Displaying 1 - 6 of 6
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 08011 DOPAMINE 40MG/ML INJ (RTM) (B) 10X5ML B 11.4496 40MG/ML 0 2024-04-01 2026-03-31 0
40 0801P DOPAMINE 40MG/ML INJ (SLS/AHI) 25X5ML B 1.42 40MG/ML 0 2022-04-01 2024-03-31 0
41 0801P DOPAMINE 40MG/ML INJ (SLS) (B) 25X5ML B 1.6147 40MG/ML 0 2024-04-01 2026-03-31 0
42 0801P DOPAMINE 40MG/ML INJ (SLS) 25X5ML BQ 2.06 40MG/ML 0 2026-04-01 No No 0
40 0801U DOPAMINE 40MG/ML INJ (MON/PHA) 5X5ML B 1.60 40MG/ML 0 2022-04-01 2024-03-31 0
41 0801V DOPAMINE 40MG/ML INJ (STP) (B) 10X5ML B 7.3395 40MG/ML 0 2024-04-01 2026-03-31 0