DIN/PIN/NPN Detail |
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DIN/PIN/NPN Detail |
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| 92:00 UNCLASSIFIED THERAPEUTIC AGENTS | |
| 92:20:00 BIOLOGIC RESPONSE MODIFIERS | LU Criteria Text |
| Interchangeables: | NO |
| Manufacturer: | Pharmascience Inc. |
| Formulary Listing Date: | 2018-09-27 |
| Drug Benefit Price or Unit Price: | 35.0000 |
| Amount MOH Pays: | 35.0000 |
| Coverage Status: |
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