DIN/PIN/NPN Detail

68:00 HORMONES AND SUBSTITUTES

68:32:00 PROGESTOGENS AND ORAL CONTRACEPTIVES

Lutera 21 (ETHINYL ESTRADIOL & LEVONORGESTREL)20mcg & 100mcg Tab-21 Pk

DIN/PIN/NPN:02401185

Interchangeables:

Manufacturer:

Formulary Listing Date:

2013-08-29

Drug Benefit Price or Unit Price:

9.7356

Amount MOH Pays:

9.7356

Coverage Status: