Drug Benefit List

88:00 VITAMINS

88:04.00 VITAMIN A

VITAMIN A

10,000IU Capsule

00557447     VIT A     VTH     *

00253820     VITAMIN A     NOP

00297720     VITAMIN A     JAM

25,000IU Capsule

00021067     VITAMIN A     NOP

50,000IU Capsule

00021075     VITAMIN A     NOP

88:08.00 VITAMIN B COMPLEX

CYANOCOBALAMIN

100MCG/ML Injection

02241500     VITAMIN B12     SDZ

1,000MCG/ML Injection

01987003     CYANOCOBALAMIN     CYX

02052717     CYANOCOBALAMIN     TAR

02229972     SCHEIN B12     SCN

00521515     VIT B12     SDZ

25MCG Tablet

00406988     VITAMIN B12     JAM     *

50MCG Tablet

00305243     VITAMIN B12     JAM

100MCG Tablet

00450642     VIT B12     VTH     *

02023598     VITAMIN B12     PMT

250MCG Tablet

00890294     VIT B12     PVR     *

00335940     VITAMIN B12     JAM

FOLIC ACID

1MG Tablet

00318973     FOLIC ACID     JAM

00647039     FOLIC ACID     VTH

02048841     FOLIC ACID     PMT

02236747     FOLIC ACID     PED

5MG Tablet

00426849     APO-FOLIC ACID     APX

00563781     FOLIC ACID     PDL

NIACIN

50MG Tablet

00268593     NIACIN     VAE

00041084     NIACIN     PMS

100MG Tablet

00268585     NIACIN     VAE

500MG Tablet

00294950     NIACIN     VAE

01939130     NIACIN     ODN

02247004     NIACIN     PMT

00557412     NIACIN YEAST FREE     VTH

00309737     VITAMIN B3     JAM

PYRIDOXINE HCL

25MG Tablet

00232475     VITAMIN B6     PMS

00268607     VITAMIN B6     VAE

01943200     VITAMIN B6     ODN

50MG Tablet

00252689     VITAMIN B6     VAE

00305227     VITAMIN B6     JAM

00608599     VITAMIN B6     PMS     *

100MG Tablet

00263958     VITAMIN B6     VAE

00329185     VITAMIN B6     JAM

00450677     VITAMIN B6     VTH     *

00653993     VITAMIN B6     LAL     *

02239348     VITAMIN B6     PMT

THIAMINE HCL

100MG/ML Injection

02241983     BETAXIN     ABB

02243525     THIAMINE     CYX

00816078     VITAMIN B1     SIL

50MG Tablet

00268631     VITAMIN B1     VAE

00610267     VITAMIN B1     PMS

100MG Tablet

00232467     VITAMIN B1     PMS     *

00294853     VITAMIN B1     VAE

88:12.00 VITAMIN C

ASCORBIC ACID

250MG Chewable Tablet

00784575     VIT C     VTH     *

00266051     VITAMIN C     PMT

00274232     VITAMIN C     PED

00372498     VITAMIN C     LAL     *

500MG Chewable Tablet

00274240     VITAMIN C     PED

00322997     VITAMIN C     LAL     *

00784591     VITAMIN C     VTH     *

02243893     VITAMIN C     PMT

02245721     VITAMIN C     PMT

1000MG Sustained Release Tablet

00760587     VITAMIN C     PMT

100MG Tablet

00466646     APO-C     APX

250MG Tablet

00466638     APO-C     APX

00221244     VIT C     ADA

00557811     VIT C     VTH     *

00162515     VITAMIN C     PMT

500MG Tablet

01901184     ACTI-SCORB     ACT     *

00266086     ASCORBIC ACID     PMT

00041114     VIT C     ADA

00322326     VIT C     LAL

00316873     VITAMIN C     LAL     *

01922378     VITAMIN C     SWS

00036188     VITAMIN C     PED

00557838     VITAMIN C     VTH     *

00721581     VITAMIN C     PVR     *

02244469     VITAMIN C     PMT

1000MG Tablet

00466603     APO-C     APX

00854670     C 1000     NUL     *

00354376     VITAMIN C     PMT

88:16.00 VITAMIN D

ALFACALCIDOL

0.25MCG Capsule

00474517     ONE-ALPHA     LEO

1MCG Capsule

00474525     ONE-ALPHA     LEO

2MCG/ML Oral Liquid

02240329     ONE-ALPHA     LEO

CALCITRIOL

0.25MCG Capsule

00481823     ROCALTROL     HLR

0.5MCG Capsule

00481815     ROCALTROL     HLR

1MCG/ML Solution

00824291     ROCALTROL     HLR

CHOLECALCIFEROL

400IU Capsule

02242651     EURO D     EUR

02243976     RIVA-D     RIV

10,000 Capsule

02253178     EURO D     EUR

400IU/ML Drop

00762881     D VI SOL     MJO

02231624     PEDIAVIT D     EUR

400IU Tablet

00765384     VITAMIN D     LAL

02229879     VITAMIN D     SWS

02238729     VITAMIN D     VTH

02240624     VITAMIN D     WAM

02240858     VITAMIN D     PMT

02244759     VITAMIN D     WNP

1,000IU Tablet

00299383     VITAMIN D     JAM

00323179     VITAMIN D     SWS

02240507     VITAMIN D     MNP

10,000IU Tablet

00821772     D-TABS     RIV

ERGOCALCIFEROL

50,000IU Capsule

02237450     D-FORTE     EUR

00009830     OSTOFORTE     FRS

8,288IU/ML Solution

02017598     DRISDOL     SAC

88:20.00 VITAMIN E

VITAMIN E

100IU Capsule

02162083     AQUASOL E     NVC

00480924     VIT E NATURAL     VTH

200IU Capsule

00201987     VITAMIN E     WAM

02041073     VITAMIN E     VTH

50IU/ML Liquid

02162075     AQUASOL E     NVC

77IU/ML Liquid

02212889     AQUASOL E     NVC

88:28.00 MULTIVITAMIN PREPARATIONS

MULTIVITAMINS (PEDIATRIC)

Limited use benefit (prior approval is not required).

Pediatric multivitamins are benefits for children up to 6 years of age.

Chewable Tablet

01932586     GARFIELD MULTIVITAMINS     WRI

00336300     MULTI-VITAMINS CHILD     NOP

Drop

00558060     INFANTOL     HOR

00762946     POLY-VI-SOL     MJO

Liquid

00558079     INFANTOL     HOR

Tablet

02247975     FLINTSTONES EXTRA C     BCD

MULTIVITAMINS (PRENATAL)

Limited use benefit (prior approval is not required.).

Prenatal and postnatal vitamins are benefits only for women of childbearing age (12 to 50 years).

Tablet

02231880     MATERNA     WAY

02248555     MATERNA     WAY

02229535     MULTI-PRE AND POST NATAL     PED

00815241     NEO-TINIC     NEO

02103044     ORIFER F     SAC

02226960     PRENATAL     VTH

02240840     PRENATAL AND POSTPARTUM     VTH

02241235     PRENATAL AND POSTPARTUM     SDR

02244374     PRENATAL VITAMINS AND MINERALS     PMT

VITAMIN A, CHOLECALCIFEROL, ASCORBIC ACID

Limited use benefit (prior approval is not required).

Pediatric multivitamins are benefits for children up to 6 years of age.

2,500IU & 666.67IU & 50MG/ML Drop

02229790     PEDIAVIT     EUR

00762903     TR- VI-SOL     MJO