Displaying 1 - 2 of 2
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 A322FZ PRISTIQ 50MG TAB (PFI/STO) DESVENLAFAXINE 28'S C 3.41 50MG 0 2022-04-01 2024-03-31 0
41 A322FZ PRISTIQ 50MG TAB (PFI) DESVENLAFAXINE (C) 28'S C 3.4445 50MG 0 2024-04-01 2026-03-31 0