DIN/PIN/NPN Detail |
56:00 GASTROINTESTINAL DRUGS | |
56:40:00 MISCELLANEOUS G.I. DRUGS | LU Criteria Text |
Hp-PAC (LANSOPRAZOLE & CLARITHROMYCIN & AMOXICILLIN)30mg & 500mg & 500mg Tab/Cap Pk
DIN/PIN/NPN:02238525
Interchangeables: | YES |
Manufacturer: | Takeda Pharmaceuticals America Inc. |
Formulary Listing Date: | 1999-04-15 |
Drug Benefit Price or Unit Price: | 67.9100 |
Amount MOH Pays: | 67.9100 |
Coverage Status: |
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