Displaying 1 - 14 of 14
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 73619 RECORMON PREFILL 4000U INJ (ROC/AHI) EPOIETIN 6X4000U BQ 36.24 4000U 0 2022-04-01 2024-03-31 0
41 73619 RECORMON PREFILL 4000U INJ (ROC) EPOIE B (BQ) 6X4000U BQ 36.2353 4000U 7 2024-04-01 2026-03-31 0
40 7361E MIRCERA PREFILL 100MCG INJ (ROC/AHI) EPOIETIN 100MCG SYN BQ 342.51 100MCG 0 2022-04-01 2024-03-31 0
41 7361E MIRCERA PREFILL 100MCG INJ (ROC) EPOIETI (BQ) 100MCG SYN BQ 342.5088 100MCG 7 2024-04-01 2026-03-31 0
42 7361E MIRCERA PREFILL 100MCG INJ (ROC) EPOIETI 100MCG SYN B 342.51 100MCG 7 2026-04-01 No No 0
40 7362B MIRCERA PREFILL 75MCG INJ (ROC/AHI) EPOIETIN BETA 75MCG SYRN BQ 244.65 75MCG 0 2022-04-01 2024-03-31 0
41 7362B MIRCERA PREFILL 75MCG INJ (ROC) EPOIETIN BETA (BQ) 75MCG SYRN BQ 244.6492 75MCG 7 2024-04-01 2026-03-31 6
42 7362B MIRCERA PREFILL 75MCG INJ (ROC) EPOIETIN BETA 75MCG SYRN B 244.65 75MCG 7 2026-04-01 No No 6
40 7362F MIRCERA PREFILL 50MCG INJ (ROC/AHI) EPOIETIN 50MCG SYRN BQ 171.25 50MCG 0 2022-04-01 2024-03-31 0
41 7362F MIRCERA PREFILL 50MCG INJ (ROC) EPOIETIN (BQ) 50MCG SYRN BQ 171.2544 50MCG 7 2024-04-01 2026-03-31 0
42 7362F MIRCERA PREFILL 50MCG INJ (ROC) EPOIETIN 50MCG SYRN B 171.25 50MCG 7 2026-04-01 No No 0
40 7363A MIRCERA PREFILL 200MCG INJ (ROC/AHI) EPOIETIN 200MCG SYN BQ 685.02 200MCG 0 2022-04-01 2024-03-31 0
41 7363A MIRCERA PREFILL 200MCG INJ (ROC) EPOIETI 200MCG SYN BQ 685.0176 200MCG 7 2024-04-01 2026-03-31 0
42 7363A MIRCERA PREFILL 200MCG INJ (ROC) EPOIETI 200MCG SYN B 685.02 200MCG 7 2026-04-01 No No 0