PRENATAL VITAMINS
| Brand Name/Generic Name | NDC/Manufacturer | FFS Clinical Prior Auth Required | PDL Prior Auth Required | Programs |
|---|---|---|---|---|
| COMPLETE NATAL DHA PNV cmb 52/iron/FA/omega-3/dha |
13811001030 TRIGEN LABORATO |
No | No | Medicaid CHIP CSHCN |
| FOLIVANE-OB CAPSULE mvn-min 74/iron fum/iron/FA |
13811053530 TRIGEN LABORATO |
No | No | Medicaid CHIP CSHCN |
| M-NATAL PLUS TABLET PNV,calcium 72/iron/folic acid |
58657017001 METHOD PHARMACE |
No | No | Medicaid CSHCN |
| PRENATE ENHANCE SOFTGEL prenatal vit68/iron/FA no6/dha |
75854030930 AVION PHARMACEU |
No | No | Medicaid CHIP CSHCN |
| SELECT-OB + DHA PACK prenatal vit 33/iron/folic/dha |
00642007530 EXELTIS USA, IN |
No | No | Medicaid CHIP CSHCN |
| THRIVITE RX TABLET prenatal vit,calc76/iron/folic |
58657013390 METHOD PHARMACE |
No | No | Medicaid CHIP CSHCN |
| TRICARE PRENATAL TABLET prenatal vit103/iron fum/folic |
67112010100 MEDECOR PHARMA |
No | No | Medicaid CHIP CSHCN |
| TRINATAL RX 1 TABLET prenatal vit27,calcium/iron/FA |
13811000710 TRIGEN LABORATO |
No | No | Medicaid CHIP CSHCN |
| VITAFOL GUMMIES PNV 112/iron/folic/om3/dha/epa |
00642012590 EXELTIS USA, IN |
No | No | Medicaid CHIP CSHCN |
| VITAFOL NANO TABLET prenatal no.75/iron/folate no1 |
00642009430 EXELTIS USA, IN |
No | No | Medicaid CHIP CSHCN |