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 A4921 ALPHAGAN P 0.1% EYE DR (ALL/COL) BRIMONIDINE 10ML C 45.94 0.1% 0 2022-04-01 2024-03-31 0
41 A4921 ALPHAGAN P 0.1% EYE DR (ALL) BRIMONIDINE (C) 10ML C 45.9397 0.1% 1 2024-04-01 2026-03-31 6
42 A4921 ALPHAGAN P 0.1% EYE DR (ALL) BRIMONIDINE 10ML C 45.94 0.1% 1 2026-04-01 No No 6
42 A492AA BRENT LS 0.1% EYE DR (HAN) BRIMONIDINE 10ML A 6.58 0.1% 1 2026-04-01 No No 6
42 A492AB BRIMONIDINE 0.1% EYE DR (FSB) 10ML A 2.17 0.1% 1 2026-04-01 No No Add to Contract as Cat A 6
40 A492B BRIMONIDINE 0.1% EYE DR (FSB/ATB) 10ML A 6.80 0.1% 1 2022-04-01 2024-03-31 6
41 A492B BRIMONIDINE 0.1% EYE DR (FSB) 10ML A 6.8502 0.1% 1 2024-04-01 2026-03-31 6
41 A492FT BRIMONIDINE 0.1% EYE DR (CHC) 10ML A 2.664 0.1% 1 2024-04-01 2026-03-31 6