Product Details
PMS-Montelukast
Montelukast Sodium4 mg
Chewable Tablet
DIN/PIN/NPN
02354977
Manufacturer
Pharmascience Inc.
Formulary Listing Date
2012-01-19
Unit Price
0.2758
Amount MOH Pays
0.2758
Coverage Status
Limited Use Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
R03DC03
Interchangeable Products
| DIN/ PIN/ NPN | Brand name | Unit Price | Amount MOH pays |
|---|---|---|---|
| 02355507 | Teva-Montelukast | 0.2758 | 0.2758 |
| 02243602 | Singulair | 1.6783 | 0.2758 |
| 02330385 | Sandoz Montelukast | 0.2758 | 0.2758 |
| 02354977 | PMS-Montelukast | 0.2758 | 0.2758 |
| 02382458 | Montelukast | 0.2758 | 0.2758 |
| 02408627 | Mint-Montelukast | 0.2758 | 0.2758 |
| 02399865 | Mar-Montelukast | 0.2758 | 0.2758 |
| 02442353 | Jamp-Montelukast | 0.2758 | 0.2758 |
| 02422867 | Auro-Montelukast Chewable Tablet | 0.2758 | 0.2758 |
| 02377608 | Apo-Montelukast | 0.2758 | 0.2758 |
| 02514877 | Jamp Montelukast Chewable Tablets | 0.2758 | 0.2758 |
| 02522101 | Nat-Montelukast | 0.2758 | 0.2758 |
LU Clinical Criteria
| LU Code | Auth. Period | Clinical Criteria |
|---|---|---|
| 382 | 1 year | For the treatment of asthma in patients aged 2-5 years old. |