DIN/PIN/NPN Detail

96:00 MISCELLANEOUS

96:01:00 NUTRITION PRODUCTS

Jevity 1.2 Cal (NUTRITIONAL PRODUCT)1.2kcal/mL Liq-237mL Reclosable Carton Pk

DIN/PIN/NPN:09858383

Interchangeables:

Manufacturer:

Formulary Listing Date:

2025-11-28

Drug Benefit Price or Unit Price:

N/A

Amount MOH Pays:

2.1842

Coverage Status: