Displaying 1 - 4 of 4
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
42 2662E SONEXA 0.1% EYE DR (ARP) DEXAMETHAS 5ML B 4.05 0.1% 1 2026-04-01 No No 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
42 2662F MONODEXA 0.1% EYE DR (SHC) DEXAMETHASONE 5ML B 4.08 0.1% 1 2026-04-01 No No 6