OTC Product Catalog
We want to make it easy for you to manage your health. To help you do that, we have partnered with CVS/
caremark™ to offer you an over-the-counter (OTC) benefit. Your OTC benefit covers the health and wellness
items that you need most.
Ordering is easy:
Go online to www.cvs.com/otcmolina
§Order 24/7 from any PC, Mac, tablet, or smartphone with online access
§Type Molina into the search box to see color photos of all Plan-approved OTC products
§Click on any image to read more about the item
§See if an item is in stock
§Select other items to order if it is out of stock
You will need a valid eMail address to order online, view your past orders, or get a tracking number so you know
when your order shipped.
OTC products are shipped right to your door.
This means fewer trips to the store and the gas pump!
To place an order by phone call CVS/caremark toll-free at (888) 700-7662, TTY (877) 279-0371.
If you need, a CVS/caremark OTC Customer Service Agent can get someone on the call who speaks your
language.
The CVS/caremark OTC Customer Service line is open Monday-Friday 8 a.m.-11 p.m. ET and on weekends
from 8:30 a.m.-9 p.m. ET. The line is closed on New Year’s Day, 4th of July, Labor Day, Memorial Day,
Thanksgiving, and Christmas.
You do not need a prescription to purchase any of the OTC items covered under this benefit. Whether you order
online or call in your order, you pay nothing for Plan-approved OTC items as long as you stay within your $20
monthly OTC benefit amount and order once a month. No out-of-pocket costs. No waiting for refunds. No trips
to the store. When you order once a month by phone or online at www.cvs.com/otcmolina.
Make sure to spend your entire OTC benefit amount each month. What you don’t use expires at the end of each
month. If the entire amount is not used, the remaining balance does not carryover. You will not have a larger
amount to spend the following month.
H8677_15_15158_0002_MMPCAOTCCatalog
October 2015 Approved
45886MMP1015
Key Things to Keep in Mind
ID Cards and Ordering
§Once you become a Molina Dual Options Cal MediConnect Plan (Medicare-Medicaid Plan) member,
CVS/caremark will mail you a CVS/caremark ExtraCare® Health card. Your card should arrive within 3-4
weeks.
§You will need your ExtraCare Health card number (found on the back of your ExtraCare Health card) to
order OTC items covered under this benefit.
§If you have an ExtraCare card or an ExtraCare Health card because you purchased items from CVS/
caremark before becoming a member, you will receive a new ExtraCare Health card in the mail. This new
card will reflect your current OTC benefit. Your card will also have your new ExtraCare Health number.
§It can take 7-10 days after you are enrolled in the Plan to show up as an active member in the CVS/
caremark system. Don’t worry. Until you get your ExtraCare Health card, you can call CVS/caremark
to place your order. The CVS/caremark OTC Customer Service Agent will simply ask you for your
member number (found on your Plan ID card). The agent will call us to confirm that you are still
enrolled in the Plan, then help you place your order. To make your order process as simple as possible
please be sure to make a list of the items you would like to order prior to calling to place your order.
§Even though you can create an online account without your ExtraCare Health card number, you will not
be able to order OTC items online without it.
§Once you receive your ExtraCare Health card, go back to the website, update your account with your
ExtraCare Health card number, and you will be ready to place your next order online.
§If you have an existing CVS.com® account because you ordered from CVS.com before becoming a
member you do not need to setup a new account. You only have to setup an account once. Simply update
your existing account with your new ExtraCare Health card number once your new card arrives.
§For online support or to place an order by phone call CVS/caremark for help.
§You can also choose to buy any of the covered Plan-approved OTC items at a store (retail, drugstore, or
online store) and get a refund.
H8677_15_15158_0002_MMPCAOTCCatalog
October 2015 Approved
45886MMP1015
We do not suggest that you choose this option for a number of reasons.
