Product Details

Mycophenolate Mofetil

Mycophenolate Mofetil
250 mg
Capsule

DIN/PIN/NPN

02457369

Manufacturer

Sanis Health Inc.

Formulary Listing Date

2020-08-28

Unit Price

0.3712

Amount MOH Pays

0.3712

Coverage Status

General Benefit

ODB Formulary Therapeutic Classification

92:00:00 Unclassified Therapeutic Agents

Therapeutic Note

NO

ATC Code

L04AA06

Interchangeable Products

DIN/ PIN/ NPN	Brand name	Unit Price	Amount MOH pays
02364883	Teva-Mycophenolate	0.3712	0.3712
02320630	Sandoz Mycophenolate Mofetil	0.3712	0.3712
02457369	Mycophenolate Mofetil	0.3712	0.3712
02383780	Mycophenolate Mofetil Capsules	0.3712	0.3712
02386399	Jamp-Mycophenolate	0.3712	0.3712
02192748	CellCept	2.1846	0.3712
02352559	Apo-Mycophenolate	0.3712	0.3712

LU Clinical Criteria

NO

EAP Criteria

NO

Product Monograph