Displaying 1 - 50 of 66 records found.

Items in this class
Brand Name/Generic Name NDC code Clinical Prior Auth Required PDL Prior Auth Required
CITRANATAL 90 DHA COMBO PACK
PNV72/iron,gluc/folic/dss/dha
00178082130 No No
CITRANATAL ASSURE COMBO PACK
PNV73/iron,gluc/folic/dss/dha
00178089130 No No
CITRANATAL DHA PACK
PNV 76/iron,gluc/folic/dss/dha
00178089430 No Yes
CITRANATAL HARMONY CAPSULE
PNV59/iron,carb,fum/FA/dss/dha
00178079630 No No
CITRANATAL RX TABLET
prenatal81/iron/folic/docusate
00178085890 No Yes
COMPLETE NATAL DHA
prenatal 2/iron/folic acid/om3
13811001030 No Yes
COMPLETENATE TABLET CHEW
prenatal vit 14/iron fum/folic
13811001490 No Yes
CONCEPT DHA CAPSULE
PNV 16/iron fum,ps/folic/om-3
52747062130 No Yes
CONCEPT OB CAPSULE
PNV 15/iron fum,ps/folic acid
52747062030 No Yes
DOTHELLE DHA SOFTGEL
PNV 16/iron fum,ps/folic/om-3
58657012130 No Yes
ELITE-OB CAPLET
prenatal no.123/iron/folic ac
13811002710 No Yes
EXTRA-VIRT PLUS DHA SOFTGEL
prenatal 57/iron/folic/dss/dha
76439025130 No Yes
FOCALGIN 90 DHA COMBO PACK
PNV72/iron,gluc/folic/dss/dha
58657011060 No Yes
FOCALGIN CA COMBO PACK
PNV73/iron,gluc/folic/dss/dha
58657011160 No Yes
FOLIVANE-OB CAPSULE
PNV 15/iron fum,ps/folic acid
13811053530 No Yes
NESTABS ABC PRENATAL COMBO PK
prenatal 86/iron/folic/dha/epa
50967030930 No Yes
NESTABS DHA COMBO PACK
prenatal 87/iron bis/folic/dha
50967031730 No Yes
NESTABS TABLET
prenatal vit86/iron/folic acid
50967021990 No Yes
OB COMPLETE CAPLET
prenatal no.123/iron/folic ac
68025001010 No Yes
OB COMPLETE GOLD SOFTGEL
PNV no.106/iron/folate no6/dha
68025006830 No Yes
OB COMPLETE ONE SOFTGEL
PNV 85/iron/folic/dha/fish oil
68025004430 No Yes
OB COMPLETE PETITE SOFTGEL
prenatal56/iron/folic acid/dha
68025005930 No Yes
OB COMPLETE PREMIER TABLET
PNV83/iron,carb,asp/folic acid
68025004330 No Yes
PREFERA-OB ONE SOFTGEL
PNV 19/iron ps,heme/folic/dha
00037008630 No Yes
PRENATE AM TABLET
prenatal vit114/folate6/ginger
75854030730 No Yes
PRENATE CHEWABLE TABLET
prenatal vit no.112/folate no6
75854030630 No Yes
PRENATE DHA SOFTGEL
prenatal 78/iron/folate 1/dha
75854031230 No Yes
PRENATE ELITE TABLET
prenatal 114/iron a-g/folate 1
75854031430 No Yes
PRENATE ENHANCE SOFTGEL
prenatal vit68/iron/FA no6/dha
75854030930 No Yes
PRENATE ESSENTIAL SOFTGEL
prenatal vit 84/iron/FA 1/dha
75854031330 No Yes
PRENATE MINI SOFTGEL
prenatal vit 87/iron/folic/dha
75854031530 No Yes
PRENATE PIXIE SOFTGEL
prenatal vit 85/iron/FA 1/dha
75854031630 No Yes
PRENATE RESTORE SOFTGEL
prenatal vit69/iron/folate6/dh
75854030830 No Yes
PRENATE STAR TABLET
prenatal no.77/iron asp gly/FA
75854031130 No Yes
PROVIDA DHA CAPSULE
prenat90/iron fum,ps/folic/dha
52747050330 No Yes
PROVIDA OB CAPSULE
prenatal vit 65/iron fum,ps/FA
52747050430 No No
RELNATE DHA PRENATAL SOFTGEL
PNV 11/iron fum/folic acid/om3
35573020030 No Yes
SE-NATAL 19 CHEWABLE TABLET
PNV no.118/iron fumarate/FA
13925011701 No Yes
SE-NATAL 19 TABLET
PNV119/iron fum/folic/docusate
13925011601 No Yes
SELECT-OB + DHA PACK
prenatal vit 33/iron/folic/dha
00642007530 No No
TARON-C DHA CAPSULE
PNV 16/iron fum,ps/folic/om-3
13811053630 No Yes
THRIVITE 19 TABLET
mv, min 59/iron/folic/docusate
58657013601 No Yes
THRIVITE RX TABLET
prenatal vit,calc76/iron/folic
58657013390 No Yes
TRICARE PRENATAL DHA ONE SFTGL
pnv20/iron/folic/docusate/om3s
67112040130 No Yes
TRICARE PRENATAL TABLET
prenatal vit103/iron fum/folic
67112010100 No No
TRINATAL RX 1 TABLET
prenatal vit27,calcium/iron/FA
13811000710 No No
TRISTART DHA SOFTGEL
prenatal 93/iron/folate 9/dha
15370025030 No Yes
TRIVEEN-DUO DHA COMBO PACK
prenatal 53/iron/folic ac/omg3
13811059130 No Yes
ULTIMATECARE ONE CAPSULE
PNV,calcium37/iron/folic/omeg3
13811004930 No Yes
VIRT-SELECT CAPSULE
PNV 80/iron fum/folic/dss/dha
76439024930 No Yes