You will have to pay the full retail price charged by the store upfront out-of-pocket. This also applies to
any Plan-approved OTC items that you buy at a CVS/pharmacy® drugstore. Plan pricing is only applied
to the Plan-approved OTC items you order online or by phone from CVS/caremark. Claims for all OTC
products are not paid. We will only refund your out-of-pocket costs for Plan-approved OTC items up to
your monthly benefit amount. Plan discounts are not applied to refunds.
After you purchase your Plan-approved items you will have to call us to get a Direct Member OTC
Refund Form. You will have to pay the postage to mail the completed form along with a copy of your
receipts. You will have to wait for a refund check. Once you get your check you will then have to get in
the car again to cash your check.
Benefit Amount
§You have a fixed amount of $20 to spend each month on Plan-approved OTC items.
§Make sure to spend your entire OTC benefit amount each month. What you don’t use expires at the end
of each month. If the entire amount is not used, the remaining balance does not carryover. You will not
have a larger amount to spend the following month.
§Refer to the list of covered OTC items below or go online to find the items that you want to order. Visit
www.cvs.com/otcmolina and type Molina into the search box. This will pull up a list of all Plan-approved
OTC products. Click on any image to read more about the item.
§OTC items and prices can change without notice.
§Total the cost of all your items and be sure to stay within your monthly OTC benefit amount.
§Your monthly OTC benefit amount can only be used to buy Plan-approved OTC items. You will have to
pay upfront out-of-pocket for any other items that you purchase. This includes taxes and shipping when
they apply.
o Our Members get a 20% discount on any CVS/pharmacy brand health-related OTC item they buy
online at CVS.com or in a CVS/pharmacy. This is a Plan benefit.
o You can also get other discounts on CVS.com and CVS/pharmacy promo items. This is not a Plan
benefit. Anyone can buy these items. Promo deals are not limited to health-related items. You may
find savings and specials on shampoo, soaps, and other items you need. Promo offers and pricing
vary.
§This OTC benefit is for Plan members only. Your monthly OTC benefit amount and 20% Plan discount
should not be used to purchase OTC items for anyone else.
Shipping, Payments, and Refunds
§Allow 7-10 days for shipping. If your order does not arrive by this time please contact CVS/caremark at
customercare@cvs.com or call (888) 700-7662, TTY (877) 279-0371.
§Shipping is free when you order once a month.
H8677_15_15158_0002_MMPCAOTCCatalog
October 2015 Approved
45886MMP1015
§When you order more than once a month you will have to pay a $5.49 flat shipping charge for each extra
order. Surcharges for heavy items may apply. American Express, MasterCard, Discover Card, and Visa are
accepted when you buy online.
§Should you receive a damaged item, please contact CVS/caremark within 72 hours at customercare@cvs.
com or call (888) 700-7662, TTY (877) 279-0371.
§If you purchased your OTC items at a store call us to get a Direct Member OTC Refund Form. You will
find our Member Services phone number on the back of your Plan ID card. Follow the steps on the form
and mail your completed form and receipts to the address on the form. Your claim will be reviewed. You
will get a refund for any Plan-approved OTC items you purchased up to your monthly benefit amount.
There are no refunds for 20% discounted or other promo OTC items. A check will be mailed to your
home address within 4 weeks.
Molina Dual Options Cal MediConnect Plan (Medicare-Medicaid Plan) is a health plan that contracts with both
Medicare and Medi-Cal to provide benefits of both programs to enrollees.
This information is available in other formats, such as Braille, large print, and audio.
Esta información está disponible en otros formatos, que incluyen Braille, letra grande y audio.
Thông tin này có ở các định dạng khác như Braille, chữ in lớn và âm thanh.
Available ang impormasyon na ito sa iba pang format, tulad ng Braille, malaking print at audio.
H8677_15_15158_0002_MMPCAOTCCatalog
October 2015 Approved
45886MMP1015
You can get this information for free in other languages. Call (855) 665-4627. The call is free.
Usted
puede
estaHealth
información
en otros
idiomas
Please
findrecibir
enclosed
Education
materials
for gratuitamente.
your reference.Llame al (855) 665-4627. Esta es una
llamada gratuita.
