Product Details

Mint-Leucovorin

Leucovorin Calcium
5 mg
Tablet

DIN/PIN/NPN

02496828

Manufacturer

Mint Pharmaceuticals Inc.

Formulary Listing Date

2021-03-29

Unit Price

3.6776

Amount MOH Pays

3.6776

Coverage Status

General Benefit

ODB Formulary Therapeutic Classification

88:08:00 Vitamin B

Therapeutic Note

NO

ATC Code

V03AF03

Interchangeable Products

DIN/ PIN/ NPN	Brand name	Unit Price	Amount MOH pays
02493357	Riva Leucovorin	3.6776	3.6776
02496828	Mint-Leucovorin	3.6776	3.6776
02170493	Leucovorin Calcium	7.3552	3.6776

LU Clinical Criteria

NO

EAP Criteria

NO

Product Monograph

View Monograph