88:00 VITAMINS

88:04.00 VITAMIN A

VITAMIN A

Table: VITAMIN A
Drug strength and dosage form DIN Brand name Manufacturer code
ST10,000IU Capsule 80054130 JAMP-VITAMIN A JMP
ST10,000IU Capsule 00297720 VITAMIN A JAM
ST10,000IU Capsule 00557447 VITAMIN A VTH

88:08.00 VITAMIN B COMPLEX

CYANOCOBALAMIN

Table: CYANOCOBALAMIN
Drug strength and dosage form DIN Brand name Manufacturer code
100MCG/ML Liquid 02241500 VITAMIN B12 SDZ
ST200MCG/ML Liquid 80039903 BEDUZIL ORM
ST200MCG/ML Liquid 80026092 JAMP-VITAMIN B12 JMP
1,000MCG/ML Liquid 00626112 B-12 OMG
1,000MCG/ML Liquid 02052717 CYANOCOBALAMIN TAR
1,000MCG/ML Liquid 02413795 CYANOCOBALAMIN MYL
1,000MCG/ML Liquid 02420147 JAMP-CYANOCOBALAMIN JMP
1,000MCG/ML Solution 01987003 CYANOCOBALAMIN RAX
1,000MCG/ML Solution 00521515 VITAMIN B12 SDZ
ST250MCG Tablet 80015294 JAMP-VITAMIN B12 JMP
ST250MCG Tablet 80055743 M-B12 MAN
ST250MCG Tablet 00335940 VITAMIN B12 JAM
ST250MCG Tablet 02239695 VITAMIN B12 PMT
ST250MCG Tablet 80004053 VITAMIN B12 WNP
ST1000MCG Tablet 80028902 JAMP VITAMIN B12 JMP
ST1000MCG Tablet 80015276 JAMP-VITAMIN B12 JMP
ST1000MCG Tablet 80055741 M-B12 MAN
ST1000MCG Tablet 02237736 VITAMIN B12 VAE
ST1000MCG Tablet 80003575 VITAMIN B12 PMT
ST1000MCG Tablet 80006939 VITAMIN B12 WNP
ST1000MCG Tablet 80012952 VITAMIN B12 SUBLINGUAL JAM

FOLIC ACID

Table: FOLIC ACID
Drug strength and dosage form DIN Brand name Manufacturer code
ST1MG Tablet 00318973 FOLIC ACID JAM
ST1MG Tablet 00647039 FOLIC ACID VTH
ST1MG Tablet 02048841 FOLIC ACID PMT
ST1MG Tablet 80000273 FOLIC ACID WNP
ST1MG Tablet 80053274 JAMP FOLIC ACID JMP
ST1MG Tablet 80061488 M-FOLIQUE MAN
ST1MG Tablet 02236747 WAMPOLE FOLIC ACID WAM
ST5MG Tablet 00426849 FOLIC ACID APX
ST5MG Tablet 02366061 JAMP-FOLIC ACID JMP
ST5MG Tablet 02285673 SANDOZ FOLIC ACID SDZ
ST1000MCG Tablet 02239882 FOLIC ACID UNK

NIACIN

Table: NIACIN
Drug strength and dosage form DIN Brand name Manufacturer code
ST500MG Caplet 00309737 NIACIN JAM
ST50MG Tablet 00041084 NIACIN ADA
ST500MG Tablet 00557412 NIACIN VTH
ST500MG Tablet 01939130 NIACIN ODN
ST500MG Tablet 02247004 NIACIN PMT

PYRIDOXINE HYDROCHLORIDE

Table: PYRIDOXINE HYDROCHLORIDE
Drug strength and dosage form DIN Brand name Manufacturer code
ST25MG Tablet 80056458 M-B6 MAN
ST25MG Tablet 00122645 VITAMIN B6 JAM
ST25MG Tablet 00232475 VITAMIN B6 ADA
ST25MG Tablet 01943200 VITAMIN B6 ODN
ST25MG Tablet 80002890 VITAMIN B6 JMP
ST50MG Tablet 00305227 VITAMIN B6 JAM
50MG Tablet 00608599 VITAMIN B6 ADA
ST100MG Tablet 00450677 B6 VTH
ST100MG Tablet 00263958 VITAMIN B6 VAE
ST100MG Tablet 00329185 VITAMIN B6 JAM
ST100MG Tablet 02239348 VITAMIN B6 PMT

