Product Details
Mar-Mycophenolate Mofetil
Mycophenolate Mofetil200 mg/mL
Powder for Oral Suspension
175-mL Pack
DIN/PIN/NPN
02522233
Manufacturer
Marcan Pharmaceuticals Inc.
Formulary Listing Date
2022-03-31
Unit Price
244.7025
Amount MOH Pays
244.7025
Coverage Status
Limited Use Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
L04AA06
Interchangeable Products
| DIN/ PIN/ NPN | Brand name | Unit Price | Amount MOH pays |
|---|---|---|---|
| 02242145 | CellCept | 342.5800 | 244.7025 |
| 02522233 | Mar-Mycophenolate Mofetil | 244.7025 | 244.7025 |
LU Clinical Criteria
| LU Code | Auth. Period | Clinical Criteria |
|---|---|---|
| 556 | Indefinite | For patients who are unable to swallow or tolerate solid oral dosage forms. |