Displaying 1 - 3 of 3
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 5581V HISTAL DM SYR (CAR/COL) GUAIFE/DEXTRO 2 LITRES B 0.04 3MG/ML|20MG/ML 0 2022-05-06 2024-03-31 Add to Contract as Cat B 0
41 5581V HISTAL DM SYR (CAR) GUAIFE/DEXTRO (B) 2 LITRES B 0.0462 3MG/ML|20MG/ML 0 2024-04-01 2026-03-31 0
42 5581V HISTAL DM 3MG/ML|20MG/ML SYR (CAR) DEXTROMETHORPHAN|GUAIFENE 2 LITRES B 0.05 3MG/ML|20MG/ML 100 2026-04-01 No No 0