THIAMINE HYDROCHLORIDE

Table: THIAMINE HYDROCHLORIDE
Drug strength and dosage form DIN Brand name Manufacturer code
100MG/ML Liquid 02193221 THIAMIJECT OMG
100MG/ML Liquid 02243525 THIAMINE RAX
100MG/ML Solution 00816078 VITAMIN B1 SDZ
ST50MG Tablet 02245506 EURO VITAMIN B1 EUR
ST50MG Tablet 80054199 M-B1 MAN
ST50MG Tablet 00268631 THIAMINE VAE
ST50MG Tablet 80009633 VITAMIN B1 JMP
ST100MG Tablet 80054205 M-B1 MAN
ST100MG Tablet 00232467 VITAMIN B1 PED
ST100MG Tablet 00407011 VITAMIN B1 JAM
ST100MG Tablet 02239350 VITAMIN B1 PMT
ST100MG Tablet 80000352 VITAMIN B1 WNP
ST100MG Tablet 80009588 VITAMIN B1 JMP

88:12.00 VITAMIN C

ASCORBIC ACID

Table: ASCORBIC ACID
Drug strength and dosage form DIN Brand name Manufacturer code
ST500MG Caplet 02163268 VITAMIN C JAM
ST250MG Tablet 00162515 VITAMIN C PMT
ST250MG Tablet 00221244 VITAMIN C ADA
ST250MG Tablet 00266051 VITAMIN C PMT
ST250MG Tablet 00557811 VITAMIN C VTH
ST500MG Tablet 00266086 ASCORBIC ACID PMT
ST500MG Tablet 00041114 VITAMIN C ADA
ST500MG Tablet 00322326 VITAMIN C ADA
ST500MG Tablet 00557838 VITAMIN C VTH
ST500MG Tablet 00784591 VITAMIN C VTH
ST500MG Tablet 01922378 VITAMIN C VAE
ST500MG Tablet 02243893 VITAMIN C PMT
ST500MG Tablet 02244469 VITAMIN C PMT
ST500MG Tablet 02245348 VITAMIN C WNP
ST500MG Tablet 02245721 VITAMIN C PMT
500MG Tablet 00322997 VITAMINE C LAL
ST500MG Tablet 00036188 WAMPOLE VITAMIN C WAM
ST500MG Tablet 00274240 WAMPOLE VITAMIN C WAM

VITAMIN C

Table: VITAMIN C
Drug strength and dosage form DIN Brand name Manufacturer code
ST500MG Tablet 80003328 VITAMIN C WNP

88:16.00 VITAMIN D

ALFACALCIDOL

Table: ALFACALCIDOL
Drug strength and dosage form DIN Brand name Manufacturer code
ST0.25MCG Capsule 00474517 ONE ALPHA LEO
ST1MCG Capsule 00474525 ONE ALPHA LEO
ST2MCG/ML Drop 02240329 ONE-ALPHA LEO

CALCITRIOL

Table: CALCITRIOL
Drug strength and dosage form DIN Brand name Manufacturer code
ST0.25MCG Capsule 02431637 CALCITRIOL-ODAN ODN
ST0.25MCG Capsule 00481823 ROCALTROL HLR
ST0.25MCG Capsule 02485710 TARO-CALCITRIOL TAR
ST0.5MCG Capsule 02431645 CALCITRIOL-ODAN ODN
ST0.5MCG Capsule 00481815 ROCALTROL HLR
ST0.5MCG Capsule 02485729 TARO-CALCITRIOL TAR

