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
40 3653AJ RYNASE AQ 64MCG NASAL SP (CAR/COL) BUDESONIDE 240 DOSES A 15.98 64MCG 1 2022-04-01 2024-03-31 6
41 3653AJ RYNASE AQ 64MCG NASAL SP (CAR) BUDESONID 240 DOSES A 16.2556 64MCG 1 2024-04-01 2026-03-31 6
40 3653BK RYNASE AQ 32MCG NASAL SP (CAR/COL) BUDESONIDE 120 DOSES C 8.15 32MCG 0 2022-04-01 2024-03-31 0
41 3653BK RYNASE AQ 32MCG NASAL SP (CAR) BUDESONID (C) 120 DOSES C 8.4268 32MCG 1 2024-04-01 2026-03-31 6