DIN/PIN/NPN Detail |
|
| 92:00 UNCLASSIFIED THERAPEUTIC AGENTS | |
| 92:36:00 DISEASE-MODIFYING ANTIRHEUMATIC AGENTS | LU Criteria Text |
| Interchangeables: | NO |
| Manufacturer: | Jamp Pharma Corporation |
| Formulary Listing Date: | 2022-05-31 |
| Drug Benefit Price or Unit Price: | 942.5400 |
| Amount MOH Pays: | 942.5400 |
| Coverage Status: |
|