CHOLECALCIFEROL

Table: CHOLECALCIFEROL
Drug strength and dosage form DIN Brand name Manufacturer code
ST400IU Capsule 80006629 DGEL JMP
ST400IU Capsule 02242651 EURO D EUR
ST400IU Capsule 80005560 RIVA-D RIV
ST800IU Capsule 80007769 DGEL JMP
1,000IU Capsule 80027592 DGEL OPU
ST1,000IU Capsule 80009635 VITAMIN D3 WAM
ST10,000IU Capsule 02253178 EURO D SDZ
ST400IU Liquid 80001869 BABY DDROPS DDP
ST400IU Liquid 80001792 DDROPS DDP
ST400IU/ML Liquid 00762881 D VI INFANTS MJO
ST400IU/ML Liquid 80003038 JAMP VITAMIN D JMP
ST400IU/ML Liquid 02231624 PEDIAVIT D EUR
ST1,000IU Liquid 80001791 DDROPS DDP
ST400IU Tablet 02238729 VITAMIN D VTH
ST400IU Tablet 02240858 VITAMIN D PMT
ST400IU Tablet 00765384 VITAMINE D LAL
ST400IU Tablet 02240624 WAMPOLE VITAMIN D WAM
ST1,000IU Tablet 02245842 VITAMIN D3 PMT
ST10,000IU Tablet 00821772 D-TABS RIV
ST10,000IU Tablet 02417995 VITAMINE D PDL

ERGOCALCIFEROL

Table: ERGOCALCIFEROL
Drug strength and dosage form DIN Brand name Manufacturer code
ST50,000IU Capsule 02237450 SANDOZ D-FORTE SDZ
ST8,288IU/ML Solution 80020776 D2-DOL JMP
ST8,288IU/ML Solution 80003615 ERDOL ODN

VITAMIN D

Table: VITAMIN D
Drug strength and dosage form DIN Brand name Manufacturer code
ST10MCG Capsule 80063895 VIT D 400 UNK
ST25MCG Capsule 80063899 VIT D 1000 UNK
ST200U Capsule 02442256 VITAMIN D3 ORM
ST400IU Capsule 80055196 M-D MAN
ST400IU Capsule 80001145 PHARMA-D PED
ST400IU Capsule 80008590 VITAMINE D BMI
ST800IU Capsule 80003010 EURO D EUR
ST800IU Capsule 80008446 VITAMINE D BMI
ST1,000IU Capsule 80007766 DGEL JMP
1,000IU Capsule 80003707 EURO-D EUR
ST1,000IU Capsule 80055204 M-D MAN
ST1,000IU Capsule 80008496 PHARMA-D PMS
ST1,000IU Capsule 80043412 VITAMINE D BMI
ST10,000IU Capsule 02371499 EURO-D PMS
ST10,000IU Capsule 02449099 JAMP-VITAMIN D JMP
ST15MCG Liquid 80013189 DDROPS BOOSTER DDP
ST400IU Liquid 80019649 D3-DOL JMP
ST400IU Liquid 80038155 DECAXIL ORM
ST400IU Liquid 80041145 DECAXIL ORM
ST800IU Liquid 80003285 PEDIAVIT D EUR
ST1,000IU Liquid 80007346 JAMP VITAMIN D JMP
ST1,000IU Liquid 80028362 JAMP VITAMIN D JMP
ST1,000IU Liquid 80028371 JAMP VITAMIN D JMP
ST25MCG Tablet 80031157 VITAMIN D WNP
ST400IU Tablet 80002452 VITAMIN D WNP
ST400IU Tablet 80009578 VITAMIN D VAE
ST1,000IU Tablet 80002169 PHARMA-D PMS
ST1,000IU Tablet 80051562 RIVA-D RIV
ST1,000IU Tablet 80000131 VITAMIN D VTH
ST1,000IU Tablet 80000436 VITAMIN D JAM
ST1,000IU Tablet 80003663 VITAMIN D WNP
ST1,000IU Tablet 80009580 VITAMIN D VAE
ST1,000IU Tablet 80015278 WAMPOLE VITAMIN D WAM
ST10,000IU Tablet 02379007 JAMP-VITAMIN D JMP
ST10,000IU Tablet 02417685 VIDEXTRA ORM

88:20.00 VITAMIN E

VITAMIN E

Limited use benefit (prior approval required).

