DIN/PIN/NPN Detail |
84:00 SKIN AND MUCOUS MEMBRANE PREPARATIONS | |
84:92:00 MISCELLANEOUS SKIN AND MUCOUS MEMBRANE AGENTS | LU Criteria Text |
Interchangeables: | NO |
Manufacturer: | Janssen Inc. |
Formulary Listing Date: | 2024-01-31 |
Drug Benefit Price or Unit Price: | 3059.7400 |
Amount MOH Pays: | 3059.7400 |
Coverage Status: |
|