DIN/PIN/NPN Detail |
|
| 52:00 EYE, EAR, NOSE AND THROAT PREPARATIONS | |
| 52:36:00 OTHER EYE, EAR, NOSE AND THROAT AGENTS | LU Criteria Text |
Jamp Brimonidine/Timolol (BRIMONIDINE TARTRATE & TIMOLOL MALEATE)0.2% & 0.5% Oph Sol-10mL Pk
DIN/PIN/NPN:02531704
| Interchangeables: | YES |
| Manufacturer: | Jamp Pharma Corporation |
| Formulary Listing Date: | 2023-08-31 |
| Drug Benefit Price or Unit Price: | 23.2900 |
| Amount MOH Pays: | 23.2900 |
| Coverage Status: |
|