DIN/PIN/NPN Detail

68:00 HORMONES AND SUBSTITUTES

68:32:00 PROGESTOGENS AND ORAL CONTRACEPTIVES

Alesse 28 (ETHINYL ESTRADIOL & LEVONORGESTREL)20mcg & 100mcg Tab-28 Pk

DIN/PIN/NPN:02236975

Interchangeables:

Manufacturer:

Formulary Listing Date:

1998-12-31

Drug Benefit Price or Unit Price:

15.7700

Amount MOH Pays:

3.9425

Coverage Status: