Product Details

Synthroid

Levothyroxine (Sodium)
0.05 mg
Tablet


DIN/PIN/NPN

02172070

Manufacturer

Abbott Laboratories Limited

Formulary Listing Date

1996-10-01  

Unit Price

0.0746

Amount MOH Pays

0.0390

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
02172070 Synthroid 0.0746 0.0390
02213192 Eltroxin 0.0390 0.0390
 

LU Clinical Criteria

NO  

EAP Criteria

NO

Product Monograph

View Monograph