Product Details

Synthroid

Levothyroxine (Sodium)
0.125 mg
Tablet


DIN/PIN/NPN

02172119

Manufacturer

Abbott Laboratories Limited

Formulary Listing Date

1996-10-01  

Unit Price

0.1304

Amount MOH Pays

0.0941

Coverage Status

General Benefit

ODB Formulary Therapeutic Classification

Therapeutic Note

NO

ATC Code

H03AA01

Interchangeable Products

DIN/ PIN/ NPN Brand name Unit Price Amount MOH pays
02172119 Synthroid 0.1304 0.0941
02550768 Apo-Levothyroxine 0.0941 0.0941
 

LU Clinical Criteria

NO  

EAP Criteria

NO

Product Monograph

View Monograph