Displaying 1 - 7 of 7
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 0164AM AMPICILLIN 500MG INJ (KWA/ATB) 500MG VIAL BQ 0.90 500MG 0 2022-04-01 2022-09-30 0
42 0164AR AMPICILLIN 500MG INJ (MON) 10X5ML B 1.32 500MG 28 2026-04-01 No No 0
40 0164AU AMPICILLIN 500MG INJ (CHC/ATB) 500MG VIAL BQ 0.82 500MG 0 2022-04-01 2024-03-31 Price Change 6
40 0164AW AMPICILLIN 500MG INJ (MON/PHA) 500MG VIAL C 1.69 500MG 0 2022-04-01 2024-03-31 0
41 0164AW AMPICILLIN 500MG INJ (MON) (BQ) 500MG VIAL BQ 1.8485 500MG 28 2024-04-01 2026-03-31 0
40 0164C AMPICILLIN 500MG INJ (RTM/PHA) 500MG VIAL C 1.82 500MG 0 2022-04-01 2024-03-31 0
41 0164C AMPICILLIN 500MG INJ (RTM) (BQ) 500MG VIAL BQ 2.3649 500MG 28 2024-04-01 2026-03-31 0