Product Details
Prograf
Tacrolimus5 mg
Capsule
DIN/PIN/NPN
02175983
Manufacturer
Astellas Pharma Canada Inc.
Formulary Listing Date
1996-12-19
Unit Price
12.9986
Amount MOH Pays
6.4993
Coverage Status
Limited Use Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
L04AD02
Interchangeable Products
| DIN/ PIN/ NPN | Brand name | Unit Price | Amount MOH pays |
|---|---|---|---|
| 02175983 | Prograf | 12.9986 | 6.4993 |
| 02416832 | Sandoz Tacrolimus | 6.4993 | 6.4993 |
| 02456109 | Ach-Tacrolimus | 6.4993 | 6.4993 |
LU Clinical Criteria
| LU Code | Auth. Period | Clinical Criteria |
|---|---|---|
| 173 | Indefinite | For solid organ transplant and bone marrow transplant. |
Requirements
NA