAM temazepam CAPSULE 15 mg N Y PA Document
67877014605 TEMAZEPAM temazepam CAPSULE 15 mg N Y PA Document
00406991403 RESTORIL temazepam CAPSULE 22.5 mg N Y PA Document
00406995903 TEMAZEPAM temazepam CAPSULE 22.5 mg N Y PA Document
43547061303 TEMAZEPAM temazepam CAPSULE 22.5 mg N Y PA Document
62332038130 TEMAZEPAM temazepam CAPSULE 22.5 mg N Y PA Document
67877014930 TEMAZEPAM temazepam CAPSULE 22.5 mg N Y PA Document
00406991701 RESTORIL temazepam CAPSULE 30 mg N Y PA Document
00228207710 TEMAZEPAM temazepam CAPSULE 30 mg N Y PA Document
00228207750 TEMAZEPAM temazepam CAPSULE 30 mg N Y PA Document
00406996201 TEMAZEPAM temazepam CAPSULE 30 mg N Y PA Document
43547061410 TEMAZEPAM temazepam CAPSULE 30 mg N Y PA Document
43547061450 TEMAZEPAM temazepam CAPSULE 30 mg N Y PA Document
50268078011 TEMAZEPAM temazepam CAPSULE 30 mg N Y PA Document
50268078013 TEMAZEPAM temazepam CAPSULE 30 mg N Y PA Document
62332038231 TEMAZEPAM temazepam CAPSULE 30 mg N Y PA Document
62332038271 TEMAZEPAM temazepam CAPSULE 30 mg N Y PA Document
67877014701 TEMAZEPAM temazepam CAPSULE 30 mg N Y PA Document
67877014705 TEMAZEPAM temazepam CAPSULE 30 mg N Y PA Document
00406991501 RESTORIL temazepam CAPSULE 7.5 mg N Y PA Document
00406991503 RESTORIL temazepam CAPSULE 7.5 mg N Y PA Document
00406996001 TEMAZEPAM temazepam CAPSULE 7.5 mg N Y PA Document
00904643604 TEMAZEPAM temazepam CAPSULE 7.5 mg N Y PA Document
43547061110 TEMAZEPAM temazepam CAPSULE 7.5 mg N Y PA Document
62332037931 TEMAZEPAM temazepam CAPSULE 7.5 mg N Y PA Document
63739000333 TEMAZEPAM temazepam CAPSULE 7.5 mg N Y PA Document
67877014801 TEMAZEPAM temazepam CAPSULE 7.5 mg N Y PA Document
68084054911 TEMAZEPAM temazepam CAPSULE 7.5 mg N Y PA Document
68084054921 TEMAZEPAM temazepam CAPSULE 7.5 mg N Y PA Document
00054485825 TRIAZOLAM triazolam TABLET 0.125 mg N Y PA Document
50742064501 TRIAZOLAM triazolam TABLET 0.125 mg N Y PA Document
59762371701 TRIAZOLAM triazolam TABLET 0.125 mg N Y PA Document
59762371703 TRIAZOLAM triazolam TABLET 0.125 mg N Y PA Document
59762371709 TRIAZOLAM triazolam TABLET 0.125 mg N Y PA Document
70710152101 TRIAZOLAM triazolam TABLET 0.125 mg N Y PA Document
00009001755 HALCION triazolam TABLET 0.25 mg N Y PA Document
00009001758 HALCION triazolam TABLET 0.25 mg N Y PA Document
00054485925 TRIAZOLAM triazolam TABLET 0.25 mg N Y PA Document
00054485929 TRIAZOLAM triazolam TABLET 0.25 mg N Y PA Document
50742064601 TRIAZOLAM triazolam TABLET 0.25 mg N Y PA Document
59762371803 TRIAZOLAM triazolam TABLET 0.25 mg N Y PA Document
59762371809 TRIAZOLAM triazolam TABLET 0.25 mg N Y PA Document
70710128901 TRIAZOLAM triazolam TABLET 0.25 mg N Y PA Document
70710128905 TRIAZOLAM triazolam TABLET 0.25 mg N Y PA Document
00054008525 ZALEPLON zaleplon CAPSULE 10 mg N Y PA Document
