Displaying 1 - 3 of 3
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 26719 FLUDROCORTISONE 0.1MG TAB (SLS/AHI) 200'S A 0.81 0.1MG 60 2022-04-01 2024-03-31 6
41 2671A FLUDROCORTISONE 0.1MG TAB (SLS) 200'S A 0.8372 0.1MG 60 2024-04-01 2026-03-31 6
42 2671A FLUDROCORTISONE 0.1MG TAB (SLS) 200'S A 0.84 0.1MG 60 2026-04-01 No No 6