Displaying 1 - 13 of 13
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 77013 GOTABIOTIC F 0.1%|0.3% EYE DR (LPO) DEXAMETHASONE|TOBRAMYCIN (C) 5ML C 7.5841 0.1%|0.3% 0 2024-04-01 2026-03-31 0
40 7701D DEXAMETHASONE/TOBRAMYCIN EYE DR (CIR/AHI) 5ML BQ 5.16 0.1%|0.3% 0 2022-04-01 2024-03-31 6
41 7701D DEXAMETHASONE|TOBRAMYCIN 0.1%|0.3% EYE DR (CIR) (BQ) 5ML BQ 5.1648 0.1%|0.3% 0 2024-04-01 2026-03-31 0
40 7701E DEXAMETHASONE/TOBRAMYCIN EYE DR (KWA/ATB) 5ML BQ 5.41 0.1%|0.3% 0 2022-04-01 2024-03-31 6
40 7701H TOBRADEX 0.1% | 0.3% EYE DR (NVS/COL) DEXAMETHA 5ML C 21.09 0.1%|0.3% 0 2022-04-01 2024-03-31 0
41 7701H TOBRADEX 0.1%|0.3% EYE DR (NVS) DEXAMETHASONE|TOBRAMYCIN (C) 5ML C 23.7853 0.1%|0.3% 0 2024-04-01 2026-03-31 0
41 7701J TOBAGRAM D 0.1%|0.3% EYE DR (HAN) DEXAMETHASONE|TOBRAMYCIN (BQ) 10ML BQ 4.2678 0.1%|0.3% 0 2024-04-01 2026-03-31 0
40 77022 GOTABIOTIC F EYE OINT (LPO/COL) DEXAMETHASON 3.5G C 11.69 0.1%|0.3% 0 2022-04-01 2024-03-31 0
41 77022 GOTABIOTIC F EYE OINT (LPO) DEXAMETHASO (C) 3.5G C 12.8577 0.1%|0.3% 0 2024-04-01 2026-03-31 0
40 77025 T-MYCIN PLUS EYE OINT (ARP/AHI) DEXAMETHASON 3.5G BQ 7.12 0.1%|0.3% 0 2022-04-01 2024-03-31 6
40 77027 TOBRADEX 0.1% | 0.3% EYE OINT (NVS/COL) DEXAMET 3.5G C 23.73 0.1%|0.3% 0 2022-04-01 2024-03-31 0
41 77027 TOBRADEX 0.1%|0.3% EYE OINT (NVS) D (C) 3.5G C 23.731 0.1%|0.3% 1 2024-04-01 2026-03-31 6
41 77028 TOBAGRAM D 0.1%|0.3% EYE DR (SPC) DEXAMETHASONE|TOBRAMYCIN (BQ) 5G BQ 4.2678 0.1%|0.3% 1 2024-04-01 2026-03-31 6