DIN/PIN/NPN Detail |
52:00 EYE, EAR, NOSE AND THROAT PREPARATIONS | |
52:36:00 OTHER EYE, EAR, NOSE AND THROAT AGENTS | LU Criteria Text |
Interchangeables: | NO |
Manufacturer: | Bayer Inc., Health Care Division |
Formulary Listing Date: | 2015-07-29 |
Drug Benefit Price or Unit Price: | 1418.0000 |
Amount MOH Pays: | 1418.0000 |
Coverage Status: |
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