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
42 5261AC CALTROL 0.25MCG CAP (JLP) CALCITRIOL 100'S A 0.18 0.25MCG 120 2026-04-01 No No 6
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