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 36223 PROLOPA 50MG | 200MG TAB (ROC/AHI) BENSERAZIDE | 30'S A 1.36 50MG|200MG 240 2022-04-01 2024-03-31 6
41 36223 PROLOPA 50MG|200MG TAB (ROC) BENSERAZIDE|LEVODOPA 30'S A 1.005 50MG|200MG 240 2024-09-27 2026-03-31 6
42 3622V BENKINSON 50MG|200MG CAP (INC) BENSERAZIDE|LEVODOPA 20'S A 0.79 50MG|200MG 240 2026-04-01 No No 6