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 43664 BURETROL INTERLINK ( 2C7564) SET (BAX/STO) SET B 16.74 0 2022-04-01 2024-03-31 0
41 43664 BURETROL INTERLINK ( 2C7564) SET (BAX) (B) SET B 23.7582 10 2024-04-01 2026-03-31 0
40 4366R BURETROL ADD ON CLEARLINK SET (BAX/STO) ADMI SET B 12.37 0 2022-04-01 2024-03-31 0
41 4366R BURETROL ADD ON CLEARLINK SET (BAX) ADM (B) SET B 17.9138 10 2024-04-01 2026-03-31 0
40 4366S BURETROL SOL PAED (2C8862) SET (BAX/STO) ADM SET B 15.85 0 2022-04-01 2024-03-31 0
41 4366S BURETROL SOL PAED (2C8862) SET (BAX) AD (B) SET B 20.9583 10 2024-04-01 2026-03-31 0