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 2662E SONEXA 0.1% EYE DR (ARP/AHI) DEXAMETHASONE 5ML B 4.57 0.1% 0 2022-04-01 2024-03-31 6
41 2662F MONODEXA 0.1% EYE DR (SHC) DEXAMETHASONE (B) 5ML B 4.0775 0.1% 1 2024-04-01 2026-03-31 6