DIN/PIN/NPN Detail |
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DIN/PIN/NPN Detail |
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| 52:00 EYE, EAR, NOSE AND THROAT PREPARATIONS | |
| 52:36:00 OTHER EYE, EAR, NOSE AND THROAT AGENTS | LU Criteria Text |
| Interchangeables: | YES |
| Manufacturer: | Allergan Inc. |
| Formulary Listing Date: | 2004-11-04 |
| Drug Benefit Price or Unit Price: | 2.6017 |
| Amount MOH Pays: | 2.0305 |
| Coverage Status: |
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