Product Details
Jamp Itraconazole Oral Solution
Itraconazole10 mg/mL
Oral Solution
DIN/PIN/NPN
02484315
Manufacturer
Jamp Pharma Corporation
Formulary Listing Date
2020-04-30
Unit Price
0.4111
Amount MOH Pays
0.4111
Coverage Status
Limited Use Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
J02AC02
Interchangeable Products
| DIN/ PIN/ NPN | Brand name | Unit Price | Amount MOH pays |
|---|---|---|---|
| 02231347 | Sporanox | NA | NA |
| 02495988 | Odan-Itraconazole | 0.4111 | 0.4111 |
| 02484315 | Jamp Itraconazole Oral Solution | 0.4111 | 0.4111 |
LU Clinical Criteria
| LU Code | Auth. Period | Clinical Criteria |
|---|---|---|
| 570 | 1 year | For patients who are unable to swallow or tolerate solid oral dosage forms. |