Standard Health Pals Formulary
Mibelas 24 FE 1 mg / 0.02 mg Tablet Pack (Generic for Minastrin 24 FE and Melode 24 FE)
Coverage Level – 100%
Copay – $0
Limitations – No more than 90 days’ supply
Restrictions – Health Pals Mail Order Pharmacy Network
Comments – Generic for Minastrin 24 FE; Generic for Melode 24 FE