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 Sort descending	Formulary	Active Ingredient	NAPPI Code	Therapeutic Group
SV Folacin (Folic Acid) TA	Core	Folic Acid Tab 400 MCG	703593006	Prenatal Vitamins
Sv Folacin(Folic Acid) Ta	Extended	Folic Acid Tab 400 Mcg	703593003	Prenatal Vitamins
Sv Folacin(Folic Acid) Ta	Extended	Folic Acid Tab 400 Mcg	703593006	Prenatal Vitamins
Sv Folacin(Folic Acid) Ta	Extended	Folic Acid Tab 800 Mcg	703594007	Prenatal Vitamins
Sv Folacin(Folic Acid) Ta	Basic	Folic Acid Tab 400 Mcg	703593003	Prenatal Vitamins
Sv Folacin(Folic Acid) Ta	Basic	Folic Acid Tab 800 Mcg	703594007	Prenatal Vitamins
SV Folacin(Folic Acid) TA	Standard	Folic Acid Tab 400 MCG	703593003	Prenatal Vitamins
SV Folacin(Folic Acid) TA	Standard	Folic Acid Tab 400 MCG	703593006	Prenatal Vitamins
SV Folacin(Folic Acid) TA	Standard	Folic Acid Tab 800 MCG	703594007	Prenatal Vitamins
SV Prenatal Nutrients Tab	Standard	Prenatal Multivitamins & Minerals w/iron & FA Tab 0.5 MG**	700494001	Prenatal Vitamins
Sv Prenatal Nutrients Tab	Extended	Prenatal Multivitamins & Minerals W/Iron & Fa Tab 0.5 Mg	700494001	Prenatal Vitamins
Viridian Pregnancy Comple	Extended	Prenatal Vit W/ Fe Fumarate-Fa Cap 60-0.8 Mg	712900001	Prenatal Vitamins
Viridian Pregnancy Comple	Standard	Prenatal Vit w/fe Fumarate-FA Tab 60-0.8 MG**	712900001	Prenatal Vitamins
Vita-Min Plus Mother Nam	Extended	Prenatal Vitamin Cap	723993001	Prenatal Vitamins
Vita-Min Plus Mother Nam	Basic	Prenatal Vitamin Cap	723993001	Prenatal Vitamins
Vita-Min Plus Mother Nam	Core	Prenatal Vitamins Cap*	723993001	Prenatal Vitamins
Vita-Min Plus Mother Nam	Standard	Prenatal Vitamin Cap*	723993001	Prenatal Vitamins
Vital Folic Complete Tabs	Extended	Folic Acid Tab 0.5 Mg	705849002	Prenatal Vitamins
Vital Folic Complete Tabs	Basic	Folic Acid Tab 0.5 Mg	705849002	Prenatal Vitamins
Vital Folic Complete Tabs	Standard	Folic Acid Tab 0.5 MG	723196001	Prenatal Vitamins
Vital Folic Complete Tabs	Core	Folic Acid Tab 0.5 MG	705849002	Prenatal Vitamins
Vitatech Prenatal Pack Ki	Extended	Prenatal W/Fe-Ca Tab & Omega 3 Cap Pack	3003101001	Prenatal Vitamins

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