Displaying 1 - 7 of 7
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 A2712 FML LIQUIFILM 0.1% EYE DR (ALL/COL) FLUOROMET 5ML C 17.67 0.1% 0 2022-04-01 2024-03-31 0
41 A2712 FML LIQUIFILM 0.1% EYE DR (ALL) FLUOROME (C) 5ML C 17.6691 0.1% 0 2024-04-01 2026-03-31 0
42 A2712 FML LIQUIFILM 0.1% EYE DR (ALL) FLUOROME 5ML C 17.67 0.1% 0 2026-04-01 No No 0
40 A271A AFM 0.1% EYE DR (ARP/AHI) FLUOROMETHOLONE 5ML BQ 6.58 0.1% 0 2022-04-01 2024-03-31 6
41 A271A AFM 0.1% EYE DR (ARP) FLUOROMETHOLONE (BQ) 5ML BQ 7.421 0.1% 0 2024-04-01 2026-03-31 0
41 A271C E-FLOW 0.1% EYE DR (SHC) FLUOROMETHOLONE (BQ) 5ML BQ 4.0775 0.1% 0 2024-04-01 2026-03-31 0
42 A271C E-FLOW 0.1% EYE DR (SHC) FLUOROMETHOLONE 5ML BQ 4.29 0.1% 0 2026-04-01 No No 0