Displaying 1 - 2 of 2
| 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 | A681GW | BIKTARVY 50MG | 200MG | 25MG TAB (GIL/COL) BICTEGRAVIR | EMTRICITABINE | TENOFOV More ... | 30'S | BL | 10.73 | 50MG|200MG|25MG | 0 | 2022-04-01 | 2024-03-31 | 0 | ||||
| 41 | A681GW | BIKTARVY 50MG|200MG|25MG TAB (GIL) BICTEGRAVIR|EMTRICITABINE (BL) | 30'S | BL | 9.6944 | 50MG|200MG|25MG | 60 | 2024-04-01 | 2026-03-31 | 6 | ||||