DIN/PIN/NPN Detail

28:00 CENTRAL NERVOUS SYSTEM DRUGS

28:12:00 ANTICONVULSANTS

LU Criteria Text

Mint-Levetiracetam (LEVETIRACETAM)750mg Tab

DIN/PIN/NPN:02442418

Interchangeables:

Manufacturer:

Mint Pharmaceuticals Inc.

Formulary Listing Date:

2021-11-30

Drug Benefit Price or Unit Price:

0.5416

Amount MOH Pays:

0.5416

Coverage Status:

Limited Use Product