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 49412 PLASBUMIN 25% INJ (GRB/COL) ALBUMIN 12.5G VIAL BQ 101.94 25% 0 2022-04-01 2024-03-31 0
41 49416 ALBUREX 20% INJ (CSL) ALBUMIN (BQ) 50ML VIAL BQ 73.1229 20% 40 2024-04-01 2026-03-31 0
42 49418 ALBUREL 25% INJ (RLS) ALBUMIN 50ML BQ 127.87 25% 40 2026-04-01 No No 0
42 4941A ALBUMIN 20% INJ (INP) 50ML VIAL BQ 277.27 20% 40 2026-04-01 No No 0
42 4941C ALBUMIN 20% INJ (INP) 50ML BQ 277.27 20% 40 2026-04-01 No No 0
41 4941U ALBUREX 25% INJ (CSL) ALBUMIN (BQ) 50ML VIAL BQ 91.0639 25% 40 2024-04-01 2026-03-31 0