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 4145AF DICLOFENAC SOD 0.1% EYE DR (FSB/ATB) DICLOFEN 5ML A 5.30 0.1% 1 2022-04-01 2024-03-31 6
41 4145AF DICLOFENAC SODIUM 0.1% EYE DR (FSB) 5ML A 3.0445 0.1% 1 2024-04-01 2026-03-31 6