DIN/PIN/NPN Detail

92:00 UNCLASSIFIED THERAPEUTIC AGENTS

LU Criteria Text

Rapamune (SIROLIMUS)1mg/mL O/L

DIN/PIN/NPN:02243237

Interchangeables:

NO

Manufacturer:

Wyeth Pharmaceuticals

Formulary Listing Date:

2005-02-22

Drug Benefit Price or Unit Price:

9.6855

Amount MOH Pays:

9.6855

Coverage Status:

Limited Use Product