Displaying 1 - 2 of 2
  • Print
Contract Number Brand Code Brand Name Active Ingredient Trade Name Package Size Formulary Category Pkg Price Unit Price Unit Description Max. Reimbursable Quantity / Month Package Description Manufacturer Code Manufacturer Name Agent Code Agent Name Benefit Therapeutic Code Therapeutic Desc Drug Contract Start Date Drug Contract End Date Status Description Default Route Max Repeats Therapeutic Head Amend Date
40 00939 GRISEOFULVIN 25MG/ML SUSP (SUE/AHI) GRISEOFULVIN GRISEOFULVIN 120ML A 14.87 0.12 SUSPENSION 500 ML SUE LABORATORIOS SUED S.R.L AHI ARMSTRONG HEALTHCARE INC 081492 ANTIFUNGALS, MISCELLANEOUS 2022-04-01 2024-03-31 Oral 6 ANTI-INFECTIVE AGENTS
41 00939 GRISEOFULVIN 25MG/ML SUSP (SUE) GRISEOFULVIN GRISEOFULVIN 120ML A 15.71 0.1309 ML 500 BOTT SUE LABORATORIOS SUED S.R.L AHI ARMSTRONG HEALTHCARE INC 081492 ANTIFUNGALS, MISCELLANEOUS 2024-04-01 2026-03-31 ORAL 6 ANTIFUNGALS, MISCELLANEOUS