Product Details

Synthroid

Levothyroxine (Sodium)
0.125 mg
Tablet


DIN/PIN/NPN

02172119

Manufacturer

Abbott Laboratories Limited

Formulary Listing Date

1996-10-01  

Unit Price

0.1304

Amount MOH Pays

0.0690

Coverage Status

General Benefit

ODB Formulary Therapeutic Classification

Therapeutic Note

NO

ATC Code

H03AA01

Interchangeable Products

DIN/ PIN/ NPN Brand name Unit Price Amount MOH pays
02172119 Synthroid 0.1304 0.0690
02550768 Apo-Levothyroxine 0.0690 0.0690
 

LU Clinical Criteria

NO  

Requirements

NA

EAP Criteria

  NO

Product Monograph

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