Displaying 1 - 2 of 2
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 40613 ALLEREX 0.05% | 0.04% EYE DR (ASL/PHA) ANTAZOLI 10ML A 5.79 0.05%|0.04% 1 2022-04-01 2024-03-31 6
41 40613 ALLEREX 0.05%|0.04% EYE DR (ASL) ANTAZOL 10ML A 8.8074 0.05%|0.04% 1 2024-04-01 2026-03-31 6