DIN/PIN/NPN Detail
92:00 UNCLASSIFIED THERAPEUTIC AGENTS
LU Criteria Text
Botox
(BOTULINUM TOXIN TYPE A)
100U/Vial Pd Inj-100U Vial Pk
DIN/PIN/NPN:
01981501
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Interchangeables:
NO
Manufacturer:
AbbVie Corporation
Formulary Listing Date:
1996-10-01
Drug Benefit Price or Unit Price:
374.8500
Amount MOH Pays:
374.8500
Coverage Status:
Limited Use Product
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