Displaying 1 - 6 of 6
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 43648 IRRIG SET Y-TYPE (2C4005) (BAX/STO) ADMIN S SET B 15.17 0 2022-04-01 2024-03-31 0
41 43648 IRRIG SET Y-TYPE (2C4005) (BAX) (B) SET B 18.5118 10 2024-04-01 2026-03-31 0
42 43648 IRRIG SET Y-TYPE (2C4005) (BAX) SET B 11.31 10 2026-04-01 No No 0
40 43649 ECOSPIKE (BRA/COL) ADMIN SET GLYCINE SET B 8.45 0 2022-04-01 2024-03-31 0
41 43649 ECOSPIKE (BRA) ADMIN SET GLYCINE (B) SET B 9.3782 10 2024-04-01 2026-03-31 0
42 43649 ECOSPIKE (BRA) ADMIN SET GLYCINE (C) SET C 13.54 10 2026-04-01 No No 0