Product Details

Leucovorin Calcium

Leucovorin Calcium
5 mg
Tablet

DIN/PIN/NPN

02170493

Manufacturer

Wyeth Pharmaceuticals

Formulary Listing Date

1999-01-07

Unit Price

7.3552

Amount MOH Pays

1.8388

Coverage Status

General Benefit

ODB Formulary Therapeutic Classification

88:08:00 Vitamin B

Therapeutic Note

NO

ATC Code

V03AF03

Interchangeable Products

DIN/ PIN/ NPN	Brand name	Unit Price	Amount MOH pays
02493357	Riva Leucovorin	1.8388	1.8388
02496828	Mint-Leucovorin	1.8388	1.8388
02170493	Leucovorin Calcium	7.3552	1.8388
02548208	Jamp Leucovorin	1.8388	1.8388

LU Clinical Criteria

NO

EAP Criteria

NO

Product Monograph

View Monograph