Displaying 1 - 6 of 6
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 7111G CISPA 1MG/ML INJ (INP/AHI) CISPLATIN 50ML VIAL BQ 19.06 1MG/ML 0 2022-04-01 2024-03-31 0
40 7111R CISPLATIN 1MG/ML INJ (DIL/AHI) 50ML BQ 18.02 1MG/ML 0 2022-04-01 2024-03-31 0
41 7111S CISPLATIN 1MG/ML INJ (FSB) (BQ) 50ML VIAL BQ 15.0051 1MG/ML 50 2024-04-01 2026-03-31 0
41 7111W CISPLATIN 1MG/ML INJ (KWA) (BQ) 50ML BQ 16.3371 1MG/ML 50 2024-04-01 2026-03-31 0
41 71123 CISPLATIN 1MG/ML INJ (KWA) (BQ) 100ML BQ 27.591 1MG/ML 0 2024-04-01 2026-03-31 0
41 71124 CISPLATIN 1MG/ML INJ (VEN) (BQ) 100ML BQ 29.1948 1MG/ML 0 2024-04-01 2026-03-31 0