Product Details

Ach-Tacrolimus

Tacrolimus
1 mg
Capsule


DIN/PIN/NPN

02456095

Manufacturer

Accord Healthcare Inc.

Formulary Listing Date

2023-11-30  

Unit Price

1.2978

Amount MOH Pays

1.2978

Coverage Status

Limited Use Product

ODB Formulary Therapeutic Classification

Therapeutic Note

NO

ATC Code

L04AD02

Interchangeable Products

DIN/ PIN/ NPN Brand name Unit Price Amount MOH pays
02175991 Prograf 2.5956 1.2978
02416824 Sandoz Tacrolimus 1.2978 1.2978
02456095 Ach-Tacrolimus 1.2978 1.2978
 

LU Clinical Criteria

LU Code Auth. Period Clinical Criteria
173 Indefinite

For solid organ transplant and bone marrow transplant.

 

EAP Criteria

NO

Product Monograph

View Monograph