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 64231 RESTASIS 0.05% EYE (ALL/COL) CYCLOSPORIN 30X0.4ML C 2.27 0.05% 0 2022-04-01 2024-03-31 0
41 64231 RESTASIS 0.05% EYE DR (ALL) CYCLOSP (C) 30X0.4ML C 2.2653 0.05% 0 2024-04-01 2026-03-31 0
41 64235 CLOSPORIL 0.1% EYE DR (LPO) CYCLOSPORIN (C) 5ML C 10.0578 0.1% 0 2024-04-01 2026-03-31 0