Product Details

Jamp Montelukast Chewable Tablets

Montelukast Sodium
4 mg
Chewable Tablet


DIN/PIN/NPN

02514877

Manufacturer

Jamp Pharma Corporation

Formulary Listing Date

2022-10-31  

Unit Price

0.2758

Amount MOH Pays

0.2758

Coverage Status

Limited Use Product

ODB Formulary Therapeutic Classification

Therapeutic Note

NO

ATC Code

R03DC03

Interchangeable Products

DIN/ PIN/ NPN Brand name Unit Price Amount MOH pays
02355507 Teva-Montelukast 0.2758 0.2758
02243602 Singulair 1.6783 0.2758
02330385 Sandoz Montelukast 0.2758 0.2758
02354977 PMS-Montelukast 0.2758 0.2758
02382458 Montelukast 0.2758 0.2758
02408627 Mint-Montelukast 0.2758 0.2758
02399865 Mar-Montelukast 0.2758 0.2758
02442353 Jamp-Montelukast 0.2758 0.2758
02422867 Auro-Montelukast Chewable Tablet 0.2758 0.2758
02377608 Apo-Montelukast 0.2758 0.2758
02514877 Jamp Montelukast Chewable Tablets 0.2758 0.2758
02522101 Nat-Montelukast 0.2758 0.2758
 

LU Clinical Criteria

LU Code Auth. Period Clinical Criteria
382 1 year

For the treatment of asthma in patients aged 2-5 years old.

 

EAP Criteria

NO

Product Monograph

View Monograph