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 43616 INTRAFIX PRIMELINE (4062181/46 SET (BRA/COL) SET B 1.25 0 2022-04-01 2024-03-31 0
41 43616 INTRAFIX PRIMELINE (4062181/46 SET (BRA (B) SET B 1.8213 10 2024-04-01 2026-03-31 0
40 4361AA BURETROL SOLUTION SET (BAX/STO) ADMIN SET AD SET B 2.58 0 2022-04-01 2024-03-31 0
41 4361AA BURETROL SOLUTION SET (BAX) ADMIN SET A (B) SET B 3.5338 10 2024-04-01 2026-03-31 0