Interactive Drug Benefit List
DIN/NPN/PIN 00990015 VORTEX TODDLER/INFANT MASK DEVICE INFANT DEVICE AEROSOL HOLDING CHAMBER/MASK
940000 DEVICES
Date Listed/Coverage Update: 01-Nov-2005
Unit Price: 13.0047
LCA Price: 0.0000
MAC Price:

0.0000

Unit of Issue: Device
Manufacturer: KEGO HEALTHCARE (KGH)
ATC: V07
1
Interchangeable Products: Yes

Coverage Status: RESTRICTED BENEFIT
Applies to Clients of: Non-Group Coverage (Group 1)
Coverage for Seniors (Group 66)
Palliative Coverage (Group 20514, Please note:Your client may have Group 1 or Group 66 coverage)
Child and Family Services (Group 20403)
Alberta Child Health Benefit (Group 20400)
Children and Youth Services (Group 19824)
Income Support (Group 19823)
Learners Program (Group 22128)
Alberta Human Services (AISH) (Group 19823)
Alberta Adult Health Benefit (AAHB) (Group 23609)

Special Authorization Request Form:

N/A

RESTRICTED BENEFIT

Coverage is limited to one of each size (infant, pediatric, adult) aerosol holding chamber mask or chamber w/ mask per plan participant per year.

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NOTICE:
The DBL, DBS and related publications require knowledgeable interpretation and are intended primarily for professional health care practitioners, pharmacies, hospitals and organizations associated with the manufacture, distribution and use of pharmaceutical preparations.
Electronic versions of all DBL and DBS related publications are unofficial versions and are provided for convenience and private use only. Official paper versions can be obtained from Alberta Blue Cross who publishes them on behalf of Alberta Health and Alberta Human Services.
Alberta Health reserves the right to make changes, without notice, to the List through the Interactive DBL(iDBL), and any such changes to the Interactive DBL(iDBL) are effective the date of the change (unless otherwise stated) and regardless of the date of publication in the paper version or updates.