DIN/PIN/NPN Detail |
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DIN/PIN/NPN Detail |
|
| 52:00 EYE, EAR, NOSE AND THROAT PREPARATIONS | |
| 52:04:12 ANTI-INFECTIVES OTHER ANTI-INFECTIVES | LU Criteria Text |
| Interchangeables: | NO |
| Manufacturer: | Allergan Inc. |
| Formulary Listing Date: | 1996-12-19 |
| Drug Benefit Price or Unit Price: | 2.8720 |
| Amount MOH Pays: | 2.8720 |
| Coverage Status: |
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