Displaying 1 - 3 of 3
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 56955 ACYVIR 3% EYE OINT (ARP/AHI) ACYCLOVIR 5G A 8.02 3% 2 2022-04-01 2024-03-31 0
41 56956 OPTIVIRAL 3% EYE OINT (SPC) ACYCLOVIR 5G A 1.1417 3% 2 2024-04-01 2026-03-31 0
42 56956 OPTIVIRAL 3% EYE OINT (SPC) ACYCLOVIR 5G A 2.36 3% 2 2026-04-01 No No 0