Product Details

Portia 21

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

DIN/PIN/NPN

02295946

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

68:32:00 Progestogens and Oral Contraceptives

Therapeutic Note

NO

ATC Code

G03AA07

Interchangeable Products

DIN/ PIN/ NPN	Brand name	Unit Price	Amount MOH pays
02295946	Portia 21	10.6600	7.2800
02387085	Ovima 21	7.2800	7.2800
02042320	Min-Ovral 21	19.2900	7.2800

LU Clinical Criteria

NO

EAP Criteria

NO

Product Monograph

View Monograph