Molina Dual Options Cal MediConnect Plan (Medicare-Medicaid Plan) is a health plan that contracts with both
Medicare and Medi-Cal to provide benefits of both programs to enrollees. You can get this information for free
Makukuha mo ang impormasyong ito nang libre sa iba pang mga wika. Tumawag sa (855) 665-4627. Libre lang
in other languages. Call (855) 665-4627. The call is free.
ang tawag.
Usted puede recibir esta información en otros idiomas gratuitamente. Llame al (855) 665-4627. Esta es una
gratuita.
Bạnllamada
có thể nhận
thông tin này miễn phí bằng các ngôn ngữ khác. Hãy gọi đến số (855) 665-4627. Cuộc gọi
miễn phí.
Makukuha mo ang impormasyong ito nang libre sa iba pang mga wika. Tumawag sa (855) 665-4627. Libre lang
ang tawag.
Bạn có thể nhận thông tin này miễn phí bằng các ngôn ngữ khác. Hãy gọi đến số (855) 665-4627. Cuộc gọi
您可以獲得本資訊的其他語言版本。請撥打免費電話（855）665-4627
索取。
miễn phí.
.‫ ھذه المكالمة مجانية‬.(855) 665-4627 ‫ اتصل على رقم‬.‫يمكنك الحصول على ھذه المعلومات مجانًا بلغات أخرى‬
Вы можете получить эту информацию на других языках совершенно бесплатно. Для этого позвоните по
您可以獲得本資訊的其他語言版本。請撥打免費電話（855）665-4627 索取。 номеру
(855) 665-4627. Звонок является бесплатным.
Вы можете получить эту информацию на других языках совершенно бесплатно. Для этого позвоните по 이 номеру (855) 665‐4627. Звонок является бесплатным. 정보는 다른 언어로 무료로 받아보실 수 있습니다. 무료 전화 (855) 665-4627번으로 연락해
주십시오.
이 정보는 다른 언어로 무료로 받아보실 수 있습니다. 무료 전화 (855) 665-4627번으로 연락해
주십시오.
‫ ھزينه ای‬.‫تماس بگيريد‬ 4627‐665 (855) ‫ با شماره‬.‫شما می توانيد اين اطالعات را به طور رايگان به زبان ھای ديگر نيز دريافت کنيد‬
.‫برای اين تماس در نظر گرفته نمی شود‬
អនកអាចទទួលបានព័ត៌មានេនះេដាយឥតគិតៃថលជាភាសាេផសងេទៀត ។ េហៅេទៅេលខ
(855) 665-4627
។ ការេហៅទូរស័ពទគឺឥតគិតៃថល ។
Այս տեղեկությունը կարող եք անվճար ստանալ այլ լեզուներով: Զանգահարեք (855) 665-4627:
Զանգն անվճար է:
Molina Dual Options Medicare-Medicaid Plan is a health plan that contracts with both Medicare and Illinois
Medicaid copays,
to provide
of both
to more
enrollees.
You can call
get this
document
in Spanish,
Limitations,
andbenefits
restrictions
mayprograms
apply. For
information,
Molina
Dual Options
Cal or speak
with
someone
about
this
information
in
other
languages
for
free.
Call
(877)
901-8181.
The
call
is free. Puede
MediConnect Plan (Medicare-Medicaid Plan) Member Services or read the Molina Dual Options Member
obtener este
documento
español,Drugs,
o hablar
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persona
acerca
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información
en otros
idiomas
Handbook.
Benefits,
List ofenCovered
pharmacy
provider
networks
copayments
may
change
gratuitamente.
Llame
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(877)
901-8181.
Esta
llamada
es
gratis.
on January 1 of each year.
Molina Dual Options MyCare Ohio Medicare-Medicaid Plan is a health plan that contracts with both Medicare
and Ohio Medicaid to provide benefits of both programs to enrollees. You can get this information for free in
other languages. Call (855) 665-4623. The call is free. Usted puede recibir esta información en otros idiomas
gratuitamente. Llame al (855) 665-4623. Esta es una llamada gratuita.
