Product Details

Mar-Amitriptyline

Amitriptyline
25 mg
Tablet


DIN/PIN/NPN

02429888

Manufacturer

Marcan Pharmaceuticals Inc.

Formulary Listing Date

2015-04-30  

Unit Price

0.0829

Amount MOH Pays

0.0829

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
02326051 Teva-Amitriptyline 0.0829 0.0829
00654515 PMS-Amitriptyline 0.0829 0.0829
02429888 Mar-Amitriptyline 0.0829 0.0829
00335061 Elavil 0.1211 0.0829
 

LU Clinical Criteria

NO  

EAP Criteria

NO

Product Monograph

View Monograph