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 30612 RHOPHYLAC 300MCG INJ (CSL/AHI) ANTI-D IMMUNOG 2ML AMP BQ 108.73 300MCG 0 2022-04-01 2024-03-31 0
41 30612 RHOPHYLAC 300MCG INJ (CSL) ANTI-D IMMUNO 2ML AMP BQ 122.3246 300MCG 2 2024-04-01 2026-03-31 0
40 3061B HYPERRHOD 300MCG INJ (GRB/COL) ANTI D IMMUNOG 300MCG VL BQ 250.09 300MCG 0 2022-04-01 2024-03-31 0