Product Details

PMS-Amitriptyline

Amitriptyline
10 mg
Tablet


DIN/PIN/NPN

00654523

Manufacturer

Pharmascience Inc.

Formulary Listing Date

2024-10-31  

Unit Price

0.0305

Amount MOH Pays

0.0305

Coverage Status

General Benefit

ODB Formulary Therapeutic Classification

Therapeutic Note

NO

ATC Code

N06AA09

Interchangeable Products

DIN/ PIN/ NPN Brand name Unit Price Amount MOH pays
02429861 Mar-Amitriptyline 0.0305 0.0305
00335053 Elavil 0.0664 0.0305
00654523 PMS-Amitriptyline 0.0305 0.0305
 

LU Clinical Criteria

NO  

EAP Criteria

NO

Product Monograph

View Monograph