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
41 6451AE 4-QUIN D 0.1%|0.5% EYE DR (HAN) DEXAMETHASONE|MOXIFLOXACIN (BQ) 5ML BQ 3.9416 0.1%|0.5% 1 2024-04-01 2026-03-31 6
40 6451Z VIGADEXA 0.1% | 0.5% EYE DR (NVS/COL) DEXAMETHA 5ML BQ 20.39 0.1%|0.5% 1 2022-04-01 2024-03-31 6
41 6451Z VIGADEXA 0.1%|0.5% EYE DR (NVS) DEXAMETHASONE|MOXIFLOXACIN (C) 5ML C 20.3874 0.1%|0.5% 1 2024-04-01 2026-03-31 6