Transcription
Medi-Cal Rx Contract Drugs List –Over-the-Counter DrugsJune 1, 2022 2022 California Department of Health Care Services. All rights reserved.
Revision HistoryDrug NameDescriptionPolicy Effective DateOlopatadine HCLAdded to CDL.April 1, 2022Cyanocobalamin (vitaminAdded to CDL with ageMay 1, 2022B-12)restriction.NiacinAdded to CDL with ageMay 1, 2022restriction.RiboflavinAdded to CDL with ageMay 1, 2022restriction.ThiamineAdded to CDL with ageMay 1, 2022restriction.Vitamin A (retinol, retinoicAdded to CDL with ageacid)restriction.Vitamin C (ascorbic acid)Added to CDL with ageMay 1, 2022May 1, 2022restriction.Vitamin D3 (cholecalciferol)Added to CDL with ageMay 1, 2022restriction.Vitamin E (Dl, tocopherylAdded to CDL with ageacetate)restriction.Calcium CarbonateAdditional formulationMay 1, 2022June 1, 2022(suspension) added to CDL.DHCS – (CDL) Over-the-Counter Drugs306/01/2022
This section lists the drug products and units of measure for Over-the-Counter (OTC)contract drugs. OTC drugs are included in the per-diem rate for beneficiaries in nursingfacilities, including subacute patients. With the exception of insulin, providers cannotseparately bill any OTC drugs for beneficiaries in these facilities. For additional help,refer to the Contract Drugs List (CDL) section of the Medi-Cal Rx Provider Manual.Restriction: All OTC antihistamines, OTC decongestants, and OTCantihistamine/decongestant combination drug products are restricted to individuals 2years of age and older. This age restriction is based on current Federal DrugAdministration (FDA) recommendations. Authorization is required for individuals under2 years of age.DHCS – (CDL) Over-the-Counter Drugs406/01/2022
Medi-Cal Rx Contract Drugs ListEffective 06/01/2022Drug NameDosageStrength/Package SizeBillingUnitUMTypeCode 1ANALGESICS: NON-NARCOTICSAcetaminophenTablets or325 mgeaALCapsules500 mgeaTablets, Extended650 mgeaTablets, chewable160 mgeaLiquid *160 mg/5 mlml* Restricted to individuals60 mlmlyounger than 21 years of age for120 mlmlthe liquid and drops only.240 mlml480 mlmlRelease500 mg/15 mlmlDrops *100 mg/mlmlSuppositories80 mgea120 mgea325 mgeaDHCS – (CDL) Over-the-Counter Drugs506/01/2022
Medi-Cal Rx Contract Drugs ListEffective 06/01/2022Drug NameAspirinStrength/Package SizeDosageBillingUnitTablets or325 mgeacapsules650 mgeaTablets or325 mgea81 mgea81 mgea325 mgea650 mgeaChewable tablet81 mgeaTablets200 mgeaSuspension100 mg/5 mlmlUMTypeCode 1capsules, bufferedE.C. pelletcapsulesE.C. tabletsIbuprofenANTI-INFECTIVES: ANTHELMINTICSPyrantel PamoateLiquidmlAUTONOMIC DRUGS: ANTIASTHMATICSEpinephrineInhalationDHCS – (CDL) Over-the-Counter Drugs1:44 to 1:50ml1:100ml606/01/2022
Medi-Cal Rx Contract Drugs ListEffective 06/01/2022Drug NameStrength/Package SizeDosageBillingUnitUMTypeCode 1AUTONOMIC DRUGS: ANTI-EMETICSMeclizineTabletseaTablets, chewableeaAUTONOMIC DRUGS: ANTIHISTAMINESBrompheniramineLiquidmlALMaleate *Cetirizine HClyears of age and older.TabletsLiquidChlorpheniramine5 mgea10 mgea1 mg/1 mlmlLiquid, syrupmlALMaleate ** Restricted to individuals 2years of age and olderTabletsDexbrompheniramine* Restricted to individuals 24 mgeaTabletseaMaleate *AL* Restricted to individuals 2years of age and older.Tablets, chewableeaLiquidmlDHCS – (CDL) Over-the-Counter Drugs706/01/2022
