DIN/PIN/NPN Detail

28:00 CENTRAL NERVOUS SYSTEM DRUGS

28:12:00 ANTICONVULSANTS

LU Criteria Text

Levetiracetam (LEVETIRACETAM)250mg Tab

DIN/PIN/NPN:02353342

Interchangeables:

Manufacturer:

Sanis Health Inc.

Formulary Listing Date:

2011-08-04

Drug Benefit Price or Unit Price:

0.3210

Amount MOH Pays:

0.3210

Coverage Status:

Limited Use Product