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

Lumigan RC (BIMATOPROST)0.01% Oph Sol-5mL Pk

DIN/PIN/NPN:09857368

Interchangeables:

NO

Manufacturer:

Formulary Listing Date:

2010-09-09

Drug Benefit Price or Unit Price:

60.1892

Amount MOH Pays:

60.1892

Coverage Status:

Limited Use Product