Drug Benefit List 2010

88:00 VITAMINS

88:04.00 VITAMIN A

VITAMIN A

10,000IU Capsule

557447 VIT A * VTH

253820 VITAMIN A NOP

297720 VITAMIN A JAM

25,000IU Capsule

21067 VITAMIN A NOP

50,000IU Capsule

21075 VITAMIN A NOP

88:08.00 VITAMIN B COMPLEX

CYANOCOBALAMIN

100mcg/mL Injection

497533 VITAMIN B12 ABB

2241500 VITAMIN B12 SDZ

1,000mcg/mL Injection

1987003 CYANOCOBALAMIN CYX

2052717 CYANOCOBALAMIN TAR

521515 VIT B12 SDZ

38830 VITAMIN B12 ABB

25mcg Tablet

406988 VITAMIN B12 * JAM

50mcg Tablet

305243 VITAMIN B12 JAM

100mcg Tablet

450642 VIT B12 * VTH

2023598 VITAMIN B12 PMT

250mcg Tablet

335940 VITAMIN B12 JAM

1000mcg Tablet

80003575 VITAMIN B12 PMT

FOLIC ACID

1mg Tablet

318973 FOLIC ACID JAM

647039 FOLIC ACID VTH

2048841 FOLIC ACID PMT

2236747 FOLIC ACID PED

5mg Tablet

426849 APO-FOLIC ACID APX

2285673 EURO-FOLIC EUR

563781 FOLIC ACID PDL

NIACIN

50mg Tablet

41084 NIACIN PMS

100mg Tablet

268585 NIACIN VAE

NIACIN

500mg Tablet

294950 NIACIN VAE

1939130 NIACIN ODN

2247004 NIACIN PMT

557412 NIACIN YEAST FREE VTH

309737 VITAMIN B3 JAM

PYRIDOXINE HCL

25mg Tablet

122645 VITAMIN B6 JAM

232475 VITAMIN B6 PMS

1943200 VITAMIN B6 ODN

80002890 VITAMIN B6 JMP

50mg Tablet

252689 VITAMIN B6 VAE

305227 VITAMIN B6 JAM

608599 VITAMIN B6 * PMS

100mg Tablet

329185 VITAMIN B6 JAM

450677 VITAMIN B6 * VTH

464325 VITAMIN B6 PED

653993 VITAMIN B6 * LAL

2239348 VITAMIN B6 PMT

THIAMINE HCL

100mg/mL Injection

2241983 BETAXIN ABB

2243525 THIAMINE CYX

816078 VITAMIN B1 SDZ

50mg Tablet

80009633 JAMP-VITAMIN B1 JMP

268631 VITAMIN B1 VAE

100mg Tablet

232467 VITAMIN B1 * PMS

407011 VITAMIN B1 JAM

88:12.00 VITAMIN C

ASCORBIC ACID

250mg Chewable Tablet

784575 VIT C * VTH

266051 VITAMIN C PMT

274232 VITAMIN C PED

372498 VITAMIN C * LAL

500mg Chewable Tablet

274240 VITAMIN C PED

322997 VITAMIN C * LAL

784591 VITAMIN C * VTH

2243893 VITAMIN C PMT

2245721 VITAMIN C PMT

1000mg Sustained Release Tablet

760587 VITAMIN C PMT

100mg Tablet

466646 APO-C APX

ASCORBIC ACID

250mg Tablet

466638 APO-C APX

221244 VIT C ADA

557811 VIT C * VTH

162515 VITAMIN C PMT

500mg Tablet

266086 ASCORBIC ACID PMT

41114 VIT C ADA

322326 VIT C LAL

36188 VITAMIN C PED

316873 VITAMIN C * LAL

557838 VITAMIN C * VTH

721581 VITAMIN C * PVR

1922378 VITAMIN C SWS

2244469 VITAMIN C PMT

1000mg Tablet

466603 APO-C APX

854670 C 1000 * NUL

897256 REDOXON HLR

354376 VITAMIN C PMT

88:16.00 VITAMIN D

ALFACALCIDOL

0.25mcg Capsule

474517 ONE-ALPHA LEO

1mcg Capsule

474525 ONE-ALPHA LEO

2mcg/mL Oral Liquid

2240329 ONE-ALPHA LEO

CALCITRIOL

0.25mcg Capsule

481823 ROCALTROL HLR

0.5mcg Capsule

481815 ROCALTROL HLR

1mcg/mL Solution

824291 ROCALTROL HLR

CHOLECALCIFEROL

400IU Capsule

2242651 EURO D EUR

80006629 JAMP-VITAMIN D JMP

2243976 RIVA-D RIV

80005560 RIVA-D 400 UNIT CAP RIV

800IU Capsule

80007769 JAMP VIT D3 JMP

10,000IU Capsule

2253178 EURO D EUR

50,000IU Capsule

2301911 OSTOFORTE TRT

400IU Drop

80001869 BABY DDROPS DDP

80001792 DDROPS VITAMIN D DDP

CHOLECALCIFEROL

400IU/mL Drop

762881 D VI SOL MJO

80003038 JAMP-VITAMIN D JMP

2231624 PEDIAVIT D EUR

1000IU Drop

80001791 DDROPS VITAMIN D DDP

400IU Tablet

765384 VITAMIN D LAL

2229879 VITAMIN D SWS

2238729 VITAMIN D VTH

2240624 VITAMIN D WAM

2240858 VITAMIN D PMT

2244759 VITAMIN D WNP

1,000IU Tablet

299383 VITAMIN D JAM

323179 VITAMIN D SWS

2245842 VITAMIN D PMT

10,000IU Tablet

821772 D-TABS RIV

ERGOCALCIFEROL

50,000IU Capsule

2237450 D-FORTE EUR

8,288IU/mL Solution

2017598 DRISDOL SAC

VITAMIN D

400IU Capsule

80008590 VITAMIN D BMI

800IU Capsule

80003010 EURO D EUR

80008446 VITAMIN D BMI

88:20.00 VITAMIN E

ALPHA TOCOPHERYL

400IU Capsule

122858 VITAMIN E NATUAL SOURCE JAM

VITAMIN E

50IU/mL Liquid

2162075 AQUASOL E NVC

77IU/mL Liquid

2212889 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

336300 MULTI-VITAMINS CHILD NOP

MULTIVITAMINS (PEDIATRIC)

Limited use benefit (prior approval is not required).

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

Drop

558060 INFANTOL HOR

762946 POLY-VI-SOL MJO

Liquid

558079 INFANTOL HOR

Tablet

80011134 CENTRUM JUNIOR COMPLETE WYE

2247975 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

80001842 CENTRUM MATERNA WAY

2229535 MULTI-PRE AND POST NATAL PED

815241 NEO-TINIC NEO

80005770 PRENATAL & POSTPARTUM PMT

2240840 PRENATAL AND POSTPARTUM VTH

2241235 PRENATAL AND POSTPARTUM SDR

2244374 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

2229790 PEDIAVIT EUR

762903 TR- VI-SOL MJO

Oral Liquid

80008471 JAMP-MULTIVITAMIN A/D/C DROPS JMP