Displaying 1 - 6 of 6
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 61211 COMBIGAN 0.2% | 0.5% EYE DR (ALL/COL) BRIMONIDINE | TIMOLOL 5ML C 37.11 0.2%|0.5% 0 2022-04-01 2024-03-31 0
41 61211 COMBIGAN 0.2%|0.5% EYE DR (ALL) BRIMONIDINE|TIMOLOL (C) 5ML C 37.1051 0.2%|0.5% 1 2024-04-01 2026-03-31 6
40 6121C BRIMONIDINE | TIMOLOL 0.2% | 0.5% EYE DR (FSB/ATB 10ML A 8.70 0.2%|0.5% 1 2022-04-01 2024-03-31 6
41 6121C BRIMONIDINE|TIMOLO 0.2%|0.5% EYE DR (FSB 10ML A 7.5569 0.2%|0.5% 1 2024-04-01 2026-03-31 6
41 6121F AB PRESS PRESERVATIVE FREE 0.2%|0.5% EYE DR (RLP) BRIMONIDIN 10ML A 12.7218 0.2%|0.5% 1 2024-04-01 2026-03-31 6
41 6121G BRIMODIN PLUS 0.2%|0.5% EYE DR (INC) BRIMONIDINE|TIMOLOL 5ML A 5.3823 0.2%|0.5% 1 2024-04-01 2026-03-31 6