DIN/PIN/NPN Detail

88:00 VITAMINS

88:08:00 VITAMIN B

Leucovorin Calcium (LEUCOVORIN CALCIUM)5mg Tab

DIN/PIN/NPN:02170493

Interchangeables:

Manufacturer:

Wyeth Pharmaceuticals

Formulary Listing Date:

1999-01-07

Drug Benefit Price or Unit Price:

7.3552

Amount MOH Pays:

1.8388

Coverage Status:

General Benefit