Displaying 1 - 4 of 4
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
41 B0517 TIVICAY 50MG TAB (GSK) DOLUTEGRAVIR (C) 30'S C 26.0714 50MG 0 2024-04-01 2026-03-31 0
40 B051B DOLUTEGRAVIR 50MG TAB (APL/ATB) 30'S BL 0.36 50MG 0 2022-04-12 2024-03-31 Add to Contract as Cat B 0
41 B051D DOLUTEGRAVIR 50MG TAB (MCP) (BL) 30'S BL 0.309 50MG 0 2024-04-01 2024-12-27 0
41 B051D DOLUTEGRAVIR 50MG TAB (MCP) (BL) 30'S BL 0.351 50MG 0 2024-12-28 2026-03-31 0