Product Details

Flovent HFA

Fluticasone Propionate
250 mcg/Metered-Dose
Inhalation Aerosol
120-Dose Pack

DIN/PIN/NPN

02244293

Manufacturer

GlaxoSmithKline Inc., GlaxoSmithKline Consumer Health Care

Formulary Listing Date

2002-07-29  

Unit Price

110.0400

Amount MOH Pays

45.0200

Coverage Status

General Benefit

ODB Formulary Therapeutic Classification

Therapeutic Note

NO

ATC Code

R03BA05

Interchangeable Products

DIN/ PIN/ NPN Brand name Unit Price Amount MOH pays
02503131 PMS-Fluticasone 45.0200 45.0200
02244293 Flovent HFA 110.0400 45.0200
02510987 Apo-Fluticasone HFA 45.0200 45.0200
 

LU Clinical Criteria

NO  

EAP Criteria

NO

Product Monograph

View Monograph