Displaying 1 - 3 of 3
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 5261W CALCITRIOL 0.25MCG CAP (FSB/ATB) 100'S A 0.16 0.25MCG 120 2022-04-01 2024-03-31 6
41 5261Y CALCITRIOL 0.25MCG CAP (KWA) 100'S A 0.1386 0.25MCG 120 2024-04-01 2026-03-31 6
41 5261Z CALCITRIOL 0.25MCG CAP (MCP) 5X10 A 0.2848 0.25MCG 120 2024-04-01 2026-03-31 6