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 31819 BENZYLBENZOATE 25% EMULSION (GPC/ATB) 120ML A 0.03 25% 100 2022-04-01 2024-03-31 6
41 31819 BENZYLBENZOATE 25% EMULSION (GPC) 120ML A 0.0748 25% 100 2024-04-01 2026-03-31 6
40 3181D BENZYLBENZOATE 25% EMUL (PDN/PHA) 1 LITRE A 0.02 25% 100 2022-04-01 2024-03-31 6