Product Details
PegLyte Powder
PEG-ElectrolytesPowder
4-L Pack
DIN/PIN/NPN
00777838
Manufacturer
Pendopharm, Division of Pharmascience Inc.
Formulary Listing Date
1996-10-01
Unit Price
16.4640
Amount MOH Pays
16.4640
Coverage Status
General Benefit
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
A06AD10
Interchangeable Products
| DIN/ PIN/ NPN | Brand name | Unit Price | Amount MOH pays |
|---|---|---|---|
| 00777838 | PegLyte Powder | 16.4640 | 16.4640 |
| 00677442 | Colyte | NA | NA |
| 02378329 | JampLyte | 16.4640 | 16.4640 |
LU Clinical Criteria
NORequirements