Product Details
Ach-Tacrolimus
Tacrolimus1 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. |
Requirements
NA