Product Details

Peridex

Chlorhexidine Gluconate
0.12%
Oral Rinse

DIN/PIN/NPN

02237452

Manufacturer

Zila Pharmaceuticals Inc.

Formulary Listing Date

2024-02-29

Unit Price

NA

Amount MOH Pays

NA

Coverage Status

Off-Formulary Interchangeable

ODB Formulary Therapeutic Classification

52:36:00 Other Eye, Ear, Nose and Throat Agents

Therapeutic Note

NO

ATC Code

A01AB03

Interchangeable Products

DIN/ PIN/ NPN	Brand name	Unit Price	Amount MOH pays
02237452	Peridex	NA	NA
02240433	Perichlor	0.0253	NA
02493160	Perichlor Without Alcohol	0.0253	NA

LU Clinical Criteria

NO

EAP Criteria

NO

Product Monograph