29300013201 ZALEPLON zaleplon CAPSULE 10 mg N Y PA Document
57237024001 ZALEPLON zaleplon CAPSULE 10 mg N Y PA Document
65862021501 ZALEPLON zaleplon CAPSULE 10 mg N Y PA Document
69452036520 ZALEPLON zaleplon CAPSULE 10 mg N Y PA Document
00054008425 ZALEPLON zaleplon CAPSULE 5 mg N Y PA Document
29300013101 ZALEPLON zaleplon CAPSULE 5 mg N Y PA Document
57237023901 ZALEPLON zaleplon CAPSULE 5 mg N Y PA Document
65862021401 ZALEPLON zaleplon CAPSULE 5 mg N Y PA Document
69452036420 ZALEPLON zaleplon CAPSULE 5 mg N Y PA Document
52427077530 ZOLPIDEM TARTRATE zolpidem tartrate CAPSULE 7.5 mg N Y PA Document
00024552131 AMBIEN CR zolpidem tartrate TAB MPHASE 12.5 mg N Y PA Document
00713552101 AMBIEN CR zolpidem tartrate TAB MPHASE 12.5 mg N Y PA Document
00955170310 ZOLPIDEM TARTRATE ER zolpidem tartrate TAB MPHASE 12.5 mg N Y PA Document
10370011610 ZOLPIDEM TARTRATE ER zolpidem tartrate TAB MPHASE 12.5 mg N Y PA Document
47335030888 ZOLPIDEM TARTRATE ER zolpidem tartrate TAB MPHASE 12.5 mg N Y PA Document
51991098201 ZOLPIDEM TARTRATE ER zolpidem tartrate TAB MPHASE 12.5 mg N Y PA Document
68180078001 ZOLPIDEM TARTRATE ER zolpidem tartrate TAB MPHASE 12.5 mg N Y PA Document
68180078004 ZOLPIDEM TARTRATE ER zolpidem tartrate TAB MPHASE 12.5 mg N Y PA Document
00024550131 AMBIEN CR zolpidem tartrate TAB MPHASE 6.25 mg N Y PA Document
00713550101 AMBIEN CR zolpidem tartrate TAB MPHASE 6.25 mg N Y PA Document
00955170210 ZOLPIDEM TARTRATE ER zolpidem tartrate TAB MPHASE 6.25 mg N Y PA Document
10370011710 ZOLPIDEM TARTRATE ER zolpidem tartrate TAB MPHASE 6.25 mg N Y PA Document
47335030788 ZOLPIDEM TARTRATE ER zolpidem tartrate TAB MPHASE 6.25 mg N Y PA Document
51991098101 ZOLPIDEM TARTRATE ER zolpidem tartrate TAB MPHASE 6.25 mg N Y PA Document
68180077901 ZOLPIDEM TARTRATE ER zolpidem tartrate TAB MPHASE 6.25 mg N Y PA Document
68180077904 ZOLPIDEM TARTRATE ER zolpidem tartrate TAB MPHASE 6.25 mg N Y PA Document
49884089811 ZOLPIDEM TARTRATE zolpidem tartrate TAB SUBL 1.75 mg N Y PA Document
49884089852 ZOLPIDEM TARTRATE zolpidem tartrate TAB SUBL 1.75 mg N Y PA Document
00037601035 EDLUAR zolpidem tartrate TAB SUBL 10 mg N Y PA Document
00037601093 EDLUAR zolpidem tartrate TAB SUBL 10 mg N Y PA Document
49884089911 ZOLPIDEM TARTRATE zolpidem tartrate TAB SUBL 3.5 mg N Y PA Document
49884089952 ZOLPIDEM TARTRATE zolpidem tartrate TAB SUBL 3.5 mg N Y PA Document
00037605035 EDLUAR zolpidem tartrate TAB SUBL 5 mg N Y PA Document
00037605093 EDLUAR zolpidem tartrate TAB SUBL 5 mg N Y PA Document
00024542131 AMBIEN zolpidem tartrate TABLET 10 mg Y Y PA Document
00713542101 AMBIEN zolpidem tartrate TABLET 10 mg Y Y PA Document
00093007401 ZOLPIDEM TARTRATE zolpidem tartrate TABLET 10 mg Y Y PA Document
00781531801 ZOLPIDEM TARTRATE zolpidem tartrate TABLET 10 mg Y Y PA Document
00781531810 ZOLPIDEM TARTRATE zolpidem tartrate TABLET 10 mg Y Y PA Document
13668000801 ZOLPIDEM TARTRATE zolpidem tartrate TABLET 10 mg Y Y PA Document
13668000805 ZOLPIDEM TARTRATE zolpidem tartrate TABLET 10 mg Y Y PA Document
13668000810 ZOLPIDEM TARTRATE zolpidem tartrate TABLET 10 mg Y Y PA Document
13668000815 ZOLPIDEM TARTRATE zolpidem tartrate TABLET 10 mg Y Y PA Document
16714062201 ZOLPIDEM TARTRATE zolpidem tartrate TABLET 10 mg Y Y PA Document
16714062202 ZOLPIDEM TARTRATE zolpidem tartrate TABLET 10 mg Y Y PA Document
55111047901 ZOLPIDEM TARTRATE zolpidem tartrate TABLET 10 mg Y Y PA Document
55111047905 ZOLPIDEM TARTRATE zolpidem tartrate TABLET 10 mg Y Y PA Document
62135077990 ZOLPIDEM TARTRATE zolpidem tartrate TABLET 10 mg Y Y PA Document
65862016001 ZOLPIDEM TARTRATE zolpidem tartrate TABLET 10 mg Y Y PA Document
65862016099 ZOLPIDEM TARTRATE zolpidem tartrate TABLET 10 mg Y Y PA Document
71093015604 ZOLPIDEM TARTRATE zolpidem tartrate TABLET 10 mg Y Y PA Document
71093015606 ZOLPIDEM TARTRATE zolpidem tartrate TABLET 10 mg Y Y PA Document
00024540131 AMBIEN zolpidem tartrate TABLET 5 mg Y Y PA Document
00713540101 AMBIEN zolpidem tartrate TABLET 5 mg Y Y PA Document
00093007301 ZOLPIDEM TARTRATE zolpidem tartrate TABLET 5 mg Y Y PA Document
00781531701 ZOLPIDEM TARTRATE zolpidem tartrate TABLET 5 mg Y Y PA Document
00781531710 ZOLPIDEM TARTRATE zolpidem tartrate TABLET 5 mg Y Y PA Document
00904608261 ZOLPIDEM TARTRATE zolpidem tartrate TABLET 5 mg Y Y PA Document
13668000701 ZOLPIDEM TARTRATE zolpidem tartrate TABLET 5 mg Y Y PA Document
13668000705 ZOLPIDEM TARTRATE zolpidem tartrate TABLET 5 mg Y Y PA Document
13668000710 ZOLPIDEM TARTRATE zolpidem tartrate TABLET 5 mg Y Y PA Document
13668000715 ZOLPIDEM TARTRATE zolpidem tartrate TABLET 5 mg Y Y PA Document
16714062101 ZOLPIDEM TARTRATE zolpidem tartrate TABLET 5 mg Y Y PA Document
16714062102 ZOLPIDEM TARTRATE zolpidem tartrate TABLET 5 mg Y Y PA Document
55111047801 ZOLPIDEM TARTRATE zolpidem tartrate TABLET 5 mg Y Y PA Document
55111047805 ZOLPIDEM TARTRATE zolpidem tartrate TABLET 5 mg Y Y PA Document
60687083801 ZOLPIDEM TARTRATE zolpidem tartrate TABLET 5 mg Y Y PA Document
60687083811 ZOLPIDEM TARTRATE zolpidem tartrate TABLET 5 mg Y Y PA Document
62135077890 ZOLPIDEM TARTRATE zolpidem tartrate TABLET 5 mg Y Y PA Document
65862015901 ZOLPIDEM TARTRATE zolpidem tartrate TABLET 5 mg Y Y PA Document
65862015999 ZOLPIDEM TARTRATE zolpidem tartrate TABLET 5 mg Y Y PA Document
68084018901 ZOLPIDEM TARTRATE zolpidem tartrate TABLET 5 mg Y Y PA Document
68084018911 ZOLPIDEM TARTRATE zolpidem tartrate TABLET 5 mg Y Y PA Document
71093015504 ZOLPIDEM TARTRATE zolpidem tartrate TABLET 5 mg Y Y PA Document
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