Product Details

Synthroid

Levothyroxine (Sodium)
0.112 mg
Tablet


DIN/PIN/NPN

02171228

Manufacturer

Abbott Laboratories Limited

Formulary Listing Date

1996-10-01  

Unit Price

0.1289

Amount MOH Pays

0.0930

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
02171228 Synthroid 0.1289 0.0930
02550741 Apo-Levothyroxine 0.0930 0.0930
 

LU Clinical Criteria

NO  

EAP Criteria

NO

Product Monograph

View Monograph