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 72712 CHROMIUM 4 MCG/ML INJ (KWA/ATB) 10ML BQ 212.03 4MCG/ML 0 2022-04-01 2024-03-31 0
41 72712 CHROMIUM 4 MCG/ML INJ (KWA) 10ML BQ 180.2249 4MCG/ML 30 2024-04-01 2026-03-31 6
42 72713 CHROMIUM 4MCG/ML INJ (KWA) 10ML BQ 459.75 4MCG/ML 0 2026-04-01 No No Add to Contract 0