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 5841A APO-CAPTO 25MG TAB (APO/COL) 100'S A 0.10 25MG 180 2022-04-01 2024-03-31 6
41 5841V CAPTOPRIL 25MG (EDK) CAPTOPRIL 100'S A 0.0758 25MG 180 2024-04-01 2026-03-31 6
41 58429 APO-CAPTO 50MG TAB (APO) 100'S A 0.1112 50MG 90 2024-04-01 2026-03-31 6
40 5842A APO-CAPTO 50MG TAB (APO/COL) 100'S A 0.11 50MG 90 2022-04-01 2024-03-31 6