DIN/PIN/NPN Detail

68:00 HORMONES AND SUBSTITUTES

68:08:00 ANDROGENS

LU Criteria Text

Testim (TESTOSTERONE)1% Top Gel-5g Pk

DIN/PIN/NPN:02280248

Interchangeables:

NO

Manufacturer:

Paladin Labs Inc.

Formulary Listing Date:

2009-09-30

Drug Benefit Price or Unit Price:

4.3180

Amount MOH Pays:

4.3180

Coverage Status:

Limited Use Product