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
40 12011 COSOPT 2% | 0.5% EYE DR (MSD/STO) DORZOLAMIDE | TIMOLOL 5ML C 24.76 2%|0.5% 0 2022-04-01 2024-03-31 0
40 12011 COSOPT 2%|0.5% EYE DR (MSD/STO) DORZOLA (C) 5ML C 24.76 2%|0.5% 2022-04-01 2022-12-31 No No Delete from contract 6
40 12012 GLAUCOTENSIL TD 2% | 0.5% EYE DR (LPO/COL) DORZ 5ML A 12.23 2%|0.5% 1 2022-04-01 2024-03-31 6
41 12012 GLAUCOTENSIL TD 2%|0.5% EYE DR (LPO) DORZOLAMIDE|TIMOLOL 5ML A 13.4557 2%|0.5% 1 2024-04-01 2026-03-31 6
40 1201Q DORZOL-T 2% | 0.5% EYE DR (CIR/AHI) DORZOLAMIDE 10ML A 21.61 2%|0.5% 1 2022-04-01 2024-03-31 6
41 1201S ENDOR PLUS 2%|0.5% EYE DR (SYP) DORZOLAMIDE|TIMOLOL 5ML A 11.6888 2%|0.5% 1 2024-04-01 2026-03-31 6