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

Trusopt (DORZOLAMIDE HCL)2% Oph Sol

DIN/PIN/NPN:02216205

Interchangeables:

Manufacturer:

Elvium Life Sciences

Formulary Listing Date:

1996-12-19

Drug Benefit Price or Unit Price:

6.1267

Amount MOH Pays:

1.4757

Coverage Status:

Limited Use Product