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 6451L QUIDEX EYE DROP (LPO/COL) CIPRO/DEXAM 5ML B 8.15 0.3%|0.1% 0 2022-04-01 2024-03-31 6
41 6451L QUIDEX 0.3%|0.1% EYE DR (LPO) CIPROFLOXACIN|DEXAMETHASONE (BH) 5ML BH 8.9705 0.3%|0.1% 1 2024-04-01 2026-03-31 6
40 6451Y CIPRODEX 0.3% | 0.1% EAR DR (NVS/COL) CIPROFLOX 7.5ML C 29.68 0.3%|0.1% 0 2022-04-01 2024-03-31 0