DIN/PIN/NPN Detail

68:00 HORMONES AND SUBSTITUTES

68:32:00 PROGESTOGENS AND ORAL CONTRACEPTIVES

Portia 21 (ETHINYL ESTRADIOL & LEVONORGESTREL)0.03mg & 0.15mg Tab-21 Pk

DIN/PIN/NPN:02295946

Interchangeables:

Manufacturer:

Formulary Listing Date:

2007-10-03

Drug Benefit Price or Unit Price:

10.6600

Amount MOH Pays:

7.2800

Coverage Status: