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| 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 | 6451AA | MAXITROL 1MG/ML | 3MG/ML | 10,000U EYE DR (NVS/COL) DEXAMETHASONE | NEOMYCIN | P More ... | 5ML | BQ | 32.08 | 1MG/ML|3MG/ML|10000U/ML | 0 | 2022-04-01 | 2024-03-31 | 6 | ||||
| 40 | 6451M | MAXISPORIN 1MG/ML | 3MG EYE DR (ASL/PHA) DEXAMETHASONE | NEOMYCIN | POLYMYXIN B | 5ML | BQ | 5.52 | 1MG/ML|3MG/ML|10000U/ML | 0 | 2022-04-01 | 2024-03-31 | 6 | ||||