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 A371E BRIZOTEN 1% EYE DR (LPO/COL) BRINZOLAMIDE 5ML A 19.03 1% 1 2022-04-01 2024-03-31 6
41 A371R AZOPT 1% EYE DR (NVS) BRINZOLAMIDE 10ML A 29.222 1% 1 2024-04-01 2024-06-17 6