vitamin A/ascorbic acid/vitamin D3/vit E mixed/vit K1/zinc

3,000 mcg-200 mg-18.75 mcg-40 mg-400 mcg-5 mg — Capsule

Also known as: MVW MODULATR FORM MINI MULTIVT

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.

1 plan

Source: Excel (XLSX) · Formulary date: Jan 5, 2026 · Checked: 1 hour, 56 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026	Tier 3 - Non-Formulary	—	—	—	None