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 22411 FRAMOPTIC D EYE DR (ASL/PHA) DEX/FRAMY/GRAMI 10ML C 8.07 0.05%|0.5%|0.005% 0 2022-04-01 2024-03-31 0
41 22411 FRAMOPTIC D 0.05%|0.5%|0.005% EYE/EAR DR (ASL) DEXAMETHASONE (C) 10ML C 12.7218 0.05%|0.5%|0.005% 1 2024-04-01 2026-03-31 0
42 22411 FRAMOPTIC D 0.05%|0.5%|0.005% EYE/EAR DR (ASL) DEXAMETHASONE 10ML C 11.55 0.05%|0.5%|0.005% 0 2026-04-01 No No 0