Displaying 1 - 8 of 8
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 25713 BETHASONE 0.1% OINT (GPC/ATB) BETAMETHASONE 15G A 1.41 0.1% 2 2022-04-01 2024-03-31 0
40 25718 BETACORT 0.1% OINT (CAR/COL) BETAMETHASONE 15G C 4.62 1MG/G 0 2022-04-01 2024-03-31 0
41 25718 BETACORT 0.1% OINT (CAR) BETAMETHASONE 15G A 4.6212 1MG/G 2 2024-04-01 2026-03-31 0
40 25737 BETACORT 0.1% CR (CAR/COL) BETAMETHASONE 15G A 4.62 0.1% 2 2022-04-01 2024-03-31 0
41 25737 BETACORT 0.1% CR (CAR) BETAMETHASONE (C) 15G C 4.6212 0.1% 2 2024-04-01 2026-03-31 0
41 2573E BETAMETHASONE 0.1% CR (GPC) 15G A 2.3378 0.1% 2 2024-04-01 2026-03-31 0
40 2573V BETNOVATE 0.1% CR (GSK/COL) BETAMETHASONE 30G C 14.57 0.1% 0 2022-04-01 2024-03-31 0
41 2573V BETNOVATE 0.1% CR (GSK) BETAMETHASONE (C) 30G C 15.6847 0.1% 2 2024-04-01 2026-03-31 0