DIN/PIN/NPN Detail |
84:00 SKIN AND MUCOUS MEMBRANE PREPARATIONS | Therapeutic Note(s) |
84:04:08 ANTI-INFECTIVES FUNGICIDES | LU Criteria Text |
Interchangeables: | YES |
Manufacturer: | Jamp Pharma Corporation |
Formulary Listing Date: | 2015-03-31 |
Drug Benefit Price or Unit Price: | 3.9424 |
Amount MOH Pays: | 3.9424 |
Coverage Status: |
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