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 36551 BRIXIA 0.05% EYE DR (LPO/COL) AZELASTINE 6ML A 6.25 0.05% 1 2022-04-01 2024-03-31 6
41 36551 BRIXIA 0.05% EYE DR (LPO) AZELASTINE 6ML A 6.8774 0.05% 1 2024-04-01 2026-03-31 6
42 36551 BRIXIA 0.05% EYE DR (LPO) AZELASTINE 6ML A 19.03 0.05% 1 2026-04-01 No No 6