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
40 4021E ERYTHROMYCIN 500MG INJ (CIR/AHI) 500MG VIAL BQ 28.92 500MG 0 2022-04-01 2024-03-31 6
41 4021E ERYTHROMYCIN 500MG INJ (CIR) (BQ) 500MG VIAL BQ 28.923 500MG 56 2024-04-01 2026-03-31 1
42 4021E ERYTHROMYCIN 500MG INJ (CIR) 500MG VIAL BQ 29.79 500MG 56 2026-04-01 No No 0
41 4021P ERYTHROMYCIN 500MG INJ (KWA) ERYTHR (BQ) 500MG VIAL BQ 26.3406 500MG 56 2024-04-01 2026-03-31 1