DIN/PIN/NPN Detail

28:00 CENTRAL NERVOUS SYSTEM DRUGS

28:24:00 SEDATIVES AND HYPNOTICS

LU Criteria Text

Lorazepam Injection USP (LORAZEPAM)4mg/mL Inj Sol (with preservative)

DIN/PIN/NPN:02243278

Interchangeables:

Manufacturer:

Sandoz Canada Inc.

Formulary Listing Date:

2017-02-28

Drug Benefit Price or Unit Price:

21.2000

Amount MOH Pays:

21.2000

Coverage Status:

Limited Use Product