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 23132 MIOSTAT OCULAR 0.01% INJ (ALC/AHI) CARBACHOL 1.5ML VIAL BQ 59.94 0.01% 0 2022-04-01 2024-03-31 0
41 23132 MIOSTAT OCULAR 0.01% INJ (ALC) CARBACHOL 1.5ML VIAL BQ 55.182 0.01% 0 2024-04-01 2026-03-31 0