All *MULTIVITAMINS*

Activite Tablet 1 MG Oral
Activite Tablet 1 MG Oral

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
ADC/F (0.5mg/ml) Solution 0.5 MG/ML Oral
ADC/F (0.5mg/ml) Solution 0.5 MG/ML Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Adrenal C Formula Tablet Oral
Adrenal C Formula Tablet Oral

Bioflavonoid Products

Tier: 3
PA Type: No Prior Authorization
ST: N
Advanced AM/PM Oral
Advanced AM/PM Oral

Tier: 3
PA Type: No Prior Authorization
ST: N
AP-Zel Tablet Oral
AP-Zel Tablet Oral

Tier: 3
PA Type: No Prior Authorization
ST: N
Atabex EC Tablet Delayed Release 29-1 MG Oral
Atabex EC Tablet Delayed Release 29-1 MG Oral

Prenatal Vit-DSS-Fe Cbn-FA

Tier: 3
PA Type: No Prior Authorization
ST: N
Atabex OB Tablet 29-1 MG Oral
Atabex OB Tablet 29-1 MG Oral

Prenatal Vit w/ Fe Bisg-FA

Tier: 3
PA Type: No Prior Authorization
ST: N
AzesChew Prenatal/Postnatal Tablet Chewable 13-1 MG Oral
AzesChew Prenatal/Postnatal Tablet Chewable 13-1 MG Oral

Tier: 3
PA Type: No Prior Authorization
ST: N
Azesco Tablet 13-1 MG Oral
Azesco Tablet 13-1 MG Oral

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
B-Complex Injectable Injection
B-Complex Injectable Injection

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
B-Plex Plus TABLET ORAL
B-Plex Plus TABLET ORAL

Tier: 1
PA Type: No Prior Authorization
ST: N
B-Plex Plus TABLET ORAL
B-Plex Plus TABLET ORAL

Tier: 1
PA Type: No Prior Authorization
ST: N