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 0472A DAPSONE 100MG TAB (LDP/AHI) 100'S A 0.33 100MG 90 2022-04-01 2024-03-31 6
41 0472A DAPSONE 100MG TAB (LDP) 100'S A 0.3262 100MG 90 2024-04-01 2026-03-31 6
41 0472J DAPSONE 100MG TAB (GSK) 1000'S A 0.1414 100MG 90 2024-07-05 2026-03-31 6