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 2401A IDEW-FLO 1MG STRP (ENT/PHA) FLUORESCEIN 100'S B 20.12 1MG 0 2022-04-01 2024-03-31 0
41 2401A IDEW-FLO 1MG STRP (ENT) FLUORESCEIN 100'S B 0.227 1MG 0 2024-04-01 2026-03-31 0
40 24041 FLUORESCEIN MINIMS 1% EYE/EAR DR (CAM/STO) 20X0.5ML B 4.74 1% 0 2022-04-01 2024-03-31 0
41 24042 FLUORESCEIN MINIMS 1% EYE DR (CAM) (B) 20X0.5ML B 4.1264 1% 0 2024-04-01 2026-03-31 0