L.A. Care Covered Drug Formulary (pdf)

Commercial FormularyT3 aminoPROTECT PLUSacids/mv,fe,other minT1 b complex with SUPPORT-500vitamin cT3 b complex with vitamin VI-CERT C1000 WITHcB12T1 e ac succ/fa/vit RENAXbcomp&c/zn/seT3 fa/multivits-min/min aa UDAMINchelT3 fa/mu-vits-min CORVITAth/lycopene/lutT3 fa/mu-vits-min CORVITEth/lycopene/lutT3 fa/niacinamide/cupric NICOMIDEox/zn oxT1 fa/niacinamide/cupricNICOTINAMIDEox/zn oxT1 fe fumarate/fa/vit DIALYVITE 800 WITHbcomp&cIRONT3 folic acid/multivits-min FEMTABST1 folic acid/mu-vits-minVITE CON FORTEthT3 folic acid/mv,fe,other NUTRICAPminT3 m-NICOMIDEtetrahyrofolate/niacin/cu/znT3 multivit, iron, min #4, faMULTICHEWT1 multivit, iron, min #5, STROVITE FORTEfaT1 multivit, iron, min #6, STROVITE PLUSfaT1 multivit, iron, min no. STROVITE FORTE9, faT1 multivit, min BACMINcmb#20/iron/faT3 multivit, min no.21/folic SUPERVITE ECacidT3 multivit, min no.23/folic PROTECT BONEacidT3 multivitamin w/iron, HEMOCYTEmineralsT1 multivitamins with V-C FORTEmin no.7/faT1 multivit-min #14/folic STROVITE ADVANCEacidT1 multivitmin12/fa/lycopene/lutFAC-XT1 multivits w- PROMARiron,hematinicT1 multivits,therap w- THEROBEC PLUSfe,hematinT3 mv, min cmb CORVITE FREE#6/fa/lut/lyco/q10T3 mv, min cmb#24/iron PROTECT IRONps cmp/faT3 mv, min cmb#8/fa/co PROTECT CARDIOq10/omega3T3 mv, min cmb#9/fa/saw UDAMIN SPpalmet xtT3 mv,min #10/fa/d3/alip STROVITE ADVANCEacid/lut+ DT1 mv,min #10/fa/d3/alip STROVITE ONEacid/lutT3 mv/dietary 4/dna/rna FORTAVITT1 om-3/caENCORAcarb/d3/fa/mv cmb 13T1 om-ANIMI-33/dha/epa/b12/fa/b6/phytostT3 om-ANIMI-33/dha/epa/d3/b12/fa/b-6/phyT3 om-ANIMI-3 WITH3/dha/epa/d3/b12/fa/b- VITAMIN D6/phyT1 vitamin b comp and STROVITEvit c no.6Pediatric Vitamin PreparationsT1 fluoride/iron/vit a,c&dTRI-VIT WITHFLUORIDE-IRONT1 multivitamins with MULTIVITAMIN ANDfluorideFLUORIDET1 multivits with iron & POLYVITAMIN WITHfluorideIRON-FLUORIDET1 pedi m.vit no.17 with MULTIVITAMINSfluorideWITH FLUORIDET1 pedi mvi no.16 with MULTIVITAMINSfluorideWITH FLUORIDET1 pediatric multivit VITAMAX#6/vit kPrenatal Vitamin PreparationsT3 pnv withNATALCARE PLUSca,no.71/iron/faT1 pnv,ca42/iron/fa/lmef PNV-DHA PLUSol ca/dhaT1 pnv80/ironPRENAISSANCEfumarate/fa/dss/dhaT3 prenatal vit/iron PRENATAL FORMULAfumarate/faVitamin B PreparationsT1 b cmplx 4/vit VITAL-D RXd3/c/fa/zinc oxT1 b1/b2/b3/b5/b6/b12/ir SENILEZOLonT1 b1/b2/b3/b5/b6/b12/vi THEROBECt c/faT1 b12/levomefolate FOLBIC RFcalcium/b-6T3 ca carb/d3/b- CALAFOL RX12/fa/b6/policosT1 cyanocobalamin/fa/p FOLBICyridoxineT3 cyanocobalamin/fa/pyriMYO VYTdoxineT3 cyanocobalamin/fa/pyriVITA-RESPAdoxinePage 56 of 91