DIN/PIN/NPN Detail
08:00 ANTI-INFECTIVE AGENTS
08:18:00 ANTIVIRALS
LU Criteria Text
Maviret
(GLECAPREVIR & PIBRENTASVIR)
100mg & 40mg Tab
DIN/PIN/NPN:
02467550
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Interchangeables:
NO
Manufacturer:
AbbVie Corporation
Formulary Listing Date:
2019-02-28
Drug Benefit Price or Unit Price:
238.0952
Amount MOH Pays:
238.0952
Coverage Status:
Limited Use Product
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