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 4331L AFINITOR 5MG TAB (NVS/COL) EVEROLIMUS 30'S C 181.22 5MG 0 2022-04-01 2024-03-31 0
41 4331L AFINITOR 5MG TAB (NVS) EVEROLIMUS (C) 30'S C 172.1605 5MG 0 2024-04-01 2026-03-31 0
40 4331M AFINITOR 10MG TAB (NVS/COL) EVEROLIMUS 30'S C 516.34 10MG 0 2022-04-01 2024-03-31 0
41 4331M AFINITOR 10MG TAB (NVS) EVEROLIMUS (C) 30'S C 344.321 10MG 0 2024-04-01 2026-03-31 0