Molina Medicare Options HMO is a Health Plan with a Medicare Contract. Enrollment in Molina Medicare
Options depends on contract renewal. Molina Medicare Options Plus HMO SNP is a Health Plan with a
Medicare Contract and a contract with the state Medicaid program. Enrollment in Molina Medicare Options
Plus depends on contract renewal. Healthy Advantage Plus HMO is a Health Plan with a Medicare Contract.
Enrollment in Healthy Advantage Plus depends on contract renewal. Healthy Advantage HMO SNP is a Health
Plan with a Medicare Contract and a contract with the state Medicaid program. Enrollment in Healthy
Advantage depends on contract renewal. This information is available for free in other languages. Please call
our customer service number at (800) 665-3086, TTY/TDD 711, 7 days a week, 8 a.m. - 8 p.m., local time. Esta
información está disponible gratuitamente en otros idiomas. Por favor, comuníquese a nuestro número de
teléfono para servicio al cliente al (800) 665-3086,TTY/TDD 711, los 7 días de la semana, de 8:00 a.m. a 8:00
H8677_15_15158_0002_MMPCAOTCCatalog
October 2015 Approved
45886MMP1015
p.m., hora local.
Category / Item Description
CVS
SKU
Price
994280
477066
896248
125507
$5.59
$3.59
$10.23
$5.99
587618
890847
688783
707032
316620
702307
973804
807034
159734
858828
6205
953436
$5.83
$10.63
$8.39
$3.19
$4.63
$16.79
$5.59
$4.39
$3.99
$4.39
$4.39
$8.79
488025
695189
836320
642686
150391
$8.39
$6.79
$3.99
$4.39
$3.59
672550
195560
$4.63
$3.19
186577
977136
690260
690261
305623
209452
707924
488021
304709
$1.34
$1.59
$9.43
$7.99
$4.39
$1.99
$13.03
$4.39
$3.51
OTC items / pricing can change without notice
Eligible OTC Items
Allergy & Asthma - Allergy & Sinus Medicine
CVS Dye-Free Allergy Liquid, Cherry (4 oz.)
CVS Small Size Allergy Tablets (24 ct.)
CVS Non-Drowsy Sinus Relief Daytime and Multi-Symptom Nighttime Softgels (48 ct.)
CVS Nasal Spray Sinus (1 oz.)
Cough, Cold, & Flu
CVS Medicated Chest Rub (3.53 oz.)
CVS Non-Drowsy Daytime & Multi-Symptom Cold & Flu Relief, Combo Pack (24 oz.)
CVS Cold Remedy Fast Melting Quick Dissolving Tablets, Cherry (25 ct.)
CVS Maximum Strength Sore Throat Lozenges, Cherry (18 ct.)
CVS Sore Throat Spray, Cherry (6 oz.)
CVS All Natural Flu Relief Quick Dissolving Pellets (12 ct.)
CVS AirShield Gummies (42 ct.)
CVS Medicated Cold Sore Treatment Maximum Strength (.23 oz.)
CVS Nasal Decongestant Inhaler (.01 oz.)
CVS No-Drip Maximum Strength Nasal Mist (.5 oz.)
CVS Saline Nasal Spray (3 oz.)
CVS Nasal Strips Large, Tan (30 ct.)
Digestive Health - Antacid / Heartburn Relief
CVS Omeprazole Magnesium Acid Reducer 20.6 mg Delayed Release Capsules (14 ct.)
CVS Acid Reducer Tablets 75mg (30 ct.)
CVS Antacid Tablets Extra Strength, Assorted Fruit (96 ct.)
CVS Stomach Relief ChewableTablets ( 48 ct.)
CVS Antacid & Pain Reliever Tablets Effervescent, Original (36 ct.)
Digestive Health - Anti-Diarrhea
CVS Anti-Diarrheal Caplets (12 ct.)
CVS Bismuth Liquid (8 oz.)
Digestive Health - Fiber & Laxitives / Constipation Relief
CVS Disposable Enema, Latex Free (4.5 oz.)
