Product Details

Synthroid

Levothyroxine (Sodium)
0.025 mg
Tablet


DIN/PIN/NPN

02172062

Manufacturer

Abbott Laboratories Limited

Formulary Listing Date

1996-10-01  

Unit Price

0.1129

Amount MOH Pays

0.0597

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
02172062 Synthroid 0.1129 0.0597
02550709 Apo-Levothyroxine 0.0597 0.0597
 

LU Clinical Criteria

NO  

Requirements

NA

EAP Criteria

  NO

Product Monograph

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