Standard Health Pals Formulary
Calcium + Vitamin D
Coverage Level – 100%
Copay – $0
Limitations – No more than 90 days’ supply
Restrictions – Health Pals Mail Order Pharmacy Network
Comments – The Health Pals Mail Order Pharmacy Network will supply a “Calcium + Vitamin D” combination with a minimum ration of 600 mg of Calcium to 400 units of Vitamin D. Actual manufacturer will vary.