CVS Epsom Salt, Unscented (16 oz.)
CVS Easy Fiber (62 doses)
CVS Easy Fiber Chewable Tablets, Wild Berry (90 ct.)
CVS Milk of Magnesia Saline Laxative, Original Flavor (12 oz.)
CVS Oral Solution Magnesium Citrate, Lemon (10 oz.)
CVS Senna Plus Laxative/Stool Softener Tablets Value Size (180 ct.)
CVS Stool Softener Capsules, Original (30 ct.)
CVS Glycerin Suppositories, Adult Size (50 ct.)
H8677_15_15158_0002_MMPCAOTCCatalog
October 2015 Approved
45886MMP1015
Category / Item Description
CVS
SKU
Price
660019
$7.19
690659
$10.79
333336
$9.59
322436
209478
152074
$3.99
$1.42
$1.82
383505
580365
336846
$2.87
$5.03
$4.39
460423
$5.19
845675
$4.23
457931
125815
961468
$5.19
$5.99
$5.59
955322
690242
695911
$6.39
$4.39
$7.19
460702
$11.19
181257
903693
$14.63
$7.19
211344
310410
$12.79
$8.47
110163
893119
893132
$2.39
$3.59
$2.55
OTC items / pricing can change without notice
Eligible OTC Items
Digestive Health - Gas Relief
CVS Gas Relief Chew Tablets, Mint (100 ct.)
Digestive Health - Lactose Intolerance
CVS Fast Acting Dairy Relief Chewable Tablets, Vanilla Twist Flavor (60 ct.)
Feminine Care - Yeast Infections
CVS Miconazole Nitrate Vaginal Cream 2% Disposable Applicators (1.59 oz.)
First Aid - Antibiotic & Antiseptic
CVS Antibiotic Ointment, Original (.5 oz.)
CVS Hydrogen Peroxide Solution (16 oz.)
CVS 70% Isopropyl Rubbing Alcohol (16 oz.)
First Aid - Bandages
CVS Clear Bandages, Assorted Sizes (45 ct.)*
CVS Elastic Bandage 4 Inches (1 ct)*
CVS Liquid Bandage (0.3 oz.)
First Aid - Burn Treatment
CVS Medicated Instant First Aid Spray (3 oz.)
First Aid - Corn Removal
CVS One Step Medicated Corn Removers, Maximum Strength
First Aid - Hemorrhoid Treatment
CVS Hemorrhoidal Ointment (1 oz.)
CVS Medicated Pads for Hemorrhoidal Relief (100 ct.)
CVS Hemorrhoidal Suppositories (12 ct.)
First Aid - Itch & Rash Treatment
CVS No-Rub Calamine Plus Spray (6 oz.)
CVS Maximum Strength Cortisone Intense Healing Anti-Itch Cream (1 oz.)
CVS Jock Itch Spray (4.6 oz.)
First Aid - Medical ID Bracelets
CVS Medical ID Bracelet (1 ct.)
First Aid - Pinworm & Lice Treatment
CVS Lice Solution Kit, Maximum Strength (1 ct.)
CVS Antifungal Ringworm Cream (.5 oz.)
First Aid - Sterile Gloves & Masks
CVS Latex-Free Super-Soft Vinyl Gloves, One Size Fits Most, Mega Pack (120 ct.)
CVS Procedural Face Masks with Earloops (50 ct.)
First Aid - Tape, Gauze, & Pads
CVS Cotton Balls (130 ct.)
