Contract Changes [25643 , 2024-12-04]

Contract Number	41
Brand Code	25643
Drug	GRAVOL INFANT 25MG SUPPOS (CDC) DIMENHYD
LAgent Code	COL
Package Size	10'S
Formulary Category	A
Package Price	13.8
Protocol Monthly Max	10
Drug Contract Start Date	2024-12-04
Drug Contract End Date	2026-03-31
Contract Changed
Change Date	2024-12-04