Displaying 1 - 11 of 11
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 5851AC DIVENIS 450MG | 50MG TAB (BCH/AHI) DIOSMIN | HESP 60'S C 0.43 450MG|50MG 0 2022-04-01 2024-03-31 0
41 5851AC DIVENIS 450MG|50MG TAB (BCH) DIOSMI (C) 60'S C 0.4757 450MG|50MG 0 2024-04-01 2026-03-31 0
41 5851AE FLOMACOR 900MG|100MG TAB (MPI) DIOSMIN|HESPERIDIN (C) 3X10 C 0.8137 900MG|100MG 0 2024-04-01 2026-03-31 0
40 5851R DAFLON 450MG | 50MG TAB (SER/STO) DIOSMIN | HESPERIDIN 60'S C 0.56 450MG|50MG 0 2022-04-01 2024-03-31 0
41 5851R DAFLON 450MG|50MG TAB (SER) DIOSMIN|HESPERIDIN (C) 60'S C 0.5577 450MG|50MG 0 2024-04-01 2026-03-31 0
40 5851S DAFLON 450MG | 50MG TAB (SER/COL) DIOSMIN | HESPERIDIN 60'S C 0.56 450MG|50MG 0 2022-04-01 2024-03-31 0
41 5851S DAFLON 450MG|50MG TAB (SER) DIOSMIN|HESPERIDIN (C) 60'S C 0.5577 450MG|50MG 0 2024-04-01 2026-03-31 0
40 5851V DAFLON 900MG | 100MG TAB (SER/STO) DISOMIN | HESPERIDIN 30'S C 1.12 900MG|100MG 0 2022-04-01 2024-03-31 0
41 5851V DAFLON 900MG|100MG TAB (SER) DISOMIN|HESPERIDIN (C) 30'S C 1.1154 900MG|100MG 0 2024-04-01 2026-03-31 0
40 5851W DAFLON 900MG | 100MG TAB (SER/COL) DISOMIN | HESPERIDIN 30'S C 1.12 900MG|100MG 0 2022-04-01 2024-03-31 0
41 5851W DAFLON 900MG|100MG TAB (SER) DISOMIN|HESPERIDIN (C) 30'S C 1.1154 900MG|100MG 0 2024-04-01 2026-03-31 0