CVS Sterile Latex-Free Gauze Pads, 2” x 2” (25 ct.)*
CVS Sterile Latex-Free Non-Stick Pads, 2” x 3” (10 ct.)*
H8677_15_15158_0002_MMPCAOTCCatalog
October 2015 Approved
45886MMP1015
Category / Item Description
CVS
SKU
Price
297584
830969
$2.22
$3.19
482021
$6.63
211037
334067
$7.99
$6.63
945987
968645
$7.19
$5.59
420928
149650
$2.39
$1.59
251606
735607
715130
791257
$2.63
$4.79
$8.39
$3.99
324111
318180
827058
440188
351297
$4.79
$11.99
$5.83
$5.59
$4.39
420029
$2.79
978991
$4.63
975085
975088
975091
$2.39
$2.39
$2.39
208334
171322
317912
$5.43
$6.39
$2.55
122344
$4.63
OTC items / pricing can change without notice
Eligible OTC Items
CVS Alcohol Prep Swabs (120 ct.)*
CVS All Purpose Cloth Tape 7.5” x 6 yards (6 yds.)*
First Aid - Wart Removal
CVS Maximum Strength Invisible Wart Remover Strips (14 ct.)
Foot Care - Antifungal & Health
CVS Clotrimazole Cream Usp 1% (1 oz.)
CVS Athlete’s Foot Powder Spray (4.6 oz.)
Health & Medicine - Compression Hosiery & Stockings
CVS Men’s Over-the-Calf Length Compression Socks, Size 7-12 (1 pair)
CVS Ladie’s Non-Binding Crew Socks, Size 6-10 (3 pairs)
Health & Medicine - Diabetic
CVS Glucose Liquid Shot, Berry Blast (2 oz.)
CVS Glucose Tablets Orange (10 ct.)
Health & Medicine - Medicine Accessories
CVS Eye Droppers and Ear Medicine (1 ct.)
CVS Medicine Bottle Magnifier (1 ct.)
CVS Weekly AM/PM Pill Case (1 ct.)
CVS Pill Splitter (1 ct.)
Hot and Cold Therapy
CVS Cold Pain Relief Pack, Reusable (1 ct.)
CVS Reusable Hot Cold Pain Relief Compress (1 ct.)
CVS Extra Strength Cold & Hot Medicated Patch XL (3 ct.)
CVS Arthritis Heatwraps, Hand & Wrist (2 ct.)
CVS Heatwraps, Neck, Shoulder, & Wrist (3 ct.)
Incontinence - Cleaners, Cloths, & Creams
Total Home by CVS Flushable Moist Wipes Tub (42 ct.)
Incontinence - Pads & Liners
CVS Maximum Absorbency Protective Pads, Long (12 ct.)
Incontinence - Protective Underwear & Briefs
CVS Men’s 4-Piece Maximum Absorbency Sizing Kit (4 ct.)
CVS Women’s 4-Piece Maximum Absorbency Lifestyle Kit, L/XL (4 ct.)
CVS Women’s 4-Piece Maximum Absorbency Lifestyle Kit, S/M (4 ct.)
Opthalmic (eyes)
CVS Eye Allergy Relief Eye Drops (15 ml)
CVS Artificial Tears Lubricant Eye Drops (1 oz.)
CVS Redness Relief Eye Drops (0.5 oz)
Oral Care (mouth)
CVS Oral Anesthetic Gel Maximum Strength (2 oz.)
H8677_15_15158_0002_MMPCAOTCCatalog
October 2015 Approved
45886MMP1015
Category / Item Description
CVS
SKU
Price
OTC items / pricing can change without notice
Eligible OTC Items
CVS Extra Strength Denture Adhesive Cream (2.4 oz.)
953690
$3.43
213330
$2.55
CVS Denture Cleanser Anti-Bacterial Tablets (40 ct.)
102319
$2.14
CVS Dental Floss, Waxed (100 yd.)
813104
$6.23
CVS Dry Mouth Mouthwash, Mint (16 oz.)
876501
$5.59
CVS Maximum Strength Oral Pain Reliever for Severe Toothaches (45 oz.)
Otic (ears)
317119
$7.03
CVS Ear Pain Relief Ear Drops (.33 oz.)
973866
$6.39
CVS Earwax Removal Kit (1 ct.)
Pain & Fever - Arthritis Pain Relief
107847
$5.99
CVS Menthol Gel (8 oz.)
213140
$5.03
CVS Arthricream Cream Rub (3 oz.)
200964
$5.03
CVS Muscle Rub (3 oz.)
