Sleeping Aids
Product
Product name
Compare to
Package
Price
code
size
121
Acetaminophen, Diphenhydramine HCI
Tylenol
PM
50
$6.00
®
Extra Strength Tabs
122
Diphenhydramine HCl (25 mg)
Sominex
Tablets
50
$8.00
®
Smoking Cessation
Product
Product name
Compare to
Package
Price
code
size
123
Stop Smoking Gum – 2 mg
Nicorette
2 mg gum
50
$20.00
®
124
Stop Smoking Gum – 4mg
Nicorette
4 mg gum
50
$20.00
®
Vitamins, Minerals and Supplements*
Product
Product name
Compare to
Package
Price
code
size
109
Calcium Citrate + Vitamin D
Citracal
Caplets+D
60
$7.00
®
248
Chewable Calcium with Vitamin D
Caltrate
600 + D Plus
60
$9.00
®
Minerals Chewables
902
Co-Enzyme Q-10 30 mg
Co-Enzyme Q-10 30 mg
30
$10.00
063
Complete Senior Vitamins and minerals
Centrum
Silver
60
$10.00
®
011
Daily Multivitamin and Mineral
Centrum
130
$8.00
®
907
Eye Care Vitamins
Ocuvite
Lutein
36
$9.00
®
240
Folic Acid 800 Mg
Folic Acid 800 mcg
100
$5.00
278
Melatonin 5 mg
Melatonin 5 mg
100
$6.50
107
One a Day Women’s Multivitamin
One-A-Day Women’s
60
$7.00
®
015
Oyster Calcium + Vitamin D
Os-Cal
500+D
60
$6.00
®
909
Timed Release Niacin 500 mg
Timed Release Niacin
100
$8.00
500 mg
238
Vitamin B12
Vitamin B12 1000 mcg
100
$7.00
279
Vitamin B-12 5000mcg Sublingual Tablet
Vitamin B-12 5000mcg
30
$8.00
Sublingual Tablet
280
Vitamin B-Complex Sublingual Tablet
Vitamin B-Complex
60
$7.00
Sublingual Tablet
903
Vitamin B-Complex with B-12
B-Complex with B-12
100
$8.00
010
Vitamin C 500Mg
Vitamin-C 500 mg
100
$6.00
209
Vitamin D 1000 IU
Vitamin D 1000 IU
100
$7.00
239
Vitamin D 5000 IU
Vitamin D 5000 IU
100
$9.00
012
Vitamin-E 400 IU Synthetic
Vitamin-E 400 IU
100
$7.00
Synthetic
* For items noted above: Prior to purchase the enrollee must have appropriate conversations with the
enrollee’s personal provider and the enrollee’s personal provider must orally recommend the OTC item.