For use in malabsorption

Table: VITAMIN E
Drug strength and dosage form DIN Brand name Manufacturer code
ST100IU Capsule (Softgel) 00122823 VITAMIN E JAM
ST200IU Capsule (Softgel) 00122831 VITAMIN E JAM
ST400IU Capsule (Softgel) 00122858 VITAMIN E JAM
ST800IU Capsule (Softgel) 00330191 VITAMIN E JAM
ST20U/ML Liquid 09991656 AQUA-E/ML UNK
ST75U/ML Liquid 09991652 AQUA-E UNK
ST50IU Oral Liquid 00480215 AQUASOL E NVC
ST50IU/ML Oral Liquid 02162075 AQUASOL E VITAMIN E CLC

88:24.00 VITAMIN K

PHYTONADIONE

Table: PHYTONADIONE
Drug strength and dosage form DIN Brand name Manufacturer code
2MG/ML Emulsion 00781878 VITAMIN K1 SDZ
10MG/ML Emulsion 00804312 VITAMIN K1 SDZ

88:28.00 MULTIVITAMIN PREPARATIONS

CALCIUM, VITAMIN D

Table: CALCIUM, VITAMIN D
Drug strength and dosage form DIN Brand name Manufacturer code
ST500-400MGU Tablet 80088060 BIO-CAL DR FORTE BIO

MULTIVITAMINS (CHILDREN AND YOUTH)

Limited use benefit (prior approval is not required).

Multivitamins are benefits for children up to 19 years of age.

Table: MULTIVITAMINS (CHILDREN AND YOUTH)
Drug strength and dosage form DIN Brand name Manufacturer code
ST Drop 00762946 ENFAMIL POLYVISOL MJO
ST450MG & 10MG & 30MG Liquid 80008471 JAMP VITAMIN A, D AND C JMP
ST2,500IU & 666.67IU & 50MG/ML Liquid 00762903 ENFAMIL TRIVISOL MJO
ST2,500IU & 666.67IU & 50MG/ML Liquid 02229790 PEDIAVIT EUR
0MG Tablet 02246362 CENTRUM PFI
0MG Tablet 80021452 CENTRUM PFI
0MG Tablet 80024482 CENTRUM FOR WOMEN PFI
2MG Tablet 80045908 ONE A DAY WOMEN BAY
10MG Tablet 80039441 STRESSTABS FOR WOMEN PFI
ST Tablet (Chewable) 80011134 CENTRUM JUNIOR COMPLETE PFI
ST Tablet (Chewable) 80020794 CENTRUM JUNIOR COMPLETE PFI
ST Tablet (Chewable) 02247995 FLINTSTONES MULTIPLE VITAMINS PLUS IRON BAY
ST Tablet (Chewable) 02247975 FLINTSTONES MULTIPLE VITAMINS WITH EXTRA C BAY

MULTIVITAMINS (PRENATAL)

Limited use benefit (prior approval is not required.).

Prenatal and postnatal vitamins are benefits only for women of childbearing age (12 to 50 years).

Table: MULTIVITAMINS (PRENATAL)
Drug strength and dosage form DIN Brand name Manufacturer code
ST Capsule 80042704 CENTRUM DHA PFI
ST Tablet 80045822 CENTRUM PRENATAL PFI
ST Tablet 80080882 MATERNA NES
ST Tablet 80082297 MATERNA NES
ST Tablet 80001842 NESTL MATERNA NES
ST Tablet 02241235 PRENATAL AND POSTPARTUM VITAMINS AND MINERALS VTH
ST Tablet 80005770 PRENATAL AND POSTPARTUM VITAMINS AND MINERALS PMT
ST Tablet 02229535 WAMPOLE COMPLETE MULT-PRE AND POST NATAL WITH FOLIC ACID WAM
2MG Tablet 80004919 NATURES BOUNTY PRENATAL VITAMINS VTH

THIAMINE HYDROCHLORIDE

Table: THIAMINE HYDROCHLORIDE
Drug strength and dosage form DIN Brand name Manufacturer code
50MG Tablet 80049777 OPUS VITAMINE B1 OPU
100MG Tablet 80049780 OPUS VITAMINE B1 OPU
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