Pain & Fever - Aspirin Relief
547802
$2.14
CVS Adult Low Dose Aspirin 81 mg Chewable Tablets, Orange (36 ct.)
230268
$5.19
CVS Enteric Aspirin 81 mg Tablets (120 ct.)
419423
$2.06
CVS Aspirin 81 mg Tablets Low Dose (32 ct.)
152314
$1.99
CVS Aspirin 325 mg Coated Tablets, Regular Strength (100 ct.)
Pain & Fever - Migraine Relief
185226
$3.83
CVS Migraine Relief Caplets (24 ct.)
Pain & Fever - Non-Aspirin Relief
594895
$5.19
CVS Backache Relief Caplets, Extra Strength (24 ct.)
235626
$9.03
CVS Ibuprofen Tablets (200 ct.)
711635
$5.59
CVS Leg Cramps Pain Relief Caplets (40 ct.)
299472
$5.03
CVS All Day Pain Relief Tablets (50 ct.)
111047
$4.39
CVS Pain Relief Tablets Extra Strength (60 ct)
Pain & Fever - Thermometers & Accessories
834794
$7.99
CVS Digital Flexible Tip Thermometer (1 ct.)
156053
$2.22
CVS Thermometer Probe Covers (30 ct.)
Under certain circumstances some items may be covered under either Part B or Part D. When you receive
these items under Part B or D you may not purchase these items through your Part C supplemental OTC benefit. For your convenience, we’ve marked these items with an (*).
Dual Purpose OTC Items
All Items listed below are Dual Purpose items. You should only order these products after discussing them
with your health care provider to see if s/he recommends the item for a specific diagnosed condition. Please
speak to your physician before ordering these items.
Health & Medicine - Blood Pressure Monitor
CVS Self-Taking Blood Pressure Monitor (1 ct.)
Vitamins - Minerals
H8677_15_15158_0002_MMPCAOTCCatalog
October 2015 Approved
800232
$14.39
45886MMP1015
Category / Item Description
CVS
SKU
Price
901330
889908
317150
$9.59
$9.03
$9.19
122869
963236
300258
247316
866534
459949
$11.19
$8.79
$3.19
$7.99
$7.19
$11.19
964600
280123
247322
227215
166595
240515
251660
$3.99
$5.59
$5.99
$3.99
$8.39
$7.19
$5.99
OTC items / pricing can change without notice
Eligible OTC Items
CVS Calcium 600 + D Tablets (120 ct.)
CVS Great Tasting Calcium 500 mg Gummy Vitamins (50 ct.)
CVS Iron 65 mg Tablets (200 ct.)
Vitamins - Supplements
CVS Coenzyme Q10 50 mg Softgels (30 ct.)
CVS Natural Fish Oil 1000 mg Softgels (120 ct.)
CVS Folic Acid 800 mcg Heart & Reproductive Health Tablets (100 ct.)
CVS Glucosamine 1500 mg Tablets (60 ct.)
CVS Melatonin Sleep Aid Tablets 5 mg (90 ct.)
CVS Niacin Capsules 500 mg (200 ct.)
Vitamins
CVS B-1 100 mg Tablets (100 ct.)
CVS Vitamin B-6 100 mg Tablets (100 ct.)
CVS Vitamin B-12 500 mcg Tablets (100 ct.)
CVS Vitamin C 500 mg Tablets (100 ct.)
CVS Vitamin C 1000 mg Chewable Tablets (100 ct.)
CVS Vitamin E 400 Iu Softgels (100 ct.)
CVS Spectravite Adult Multivitamin Tablets (130 ct.)
Non-Eligiblel OTC Items
Non-Eligible OTC items, if purchased, will not be covered by the Plan.
Alternative Medicines
Baby Items
Contraceptives
Convenience (Non-Medical) Items
Cosmetics
Food Product or Supplements
Replacement Items, Attachments, Peripherals
H8677_15_15158_0002_MMPCAOTCCatalog
October 2015 Approved
45886MMP1015