Product Details
PMS-Ciprofloxacin XL
Ciprofloxacin HCl + Ciprofloxacin Base500 mg
ER Tablet
DIN/PIN/NPN
02416433
Manufacturer
Pharmascience Inc.
Formulary Listing Date
2014-03-27
Unit Price
2.3110
Amount MOH Pays
2.3110
Coverage Status
Limited Use Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
J01MA02
Interchangeable Products
| DIN/ PIN/ NPN | Brand name | Unit Price | Amount MOH pays |
|---|---|---|---|
| 02416433 | PMS-Ciprofloxacin XL | 2.3110 | 2.3110 |
| 02247916 | Cipro XL | NA | NA |
LU Clinical Criteria
| LU Code | Auth. Period | Clinical Criteria |
|---|---|---|
| 394 | 1 year | For patients with uncomplicated urinary tract infections (acute cystitis) who have failure, intolerance or hypersensitivity to all formulary antibiotic alternatives that are listed as General Benefits. |