DIN/PIN/NPN Detail

96:00 MISCELLANEOUS

96:01:00 NUTRITION PRODUCTS

PediaSure Peptide 1 Cal (NUTRITIONAL PRODUCT)1.0kcal/mL Liq-237mL Pk Reclosable Plastic Bottle

DIN/PIN/NPN:09857523

Interchangeables:

Manufacturer:

Formulary Listing Date:

2015-05-28

Drug Benefit Price or Unit Price:

N/A

Amount MOH Pays:

2.6892

Coverage Status: