DIN/PIN/NPN Detail

68:00 HORMONES AND SUBSTITUTES

68:08:00 ANDROGENS

LU Criteria Text

Androgel (TESTOSTERONE)1% 5.0g Foil Packet

DIN/PIN/NPN:02245346

Interchangeables:

Manufacturer:

Solvay Pharma Inc.

Formulary Listing Date:

2005-02-22

Drug Benefit Price or Unit Price:

4.4145

Amount MOH Pays:

2.9575

Coverage Status:

Limited Use Product