DIN/PIN/NPN Detail
96:00 MISCELLANEOUS
96:01:00 NUTRITION PRODUCTS
Portagen
(NUTRITIONAL PRODUCT)
1.02kcal/mL Pd-454g Pk
DIN/PIN/NPN:
09854401
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Interchangeables:
NO
Manufacturer:
Mead Johnson Nutritionals
Formulary Listing Date:
2003-01-30
Drug Benefit Price or Unit Price:
N/A
Amount MOH Pays:
55.7800
Coverage Status:
Nutrition Product
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