DIN/PIN/NPN Detail

68:00 HORMONES AND SUBSTITUTES

68:08:00 ANDROGENS

LU Criteria Text

PMS-Testosterone (TESTOSTERONE UNDECANOATE)40mg Cap

DIN/PIN/NPN:02322498

Interchangeables:

Manufacturer:

Pharmascience Inc.

Formulary Listing Date:

2010-04-23

Drug Benefit Price or Unit Price:

0.4700

Amount MOH Pays:

0.4700

Coverage Status:

Limited Use Product