DIN/PIN/NPN Detail |
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52:00 EYE, EAR, NOSE AND THROAT PREPARATIONS | |
52:36:00 OTHER EYE, EAR, NOSE AND THROAT AGENTS | LU Criteria Text |
Interchangeables: | YES |
Manufacturer: | Elvium Life Sciences |
Formulary Listing Date: | 1996-12-19 |
Drug Benefit Price or Unit Price: | 5.9540 |
Amount MOH Pays: | 1.4757 |
Coverage Status: |
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