Product Details

JampLyte

PEG-Electrolytes

Powder
4-L Pack

DIN/PIN/NPN

02378329

Manufacturer

Jamp Pharma Corporation

Formulary Listing Date

2026-06-30  

Unit Price

16.4640

Amount MOH Pays

16.4640

Coverage Status

General Benefit

ODB Formulary Therapeutic Classification

Therapeutic Note

NO

ATC Code

A06AD65

Interchangeable Products

DIN/ PIN/ NPN Brand name Unit Price Amount MOH pays
00777838 PegLyte Powder 16.4640 16.4640
00677442 Colyte NA NA
02378329 JampLyte 16.4640 16.4640
 

LU Clinical Criteria

NO  

Requirements


EAP Criteria

  NO

Product Monograph

View Monograph