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 20413 AMINOPLASMAL E 10% SOLN (BRA/COL) AMINO ACID 500ML BQ 15.20 10% 0 2022-04-01 2024-03-31 0
41 20413 AMINOPLASMAL E 10% (BRA) AMINO ACID (BQ) 500ML BQ 16.4459 10% 100 2024-04-01 2026-03-31 0
40 20425 AMINOPLASMAL E 5% SOLN (BRA/COL) AMINO ACID 500ML BQ 13.75 5% 0 2022-04-01 2024-03-31 0
41 20425 AMINOPLASMAL E 5% (BRA) AMINO ACID (BQ) 500ML BQ 14.3528 5% 100 2024-04-01 2026-03-31 0
40 20443 AMINOPLASMAL W | O ELECTROLYTES 15% INJ (BRA/COL) AMINO ACID 500ML BQ 26.45 15% 0 2022-04-01 2024-03-31 0
41 20443 AMINOPLASMAL W|O ELECTROLYTES 15% INJ (BRA) AMINO ACID (BQ) 500ML BQ 28.189 15% 100 2024-04-01 2026-03-31 0