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 1121KB PMS-CHOLESTYRAMINE GRANUL (PMS/COL) 30X4G A 1.45 4G 60 2022-04-01 2024-03-31 6
41 1121KB PMS-CHOLESTYRAMINE 4G GRAN (PMS) 30X4G A 1.7669 4G 60 2024-04-01 2026-03-31 6
42 1121KE OLESTYR CHOLESTYRAMINE RESIN 4G GRAN (PMS) 30X4G A 1.63 4G 60 2026-04-01 No No 6