Drug Identification Number and Pricing Information Drug sponsors must complete the table below. If the drug is a pre-NOC or pre-NOC/c, leave the DIN field blank. The submitted price is the current anticipated marketed price for each Drug Identification Number (DIN). Package Daily drug Package Smallest format cost per Dosage Route of format + unit price $ DIN Strength $ (to 4 patient $ (to form administration units per (to 4 decimal decimal 4 decimal package places) places) places)
Drug Identification Number and Pricing Information Drug sponsors must complete the table below. If the drug is a pre-NOC or pre-NOC/c, leave the DIN field blank. The submitted price is the current anticipated marketed price for each Drug Identification Number (DIN). DIN Strength Dosage form Route of administration Package format + units per package Package format $ (to 4 decimal places) Smallest unit price $ (to 4 decimal places) Daily drug cost per patient $ (to 4 decimal places)
drug-product-request-form-cdr-drugs.docx