DIN/PIN/NPN Detail

86:00 SPASMOLYTICS

86:12:04 GENITOURINARY SMOOTH MUSCLE RELAXANTS ANTIMUSCARINICS

LU Criteria Text

Mictoryl Pediatric (PROPIVERINE HYDROCHLORIDE)5mg Tab

DIN/PIN/NPN:02460289

Interchangeables:

NO

Manufacturer:

Formulary Listing Date:

2018-05-31

Drug Benefit Price or Unit Price:

0.3889

Amount MOH Pays:

0.3889

Coverage Status:

Limited Use Product