DIN/PIN/NPN Detail

52:00 EYE, EAR, NOSE AND THROAT PREPARATIONS

52:36:00 OTHER EYE, EAR, NOSE AND THROAT AGENTS

LU Criteria Text

Liquifilm Tears (POLYVINYL ALCOHOL)1.4% Oph-Sol

DIN/PIN/NPN:00045616

Interchangeables:

NO

Manufacturer:

Formulary Listing Date:

1996-10-01

Drug Benefit Price or Unit Price:

0.6373

Amount MOH Pays:

0.6373

Coverage Status:

Limited Use Product