Product Details

Portia 28

Ethinyl Estradiol + Levonorgestrel
0.03 mg + 0.15 mg
Tablet
28's Pack

DIN/PIN/NPN

02295954

Manufacturer

Barr Laboratories Inc.

Formulary Listing Date

2007-10-03  

Unit Price

10.6600

Amount MOH Pays

7.2800

Coverage Status

General Benefit

ODB Formulary Therapeutic Classification

Therapeutic Note

NO

ATC Code

G03AA07

Interchangeable Products

DIN/ PIN/ NPN Brand name Unit Price Amount MOH pays
02295954 Portia 28 10.6600 7.2800
02387093 Ovima 28 7.2800 7.2800
02042339 Min-Ovral 28 19.2900 7.2800
 

LU Clinical Criteria

NO  

EAP Criteria

NO

Product Monograph

View Monograph