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 A1916 ALPROSTADIL 500MCG/ML INJ (SLS/AHI) 1ML AMP BQ 399.59 500MCG/ML 0 2022-04-01 2024-03-31 0
40 A1917 BIOGLANDIN 500MCG/ML INJ (UBI/RXP) ALPROSTADI 1ML AMP BQ 237.85 500MCG/ML 0 2022-04-01 2024-03-31 0
41 A1919 ALPROSTADIL 500MCG/ML INJ (KWA) 1ML AMP BQ 485.2208 500MCG/ML 7 2024-04-01 2026-03-31 6