Product Details
Soothe Night Time
Petrolatum + Mineral Oil80% + 20%
Ophthalmic Ointment
3.5-g Tube Pack
DIN/PIN/NPN
02125706
Manufacturer
Bausch & Lomb Inc.
Formulary Listing Date
1996-10-01
Unit Price
5.4800
Amount MOH Pays
5.4800
Coverage Status
Limited Use Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
S01XA20
Interchangeable Products
NOLU Clinical Criteria
| LU Code | Auth. Period | Clinical Criteria |
|---|---|---|
| 49 | Indefinite | For patients with objective evidence of keratoconjunctivitis sicca as confirmed by filamentary keratopathy on slit lamp examination or biopsy. |