DIN/PIN/NPN Detail

92:00 UNCLASSIFIED THERAPEUTIC AGENTS

92:44:00 IMMUNOSUPPRESSIVE AGENTS

LU Criteria Text

Envarsus PA (TACROLIMUS)4mg ER Tab

DIN/PIN/NPN:02485893

Interchangeables:

NO

Manufacturer:

Endo Ventures Ltd.

Formulary Listing Date:

2020-09-30

Drug Benefit Price or Unit Price:

10.9719

Amount MOH Pays:

10.9719

Coverage Status:

Limited Use Product