Displaying 1 - 5 of 5
Contract Number Brand Code Brand Name Package Size Formulary Category Unit Price Strength Max. Reimbursable / Month Drug Contract Start Date Drug Contract End Date Restrict To Ophthalmologist Restrict To Pulmonologist Status Description Max Repeats
40 72211 BETAFERON 8MU/ML INJ (BSP/AHI) INTERFERON BET 15X3ML C 2,786.28 8MU/ML 0 2022-04-01 2024-03-31 0
42 72211 BETAFERON 8MU/ML INJ (BSP) INTERFERON B1 15X3ML BQ 2,721.04 8MU/ML 0 2026-04-01 No No 0
40 72218 BETAFERON 8MU/ML INJ (BSP/COL) INTERFERON BET 15X3ML C 2,786.28 8MU/ML 0 2022-04-01 2024-03-31 0
41 72218 BETAFERON 8MU/ML INJ (BSP) INTERFERON B1 (C) 15X3ML C 2786.2821 8MU/ML 0 2024-04-01 2026-03-31 0
42 72218 BETAFERON 8MU/ML INJ (BSP) INTERFERON B1 15X3ML BQ 2,476.15 8MU/ML 0 2026-04-01 No No 0