Medi-Cal Rx Contract Drugs ListEffective 06/01/2022Drug NameDiphenhydramineDosageCapsulesHydrochloride *Liquid or syrupStrength/Package SizeBillingUnitUMType25 mgeaAL50 mgeatreatment of allergies or allergic12.5 mg/5 mlmlconditions only and toCode 1* Restricted to use in theindividuals 2 years of age andTablets25 mgea50 mgeaFexofenadineTablets180 mgeaLoratadine *Tablets10 mgeaLiquid5 mg/5 mlmlTriporolidine *DropsmlSyrupmlolder.AL* Restricted to individuals 2years of age and older.AL* Restricted to individuals 2years of age and older.BLOOD MODIFIERS: HEMATINICSFerrous SulfateTablets200 mgea325 mgeaDrops15 mg/0.6 mlmlLiquid15 mgmlDILUENTPropylene glycolLiquidDHCS – (CDL) Over-the-Counter Drugsea806/01/2022
Medi-Cal Rx Contract Drugs ListEffective 06/01/2022Drug NameDosageStrength/Package SizeBillingUnitUMTypeCode 1GASTRO-INTESTINAL DRUGS: ANTACIDS AND ADSORBENTSAluminum andTabletseaTablets doubleeamagnesium hydroxidegelstrengthLiquidAluminum HydroxideTabletsand Magnesiumml80 mg-20 mgea160 mg-40 mgeaTrisilicate gelLiquidAluminum HydroxideTablets or325 mgeagelcapsules475-500 mgea650 mgeamlLiquidAluminum Hydroxide,Tabletsml200 mg-200 mg-20 mg eaMagnesium200 mg-200 mg-25 mg eaHydroxide, and240 mg-240 mg-20 mg eaSimethicone300 mg-200 mg-25 mg ea400 mg-400 mg-30 mg eaDHCS – (CDL) Over-the-Counter Drugs906/01/2022
Medi-Cal Rx Contract Drugs ListEffective 06/01/2022Drug Name(continued)DosageLiquidStrength/Package SizeBillingUnitUMTypeCode 1200 mg-200 mg-20 mg ml/5 ml200 mg-200 mg-25 mg ml/5 ml225 mg-200 mg-25 mg ml/5 ml240 mg-240 mg-20 mg ml/5 ml300 mg-200 mg-25 mg ml/5 ml400 mg-400 mg-30 orml40 mg/5 ml500 mg-450 mg-40 mg ml/5 mlCalcium CarbonateTabletseaand MagnesiumCarbonateDHCS – (CDL) Over-the-Counter Drugs1006/01/2022
Medi-Cal Rx Contract Drugs ListEffective 06/01/2022Drug NameStrength/Package SizeDosageBillingUnitUMTypeCode 1GASTRO-INTESTINAL DRUGS: ANTI-DIARRHEA AGENTSBismuth SubsalicylateLoperamideTablets262 mgeaTablets, chewable262 mgeaLiquid262 mg/15 mlml524 mg/15 mlml525 mg/15 mlmlCapsules2 mgeaSuspension1 mg/7.5 mlmlGASTRO-INTESTINAL DRUGS: LAXATIVESBisacodylSuppositories 10 mgeaDocusate sodiumCapsules 100 mgea250 mgea100 mg/5 mlea283 mg/5 ml (5 ml x 5)ea283 mg-20 mg/5 mleaEnema *Docusate sodium/Enemabenzocaine *DHCS – (CDL) Over-the-Counter Drugs(5ml x 5)LR* Restricted to NDC labeler code17433 for rectal enemas only.LR* Restricted to NDC labeler code17433.1106/01/2022
Medi-Cal Rx Contract Drugs ListEffective 06/01/2022Drug NamePolyethylene ckage SizeBillingUnit238 gmgm510 gmgm8.6 mgeaUMTypeCode 1HORMONES: CONTRACEPTIVESLevonorgestrelTablets1.5 mg *eaQL* Restricted to a maximumquantity of one tablet perdispensing with a maximum ofsix dispensings in any 12-monthperiod and to use in femalesonly.Nonoxynol 9Cream withcontraceptiveapplicatorgmproductsRefillgmFoam withgmapplicatorRefillDHCS – (CDL) Over-the-Counter Drugsgm1206/01/2022
Medi-Cal Rx Contract Drugs ListEffective 06/01/2022Drug Name(continued)DosageStrength/Package SizeJelly withBillingUnitUMTypeCode 1gmapplicatorRefillgmSuppositorieseaWith applicatoreaWithouteaapplicatorHORMONES: HYPOGLYCEMICSInsulinInjections: Lente,40 Units/ml 10 mlmlA separately payable benefit forNPH, Protamine80 Units/ml 10 mlmlbeneficiaries in nursing facilities,Zinc, Semilente,100 Units/ml 10 mlmlincluding subacute patients.100 Units/ml 10 mlmlUltralenteLente, NPH,Protamine Zinc(purified pork)DHCS – (CDL) Over-the-Counter Drugs1306/01/2022
