DIN/PIN/NPN Detail

68:00 HORMONES AND SUBSTITUTES

68:32:00 PROGESTOGENS AND ORAL CONTRACEPTIVES

Alysena 28 (ETHINYL ESTRADIOL & LEVONORGESTREL)20mcg & 100mcg Tab-28 Pk

DIN/PIN/NPN:02387883

Interchangeables:

Manufacturer:

Formulary Listing Date:

2012-11-27

Drug Benefit Price or Unit Price:

3.9425

Amount MOH Pays:

3.9425

Coverage Status: