Interchangeable Grouping
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68:00 HORMONES AND SUBSTITUTES
68:08:00 ANDROGENS
LU Criteria Text
TESTOSTERONE ENANTHATE
1000mg/5mL Oily Inj Sol-5mL Pk
Interchangeables found: 2
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DIN/ PIN/ NPN
Brand Name
Drug Benefit Price or Unit Price
Amount MOH Pays:
00029246
Delatestryl
(Not a Benefit)
N/A
N/A
02536315
Testosterone Enanthate Injection, USP
35.5943
35.5943
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