Medi-Cal Rx Contract Drugs ListEffective 06/01/2022Drug e SizeBillingUnit40 Units/ml 10 mlml80 Units/ml 10 mlml100 Units/ml 10 mlml100 Units/ml 10 mlml40 Units/ml 10 mlml80 Units/ml 10 mlml100 Units/ml 10 mlmlUMTypeCode 1(purified pork)GlobinInsulin (human)Injections:A separately payable benefit forRegular100 Units/mlmlbeneficiaries in nursing facilities,Lente100 Units/mlmlincluding subacute patients.NPH100 Units/mlmlNPH 50 % and100 Units/mlml100 Units/mlml100 Units/mlmlRegular 50 %NPH 70 % andRegular 30 %UltralenteDHCS – (CDL) Over-the-Counter Drugs1406/01/2022
Medi-Cal Rx Contract Drugs ListEffective 06/01/2022Drug NameStrength/Package SizeDosageBillingUnitUMTypeCode 1METABOLIC SUPPLEMENTS: CALCIUM SUPPLEMENTS AND VITAMIN D ANALOGSCalcium CarbonateTablets or650 mgeacapsules1250 mgeaSuspension1,250 mg/5 mlml(500mg elementalCalcium)Calcium GluconateCalcium LactateTablets or wafersTablets325 mgea500 mgea650 mgea1 gmea325 mgea650 mgeaMETABOLIC SUPPLEMENTS: VITAMINSCyanocobalaminTablets(vitamin B-12) *Folic acid *Tablets500 mcgea1000 mcgea400 μg (0.4mg)eaAL* Restricted to beneficiaries thatare under the age of 21.AL* Restricted to females, ages 14through 45 years, to preventneural tube defects in currentand future pregnancies only.DHCS – (CDL) Over-the-Counter Drugs1506/01/2022
Medi-Cal Rx Contract Drugs ListEffective 06/01/2022Drug NameNiacin *PyridoxineRiboflavin *Sodium Fluoride *DosageTabletsTabletsTabletsTablets Strength/Package SizeBillingUnitUMType50 mgeaAL100 mgea250 mgea500 mgea10 mgea25 mgea50 mgea100 mgea25 mgea50 mgea100 mgea2.2 mgeaCode 1* Restricted to beneficiaries thatare under the age of 21.AL* Restricted to beneficiaries thatare under the age of 21.QL* Not subject to the 100maximum calendar day supplyChewable0.25 (0.55) mgeatablets 0.50 (1.1) mgea1.0 (2.2) mgeaDropsmlSolution (doesmllimitation.not includerinses)DHCS – (CDL) Over-the-Counter Drugs1606/01/2022
Medi-Cal Rx Contract Drugs ListEffective 06/01/2022Drug NameThiamine *Vitamin A (retinol,DosageTabletsCapsulesretinoic acid) *Vitamins A, D, and CChewablewith Sodiumtablets Fluoride †Vitamins A, D, CStrength/Package SizeBillingUnitUMType50 mgeaAL100 mgea250 mgea8,000 unitsea10,000 unitsea100’seaDrops50 mlml†Drops30 mlml50 mlmlDropsare under the age of 21.ALALReimbursable for children up toALReimbursable for children up tothe 5th birthday only.ea50 mlmlALReimbursable for children up tothe 5th birthday only.Tabletsacid) *Vitamin D3* Restricted to beneficiaries thatare under the age of 21.with ironVitamin C (ascorbic* Restricted to beneficiaries thatthe 5th birthday only.Chewable tabletsVitamins A, D, CCode 1Drops(cholecalciferol) *DHCS – (CDL) Over-the-Counter Drugs250 mgea500 mgea1000 mgea400 units/ml, 50 mlmlbottleAL* Restricted to beneficiaries thatare under the age of 21.AL* Restricted to beneficiaries thatare under the age of 21.1706/01/2022
Medi-Cal Rx Contract Drugs ListEffective 06/01/2022Drug Name(continued)DosageStrength/Package SizeBillingUnitTablets or25 mcg (1000u)eaCapsules50 mcg (2000u)ea125 mcg (5000u)ea250 mcg (10,000u)ea1,250 mcg (50,000u)ea90 mg (200u)ea(Dl, tocopheryl180 mg (400u)eaacetate) *450 mg (1000u)eaTablets orCombination product,EacapsulesprenatalVitamin EVitamins-mineral *CapsulesUMTypeALCode 1* Restricted to beneficiaries thatare under the age of 21.* Restricted to use by anexpectant female withconfirmed positive pregnancyNonprescription onlytest conducted by her physician.(1) The nonprescription prenatalproduct tablet or capsule shallcontain the following:(A) Not less than one-half normore than the U.S.Recommended DietaryAllowance for pregnant womenbased on dietary standardsestablished by the NationalDHCS – (CDL) Over-the-Counter Drugs1806/01/2022
Medi-Cal Rx Contract Drugs ListEffective 06/01/2022Drug NameDosageStrength/Package Size(continued)BillingUnitUMTypeCode 1Academy of Sciences,Washington, D.C., 1980 ofvitamins A (e.g., 5,000 IU) andvitamin D (e.g., 400 IU).(B) Not less than one-half normore than twice the U.S.Recommended DietaryAllowance for pregnant womenas established by the NationalAcademy of Sciences,Washington, D.C., 1980, ofvitamins B1, (e.g., 1.5 mg), B2(e.g., 1.6 mg), B6 (e.g., 2.6 mg),B12 (e.g., 4 mcg), C (e.g., 80 mg)and B3 Niacin (e.g., 16 mg).(C) Not less than the equivalentof 200mg elemental Calcium,and 30 mg elemental Iron.(2) The nonprescription prenatalproduct may contain thefollowing:DHCS – (CDL) Over-the-Counter Drugs1906/01/2022
Medi-Cal Rx Contract Drugs ListEffective 06/01/2022Drug NameDosageStrength/Package SizeBillingUnitUMType(continued)Code 1(A) Up to the U.S.Recommended DietaryAllowance for pregnant womenbased on dietary standardsestablished by the NationalAcademy of Sciences,Washington, D.C., 1980 ofvitamin E (e.g., 15 IU), Folic Acid(e.g., 0.8 mg), Phosphorus (e.g.,1200 mg), Magnesium (e.g., 450mg), except for Iodine (200mcg), and Zinc (25 mg).MISCELLANEOUS: ANTIHISTAMINE AND DECONGESTANT COMBINATIONSDexbrompheniramineTabletseaALMaleate/* Restricted to individuals 2years of age and older.Phenylephrine d to individuals 2 yearsof age and older.Phenylephrine *DHCS – (CDL) Over-the-Counter Drugs2006/01/2022
Medi-Cal Rx Contract Drugs ListEffective 06/01/2022Drug NameDoxylamineDosageStrength/Package SizeLiquidBillingUnitUMTypemlALSuccinate/Code 1*Restricted to individuals 2 yearsof age and older.Pseudoephedrine *PhenylephrineSolutionmlALHydrochloride/* Restricted to individuals 2years of age and older.BrompheniramineMaleate lephrineLiquid, SolutionmlHydrochloride/TabletseaTabletseaAL* Restricted to individuals 2years of age and older.ChlorpheniramineMaleate *AL* Restricted to individuals 2years of age and older.DiphenhydramineHydrochloride *PhenylephrineHydrochloride/AL* Restricted to individuals 2years of age and older.Pyrilamine Maleate *DHCS – (CDL) Over-the-Counter Drugs2106/01/2022
Medi-Cal Rx Contract Drugs ListEffective 06/01/2022Drug NamePhenylephrineDosageLiquid, SolutionStrength/Package Size10 – 2.5 mg/5 mlBillingUnitUMTypemlALHydrochloride/Code 1* Restricted to individuals 2years of age and older.Triprolidine *TabletsPseudoephedrineLiquid10 mg/2.5 mgeamlALhydrochloride/* Restricted to individuals 2years of age and older.brompheniraminemaleate *PseudoephedrineLiquid, syrupmlALhydrochloride/chlorpheniramine* Restricted to individuals 2years of age and older.TabletseaSolutionmlmaleate * Restricted to individuals 2years of age and older.TabletseaLiquid, syrupmlmaleate cted to individuals 2 yearsof age and older.TabletseaTabletsEaHydrochloride *Triprolidine/Phenylephrine *DHCS – (CDL) Over-the-Counter DrugsAL* Restricted to individuals 2years of age and older.2206/01/2022
Medi-Cal Rx Contract Drugs ListEffective 06/01/2022Drug NameTriprolidine/DosageStrength/Package SizeTabletsBillingUnitUMTypeeaALPseudoephedrine *Code 1* Restricted to individuals 2years of age and older.SyrupmlMISCELLANEOUS: BRONCHO-PULMONARY SECRETION MODIFIERSSodium Chloride forSolution0.9 %mlAerosol solution0.9 %mlInhalationMISCELLANEOUS: e*Pseudoephedrine* Restricted to individuals 2years of age and older.Tablets10 mgeaLiquid, syrup15 mg/5 mlml30 mg/5 mlmlTablets,30 mgeaimmediate60 mgeahydrochloride *AL* Restricted to individuals 2years of age and older.releaseDHCS – (CDL) Over-the-Counter Drugs2306/01/2022
Medi-Cal Rx Contract Drugs ListEffective 06/01/2022Drug NameStrength/Package SizeDosageBillingUnitUMTypeCode 1MISCELLANEOUS: ELECTROLYTE SOLUTIONSElectrolytes, oralCompositionSodium - 40 tomaintenanceml60 mEq/LPotassium - 20mEq/LAnionsCarbohydrateGlucose/dextrose 2.0%(20 gm/L) to 2.5%(25 gm/L)Liquid, ready-to-480 ml and aboveuseMISCELLANEOUS: SMOKING DETERRENTSNicotine *Transdermal7 mg/24 hreaQL* To be part of comprehensivesystem14 mg/24 hreasmoking cessation treatment,21 mg/24 hreawhich includes behavioralmodification support. Alsorestricted to (1) a maximumquantity of 28 patches perdispensing; (2) one dispensingin any 25-day period; and (3)DHCS – (CDL) Over-the-Counter Drugs2406/01/2022
Medi-Cal Rx Contract Drugs ListEffective 06/01/2022Drug NameDosageStrength/Package SizeBillingUnitUMType(continued)Code 1eight dispensings within a 12month period.Note: Pharmacies no longerneed to obtain or verify a letteror certificate prior to dispensing.Note: Refer to theReimbursement section of thismanual for reimbursementguidelines and detailsconcerning the use of smokingcessation products duringpregnancy for fee-for-serviceMedi-Cal patients.Nicotine Polacrilex *Gum2 mgea4 mgeaQL* To be part of comprehensivesmoking cessation treatment,which includes behavioralLozenges2 mgeamodification support. Also4 mgearestricted to (1) a maximumquantity of 220 lozenges orDHCS – (CDL) Over-the-Counter Drugs2506/01/2022
Medi-Cal Rx Contract Drugs ListEffective 06/01/2022Drug NameDosageStrength/Package SizeBillingUnit(continued)UMTypeCode 1pieces of gum per dispensing;(2) one dispensing in any 25-dayperiod; and (3) eight dispensingswithin any 12-month period.Note: Pharmacies no longerneed to obtain or verify a letteror certificate prior to dispensing.Note: Refer to theReimbursement section of thismanual for reimbursementguidelines and detailsconcerning the use of smokingcessation products duringpregnancy for fee-for-serviceMedi-Cal patients.NASAL CORTICOSTEROIDSFluticasone FuroateNasal spray27.5 mcg/actuationml9.9 mlml15.8 mlDHCS – (CDL) Over-the-Counter Drugs2606/01/2022
