Product Details

Sulcrate

Sucralfate
1 g
Tablet


DIN/PIN/NPN

02100622

Manufacturer

Axcan Pharma Inc.

Formulary Listing Date

1996-10-01  

Unit Price

0.7408

Amount MOH Pays

0.3089

Coverage Status

General Benefit Chronic-Use Medication

ODB Formulary Therapeutic Classification

Therapeutic Note

NO

ATC Code

A02BX02

Interchangeable Products

DIN/ PIN/ NPN Brand name Unit Price Amount MOH pays
02045702 Teva-Sucralfate 0.3089 0.3089
02100622 Sulcrate 0.7408 0.3089
02125250 Apo-Sucralfate 0.3089 0.3089
 

LU Clinical Criteria

NO  

EAP Criteria

NO

Product Monograph

View Monograph