DIN/NPN/PIN 00999399 OPTICHAMBER DIAMOND (CHAMBER ONLY) DEVICE AEROSOL HOLDING CHAMBER |
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Date Listed/Coverage Update: | 01-Nov-2012 | ||
Unit Price: | 18.0600 | ||
LCA Price: | 0.0000 | ||
MAC Price: |
0.0000 |
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Unit of Issue: | Device | ||
Manufacturer: | RESPIRONICS NJ INC-AUTO CONTROL MED INC (RNA) | ||
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) Alberta Human Services (AISH) (Group 19823) Alberta Adult Health Benefit (AAHB) (Group 23609) |
Special Authorization Request Form: |
N/A |
RESTRICTED BENEFIT |
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Review Status / Past Decisions
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