Displaying 1 - 9 of 9
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 A3711 TRUSOPT 2% EYE DR (MSD/STO) DORZOLAMIDE 5ML C 28.54 2% 0 2022-04-01 2024-03-31 0
40 A3711 TRUSOPT 2% EYE DR (MSD/STO) DORZOLAMIDE (C) 5ML C 28.54 2% 0 2022-04-01 2022-12-31 Del 0
40 A3711 TRUSOPT 2% EYE DR (MSD/STO) DORZOLAMIDE (C) 5ML C 28.54 2% 2022-04-04 2022-12-31 No No Delete from contract 6
40 A3714 GLAUCOTENSIL D 2% EYE DR (LPO/COL) DORZOLAMID 5ML A 14.95 2% 1 2022-04-01 2024-03-31 6
41 A3714 GLAUCOTENSIL D 2% EYE DR (LPO) DORZOLAMI (C) 5ML C 16.4459 2% 1 2024-04-01 2026-03-31 6
40 A371H DORZOL 2% EYE DR (CIR/AHI) 5ML A 12.12 2% 1 2022-04-01 2024-03-31 6
41 A371H DORZOL 2% EYE DR (CIR) 5ML A 13.7275 2% 1 2024-04-01 2026-03-31 6
41 A371T ENDOR 2% EYE DR (SYP) DORZOLAMIDE 5ML A 12.6946 2% 1 2024-04-01 2026-03-31 6
41 A371W DORZOL 2% EYE DR (CIR) 10ML A 21.75 2% 1 2025-01-10 2026-03-31 6