DIN/PIN/NPN Detail
92:00 UNCLASSIFIED THERAPEUTIC AGENTS
LU Criteria Text
Omlyclo
(OMALIZUMAB)
75mg/0.5mL Inj Sol-0.5mL Pref Syr Pk
DIN/PIN/NPN:
02553805
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Interchangeables:
NO
Manufacturer:
Celltrion Inc.
Formulary Listing Date:
2025-08-29
Drug Benefit Price or Unit Price:
168.7440
Amount MOH Pays:
168.7440
Coverage Status:
Limited Use Product
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