DIN/PIN/NPN Detail
68:00 HORMONES AND SUBSTITUTES
68:04:00 CORTICOSTEROIDS
LU Criteria Text
Trispan
(TRIAMCINOLONE HEXACETONIDE)
20mg/mL 1mL-Amp Pk
DIN/PIN/NPN:
02470632
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Interchangeables:
NO
Manufacturer:
Medexus Inc.
Formulary Listing Date:
2020-06-30
Drug Benefit Price or Unit Price:
18.0000
Amount MOH Pays:
18.0000
Coverage Status:
Limited Use Product
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