Displaying 1 - 2 of 2
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 77116 AFM-T 1MG | 0.25MG EYE DR (ARP/AHI) FLUOROMETHOLONE | TETRAHYDROZOLINE 5ML BQ 13.89 1MG/ML|0.25MG/ML 0 2022-04-01 2024-03-31 6
41 77116 AFM-T 1MG|0.25MG EYE DR (ARP) FLUOROMETHOLONE|TETRAHYDROZOLI 5ML BQ 13.8906 1MG/ML|0.25MG/ML 2 2024-04-01 2026-03-31 6