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Formulary List

Explore our comprehensive list of medications covered under your health plan. This list currently shows pre-natal formularies to support our patient’s well-being. All Core health plans use the Pregnancy Core formulary, All Plus health plans use the Pregnancy Basic, All Extra health plans use the Pregnancy Standard and All Max health plans use the Pregnancy Extended. Review this page regularly to stay informed.
Drug Name9 Months + Calcium & Omega
Active Ingredient
Prenatal W/Fe-Fa Tab & Omega 3 Cap Pack
NAPPI Code
723620001
Therapeutic Group
Prenatal Vitamins
Drug Name Formulary Active Ingredient NAPPI Code Therapeutic Group
Folic Select 800MCG/25MCG Core Folic Acid Tab 800 MCG 710915001 Prenatal Vitamins
Folic Select 800Mcg/25Mcg Extended Folic Acid Tab 800 Mg 710915001 Prenatal Vitamins
Folic Select 800Mcg/25Mcg Basic Folic Acid Tab 800 Mcg 710915001 Prenatal Vitamins
Folic Select 800MCG/25MCG Standard Folic Acid Tab 800 MCG 710915001 Prenatal Vitamins
Folik 0.5Mg Tabs Extended Folic Acid Tab 0.5 Mg 721661001 Prenatal Vitamins
Folik 0.5Mg Tabs Basic Folic Acid Tab 0.5 Mg 721661001 Prenatal Vitamins
Folik 0.5MG Tabs Standard Folic Acid Tab 0.5 MG 721661001 Prenatal Vitamins
Folik 0.5MG Tabs Core Folic Acid Tab 0.5 MG 721661001 Prenatal Vitamins
Fs Pregnancy Form Basic *Prenatal Multivitamins & Minerals W/ Iron Tab*** 704200001 Prenatal Vitamins
FS Pregnancy Form Standard *Prenatal Multivitamins & Minerals w/iron Tab*** 704200001 Prenatal Vitamins
Fs Pregnancy Form Extended Prenatal Multivitamins & Minerals W/ Iron Tab 704200001 Prenatal Vitamins
Gulf Calcium Gluconate Ta Basic Calcium Gluconate Tab 300 Mg (Elemental Ca) 703445001 Calcium
Gulf Calcium Gluconate TA Core Calcium Gluconate Tab 300 MG (Elemenatl CA) 703445001 Calcium
Gulf Calcium Gluconate TA Standard Calcium Gluconate Tab 300 MG (Elemental CA) 703445001 Calcium
Gulf Calcium Gluconate Ta Extended Calcium Gluconate Tab 300 Mg (Elemental Ca) 703445001 Calcium
Gulf Folic Acid 5MG Tabs Folic Acid Tab 5 MG 720727001 Prenatal Vitamins
Gulf Folic Acid 5MG Tabs Core Folic Acid Tab 5 MG 720727002 Prenatal Vitamins
Gulf Folic Acid 5Mg Tabs Extended Folic Acid Tab 5 Mg 720727001 Prenatal Vitamins
Gulf Folic Acid 5Mg Tabs Extended Folic Acid Tab 5 Mg 720727002 Prenatal Vitamins
Gulf Folic Acid 5Mg Tabs Basic Folic Acid Tab 5 Mg 720727001 Prenatal Vitamins
Gulf Folic Acid 5Mg Tabs Basic Folic Acid Tab 5 Mg 720727002 Prenatal Vitamins
Gulf Folic Acid 5MG Tabs Standard Folic Acid Tab 5 MG 720727001 Prenatal Vitamins
Gulf Folic Acid 5MG Tabs Standard Folic Acid Tab 5 MG 720727002 Prenatal Vitamins
H&B Folic Acid 400Cg Tab Basic Folic Acid Cap 400 Mcg 711631001 Prenatal Vitamins
H&B Folic Acid 400Mcg Tab Extended Folic Acid Cap 400 Mcg 711631001 Prenatal Vitamins
H&B Folic Acid 400MCG Tab Standard Folic Acid Cap 400 MCG 711631001 Prenatal Vitamins
H&B Folic Acid 400MCG Tab Core Folic Acid Cap 400 MCG 711631001 Prenatal Vitamins
H&B Folic Acid 800MCG Tab Core Folic Acid Tab 800 MCG 711549001 Prenatal Vitamins
H&B Folic Acid 800Mcg Tab Extended Folic Acid Tab 800 Mcg 711549001 Prenatal Vitamins
H&B Folic Acid 800Mcg Tab Basic Folic Acid Tab 800 Mcg 711549001 Prenatal Vitamins
H&B Folic Acid 800MCG Tab Standard Folic Acid Tab 800 MCG 711549001 Prenatal Vitamins
Holisitix Total Supply Pre Basic Prenatal Vitamin Capp 716535002 Prenatal Vitamins
Holistix Folic Acid 400Mc Extended Folic Acid Cap 400 Mcg 716533001 Prenatal Vitamins
Holistix Folic Acid 400Mc Extended Folic Acid Tab 400 Mcg 714256001 Prenatal Vitamins
Holistix Folic Acid 400Mc Extended Folic Acid Tab 400 Mcg 714256002 Prenatal Vitamins
Holistix Folic Acid 400Mc Basic Folic Acid Cap 400 Mcg 716533001 Prenatal Vitamins
Holistix Folic Acid 400Mc Basic Folic Acid Tab 400 Mcg 714256001 Prenatal Vitamins
Holistix Folic Acid 400Mc Basic Folic Acid Tab 400 Mcg 714256002 Prenatal Vitamins
Holistix Folic Acid 400MC Standard Folic Acid Cap 400 MCG 716533001 Prenatal Vitamins
Holistix Folic Acid 400MC Core Folic Acid Cap 400 MCG 716533001 Prenatal Vitamins
Holistix Folic Acid 400MC Standard Folic Acid Tab 400 MCG 714256001 Prenatal Vitamins
Holistix Folic Acid 400MC Standard Folic Acid Tab 400 MCG 714256002 Prenatal Vitamins
Holistix Folic Acid 400MC Core Folic Acid Tab 400 MCG 714256001 Prenatal Vitamins
Holistix Folic Acid 400MC Core Folic Acid Tab 400 MCG 714256002 Prenatal Vitamins
Holistix Platinumnpreg Pa Extended Prenatal W/Fe-Fa-Ca Tab & Omega 3 Cap Pack 717236001 Prenatal Vitamins
Holistix Total Supply Pre Extended Prenatal Vitamin Cap 716535002 Prenatal Vitamins
Holistix Total Supply Pre Extended Prenatal Vitamin Cap 716535003 Prenatal Vitamins
Holistix Total Supply Pre Basic Prenatal Vitamin Capp 716535001 Prenatal Vitamins
Holistix Total Supply Pre Basic Prenatal Vitamin Cap 716535003 Prenatal Vitamins
Holistix Total Supply Pre Core *Prenatal Vitamins Cap** 716535001 Prenatal Vitamins

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