Displaying 1 - 4 of 4
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
41 A531AW BIMATOPROST 0.01% EYE DR (CIR) 2.5ML A 9.24 0.01% 1 2024-07-23 2025-01-16 6
41 A531AW BIMATOPROST 0.01% EYE DR (CIR) 2.5ML A 12.83 0.01% 1 2025-01-17 2026-03-31 Yes 6
40 A531J LUMIGAN 0.01% EYE DR (ALL/COL) BIMATOPROST 2.5ML C 41.32 0.01% 0 2022-04-01 2024-03-31 0
41 A531J LUMIGAN 0.01% EYE DR (ALL) BIMATOPROST (C) 2.5ML C 41.3185 0.01% 1 2024-04-01 2026-03-31 Yes 6