Displaying 1 - 8 of 8
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 07211 CALCORT 6MG TAB (SFA/COL) DEFLAZACORT 10'S C 2.72 6MG 0 2022-04-01 2024-03-31 0
40 07219 FLACORT 6MG TAB (ARP/AHI) DEFLAZACORT 3X10 C 0.30 6MG 0 2022-04-01 2024-03-31 0
41 0721B DEFLARIN 6MG TAB (EXE) DEFLAZACORT (C) 10'S C 0.2936 6MG 0 2024-04-01 2026-03-31 0
42 0721E DEFJOHN 6MG TAB (JLP) DEFLAZACORT 10X10 C 0.21 6MG 0 2026-04-01 No No 0
40 07221 CALCORT 30MG TAB (SFA/COL) DEFLAZACORT 10'S C 3.81 30MG 0 2022-04-01 2024-03-31 0
40 07229 AVEXA 30MG TAB (MBL/AHI) DEFLAZACORT 1X10 C 2.90 30MG 0 2022-04-01 2024-03-31 Add to Contract as Cat C 0
41 0722B DEFLAZACORT 30MG TAB (KWA) (C) 10'S C 1.3864 30MG 0 2024-04-01 2026-03-31 0
42 0722C DEFJOHN 30MG TAB (JLP) DEFLAZACORT 10X10 C 0.11 30MG 0 2026-04-01 No No 0