Product Details

Tri-Cyclen Lo

Norgestimate + Ethinyl Estradiol
3-Phase
Tablet
21's Pack

DIN/PIN/NPN

02258560

Manufacturer

Janssen Inc.

Formulary Listing Date

2008-02-12  

Unit Price

NA

Amount MOH Pays

NA

Coverage Status

Not a Benefit

ODB Formulary Therapeutic Classification

Therapeutic Note

NO

ATC Code

G03AB11

Interchangeable Products

DIN/ PIN/ NPN Brand name Unit Price Amount MOH pays
02258560 Tri-Cyclen Lo NA NA
02401967 Tricira Lo (21 Day) 13.3900 13.3900
 

LU Clinical Criteria

NO  

EAP Criteria

NO

Product Monograph

View Monograph