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 30316 ADRENALINE | LIDOCAINE 0.001% | 1% INJ (FSB/ATB) 30ML B 3.94 0.001%|1% 0 2022-04-01 2024-03-31 Add to Contract as Cat B 0
41 30317 ADRENALINE|LIDOCAINE 0.001%|1% INJ (KWA) 30ML B 7.4754 0.001%|1% 0 2024-04-01 2026-03-31 0
40 3032C ADRENALINE | LIDOCAINE 0.001% | 2% INJ (FSB/ATB) 30ML B 4.08 0.001%|2% 0 2022-04-01 2024-03-31 Add to Contract as Cat B 0