Product Details

Elavil

Amitriptyline
50 mg
Tablet


DIN/PIN/NPN

00335088

Manufacturer

A A Pharma Inc.

Formulary Listing Date

1996-10-01  

Unit Price

0.2347

Amount MOH Pays

0.1078

Coverage Status

General Benefit

ODB Formulary Therapeutic Classification

Therapeutic Note

NO

ATC Code

N06AA09

Interchangeable Products

DIN/ PIN/ NPN Brand name Unit Price Amount MOH pays
00654507 PMS-Amitriptyline 0.1078 0.1078
02429896 Mar-Amitriptyline 0.1078 0.1078
00335088 Elavil 0.2347 0.1078
02457687 Jamp-Amitriptyline 0.1078 0.1078
 

LU Clinical Criteria

NO  

Requirements


EAP Criteria

  NO

Product Monograph

View Monograph