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 4701AQ TEARS NATURALE II 0.1% | 0.3% EYE DR (ALC/AHI) DEXTRAN | HYPROMELLOSE 15ML C 12.67 1MG/ML|3MG/ML 0 2022-04-01 2024-03-31 0
41 4701AQ TEARS NATURALE II 0.1%|0.3% EYE DR (ALC) DEXTRAN|HYPROMELLOS (C) 15ML C 17.8866 1MG/ML|3MG/ML 1 2024-04-01 2026-03-31 6