DIN/PIN/NPN Detail
40:00 ELECTROLYTIC, CALORIC AND WATER BALANCE
40:28:00 DIURETICS
LU Criteria Text
Mar-Midodrine
(MIDODRINE HCL)
5mg Tab
DIN/PIN/NPN:
02473992
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Interchangeables:
YES
Manufacturer:
Marcan Pharmaceuticals Inc.
Formulary Listing Date:
2018-11-29
Drug Benefit Price or Unit Price:
0.1921
Amount MOH Pays:
0.1921
Coverage Status:
Limited Use Product
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