Medi-Cal Rx Contract Drugs ListEffective 06/01/2022Drug NameFluticasoneStrength/Package SizeDosageNasal spray50 mcg/actuationPropionate9.9 mlBillingUnitUMTypeCode 1mlml15.8 mlOPHTHALMIC PREPARATIONS: OPHTHALMIC ANTIHISTAMINESKetotifen FumarateOphthalmic drops0.025 %mlOlopatadine HCLOphthalmic0.1 %, 5 mlmlSolution0.2 %, 2.5 mlmlOPHTHALMIC PREPARATIONS: OPHTHALMIC MISCELLANEOUSSodium 2%mlsolution5%mlTyloxapol withOphthalmic0.25 %-0.02 % /15 mlmlBenzalkoniumsolutionChlorideDHCS – (CDL) Over-the-Counter Drugs2706/01/2022
Medi-Cal Rx Contract Drugs ListEffective 06/01/2022Drug NameStrength/Package SizeDosageBillingUnitUMTypeCode 1TOPICAL AND LOCAL PREPARATIONS: DERMATOLOGICAL PREPARATIONSAluminum AcetateTabletseaLiquid solution –mlnot lotionPowder packetsBacitracin/BacitracinTopical ointmentZincBenzoyl PeroxideGelWashButenafine HClCream12sea100sea15 gmgm30 gmgm120 gmgm5%gm10 %gm5%gm10 %gm1%gmCalamine LotionHydrocortisonemlCreamOintmentDHCS – (CDL) Over-the-Counter Drugs0.5 %gm1%gm0.5 %gm1%gm2806/01/2022
Medi-Cal Rx Contract Drugs ListEffective 06/01/2022Drug Name(continued)Strength/Package SizeDosageLotionBillingUnit0.5 %ml1%mlPermethrinCream rinse1%60 mlmlPolymyxin, b 0 mlml120 mlmlLiquid1%mlCream1%gmand bacitracin zincPyrethrins, PiperonylLiquidButoxide, PetroleumUMTypeCode 1DistillateTolnaftateTOPICAL AND LOCAL PREPARATIONS: VAGINAL PREPARATIONSButoconazole NitrateVaginal Vaginal creamVaginal tablets100 mgTopical cream1%Topical lotion1%DHCS – (CDL) Over-the-Counter Drugs7seagm30 ml29ml06/01/2022
Medi-Cal Rx Contract Drugs ListEffective 06/01/2022Drug Name(continued)Miconazole NitrateStrength/Package SizeDosageTopical solution1%Topical cream2%Vaginal100 mgBillingUnit10 mlml30 mlmlUMTypeCode 1gm7seasuppositoriesVaginal cream2%gmDual package(Topical cream 2%,ea3 vaginal suppositoriespackage200 mg)DHCS – (CDL) Over-the-Counter Drugs3006/01/2022
Medi-Cal Rx Contract Drugs ListEffective 06/01/2022DOS Drugs/No Longer MFGRAluminum Carbonate gel, basicStrengthEnd DateCapsules equivalent to 500These productsmg aluminum hydroxide,are no longerTablets equivalent to 500 mgmanufactured oraluminum hydroxide,available.Suspension equivalent to 400mg aluminum hydroxide per5cc.Coal TarCream or ointmentThese productsare no longermanufactured oravailable.Dicalcium Phosphate with orCapsules, tablets, or wafersThese productswithout vitamin D105 mgare no longermanufactured oravailable.Ferrous Sulfate suspension15 mg/1.5 mg (118ml)dropsSuspension drops.Suspended untilfurther notice.LevonorgestrelTablets: 0.75 mgLiquor Carbonis Detergens9/30/2015This product is nolongermanufactured oravailable.Naphazoline HCL andOphthalmic solution 0.05 % –This product is noAntazoline Phosphate0.5%longermanufactured oravailable.NiacinTablets: 25 mg, 50 mg,8/31/2005100 mg, 500 mgDHCS – (CDL) Over-the-Counter Drugs3106/01/2022
Medi-Cal Rx Contract Drugs ListEffective 06/01/2022DOS Drugs/No Longer MFGRStrengthEnd DateOctoxynol 9 contraceptiveCream with applicator (gm),These productsproductsfoam with applicator (gm),are no longerjelly with applicator (gm)manufactured oravailable.Omeprazole MagnesiumTablets: 20.6 mg4/30/2016PseudoephedrineLiquidThis product is noHydrochloride/longerDiphenhydramine Hydrochloridemanufactured oravailable.QuinineCapsules or tablets: 200 mg,5/1/2007325 mgDHCS – (CDL) Over-the-Counter Drugs3206/01/2022
Medi-Cal Rx Contract Drugs List Effective 06/01/2022 DHCS - (CDL) Over-the-Counter Drugs 5 06/01/2022 Drug Name Dosage Strength/ Package Size
