Displaying 1 - 5 of 5
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 10718 TOLOXIN 0.125MG TAB (PMS/COL) 250'S A 0.08 0.125MG 60 2022-04-01 2024-03-31 6
40 1072Y DIXIN 0.25MG TAB (SLS/AHI) DIGOXIN 200'S A 0.08 0.25MG 60 2022-04-01 2024-03-31 6
40 10739 TOLOXIN 50MCG/ML SOLN (PMS/COL) 115ML A 0.43 50MCG/ML 120 2022-04-01 2024-03-31 6
40 10745 DIGOXIN 0.25MG/ML INJ (SLS/AHI) 10X2ML B 1.94 0.25MG/ML 0 2022-04-01 2024-03-31 0
40 1074S DIGOXIN 0.25MG/ML INJ (LDP/AHI) 10X2ML B 1.92 0.25MG/ML 0 2022-04-01 2024-03-31 0