DIN/PIN/NPN Detail

68:00 HORMONES AND SUBSTITUTES

68:32:00 PROGESTOGENS AND ORAL CONTRACEPTIVES

Plan B (LEVONORGESTREL)1.5mg Tab-1 Tab Pk

DIN/PIN/NPN:02293854

Interchangeables:

Manufacturer:

Teva Branded Pharmaceutical Products R&D Inc.

Formulary Listing Date:

2016-09-29

Drug Benefit Price or Unit Price:

17.2000

Amount MOH Pays:

8.6000

Coverage Status:

General Benefit