Product Details

Synthroid

Levothyroxine (Sodium)
0.088 mg
Tablet


DIN/PIN/NPN

02172097

Manufacturer

Abbott Laboratories Limited

Formulary Listing Date

1996-12-19  

Unit Price

0.1220

Amount MOH Pays

0.0646

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
02172097 Synthroid 0.1220 0.0646
02550733 Apo-Levothyroxine 0.0646 0.0646
 

LU Clinical Criteria

NO  

Requirements

NA

EAP Criteria

  NO

Product Monograph

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