DIN/PIN/NPN Detail

40:00 ELECTROLYTIC, CALORIC AND WATER BALANCE

40:28:00 DIURETICS

LU Criteria Text

Apo-Midodrine (MIDODRINE HCL)2.5mg Tab

DIN/PIN/NPN:02278677

Interchangeables:

Manufacturer:

Formulary Listing Date:

2006-08-24

Drug Benefit Price or Unit Price:

0.1153

Amount MOH Pays:

0.1153

Coverage Status:

Limited Use Product