Product Details

pH 12 Sterile Diluent for Flolan

Glycine + Sodium Chloride + Water
94 mg + 73.3 mg + 50 mL/Vial
Solution for Injection
50-mL Plastic Vial

DIN/PIN/NPN

02443651

Manufacturer

GlaxoSmithKline Inc., GlaxoSmithKline Consumer Health Care

Formulary Listing Date

2023-04-28  

Unit Price

11.9150

Amount MOH Pays

11.9150

Coverage Status

Exceptional Access Program Product

ODB Formulary Therapeutic Classification

Therapeutic Note

NO

ATC Code

V07AB

Interchangeable Products

NO  

LU Clinical Criteria

NO  

EAP Criteria

Therapeutic Class Reimbursement Criteria
Unclassified EAP Drugs

These drugs are not currently listed in the Exceptional Access Program Reimbursement Criteria for Frequently Requested Drugs – August 8, 2023 Edition

Physicians may wish to contact the EAP directly by phone at 416-327-8109 or 1-866-811-9893 or by email at EAPFeedback.MOH@ontario.ca to see if an unlisted drug product and/or indication may be considered for EAP funding.

Product Monograph

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