Displaying 1 - 26 of 26 records found.

Items in this class
Brand Name/Generic Name NDC code Clinical Prior Auth Required PDL Prior Auth Required
CENTRATEX CAPSULE
iron fum/folic acid/mv,min 15
23359010010 No No
CENTRATEX CAPSULE
iron fum/folic acid/mv,min 15
23359010030 No No
CITRANATAL BLOOM TABLET
iron carb,gl/FA/B12/C/docusate
00178081330 No Yes
CORVITE 150 TABLET
iron,carb/folate6/mv,min no.41
68025005230 No Yes
CORVITE FE TABLET
iron/folate no.6/mv,mins no.40
68025006030 No Yes
FERIVA 21-7 TABLET
iron/folate no1/C/B12/zinc/dss
75854031828 No Yes
FERIVA FA CAPSULE
IRON/FOLAT6/C/B12/BIOT/COP/DSS
75854031030 No Yes
FERIVA FA CAPSULE
iron/folat1/C/B12/biot/docusat
75854031930 No Yes
FERRALET 90 TABLET
iron carb,gl/FA/B12/C/docusate
00178008990 No No
FERRAPLUS 90 TABLET
iron/folic acid/B12/C/docusate
13811001290 No Yes
FOCALGIN DSS TABLET
iron carb,gl/FA/B12/C/docusate
58657011290 No Yes
FUSION PLUS CAPSULE
iron,fm,ps/folic/B,C18/L.casei
52747050230 No Yes
HEMOCYTE PLUS CAPSULE
iron fum/folic acid/mv,min 15
52747080030 No No
HEMOCYTE PLUS CAPSULE
iron fum/folic acid/mv,min 15
52747080060 No No
HEMOCYTE-F TABLET
ferrous fumarate/folic acid
52747030630 No No
HEMOCYTE-F TABLET
ferrous fumarate/folic acid
52747030670 No No
INTEGRA F CAPSULE
iron fum,ps/folic acid/vitC/B3
52747071130 No No
INTEGRA F CAPSULE
iron fum,ps/folic acid/vitC/B3
52747071160 No No
INTEGRA PLUS CAPSULE
iron fum,ps/folic/Bcomp,C no.9
52747071230 No No
INTEGRA PLUS CAPSULE
iron fum,ps/folic/Bcomp,C no.9
52747071260 No No
IROSPAN 24/6 TABLET
iron bg,ps/folic/B,C no.12/suc
50967012630 No Yes
NEPHRON FA TABLET
iron fum/docusat/folic/Bcomp,C
59528445601 No No
SE-TAN PLUS CAPSULE
iron fm,ps no.1/folic/mv no.18
13925011890 No No
TANDEM DUAL ACTION CAPSULE
ferrous fumarate/iron ps cplx
52747090090 No No
TANDEM PLUS CAPSULE
iron fm,ps no.1/folic/mv no.18
52747090260 No No
TARON FORTE CAPSULE
iron bg,ps/vitC/B12/FA/calcium
13811004210 No Yes