Displaying 1 - 4 of 4
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 43683 VENTED PACLITAXEL (2C7557) SET (BAX/STO) ADM SET B 11.55 0 2022-04-01 2024-03-31 0
41 43683 VENTED PACLITAXEL (2C7557) SET (BAX) AD (B) SET B 18.5118 10 2024-04-01 2026-03-31 0
40 43684 INTRAFIX PRIME LINE COMFORT PV SET (BRA/COL) ADMIN SET SET B 1.88 0 2022-04-01 2024-03-31 0
41 43684 INTRAFIX PRIME LINE COMFORT PV SET (BRA) ADMIN SET (B) SET B 2.1475 10 2024-04-01 2026-03-31 0