DIN/PIN/NPN Detail

96:00 MISCELLANEOUS

96:01:00 NUTRITION PRODUCTS

Similac Alimentum (NUTRITIONAL PRODUCT)5.17Kcal/g Pd-400g Can Pk

DIN/PIN/NPN:09857564

Interchangeables:

Manufacturer:

Formulary Listing Date:

2017-10-30

Drug Benefit Price or Unit Price:

N/A

Amount MOH Pays:

16.4700

Coverage Status: