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 6734AC GADOVIST 604MG/ML INJ (BSP/AHI) GADOBUTROL 7.5ML BQ 135.43 604MG/ML 0 2022-04-01 2024-03-31 0
41 6734AC GADOVIST 604MG/ML INJ (BSP) GADOBUT (C) 7.5ML C 135.7259 604MG/ML 0 2024-04-01 2026-03-31 0
40 6734Z GADOVIST 604MG/ML INJ (BSP/COL) GADOBUTROL 7.5ML BQ 135.43 604MG/ML 0 2022-04-01 2024-03-31 0
41 6734Z GADOVIST 604MG/ML INJ (BSP) GADOBUTROL (C) 7.5ML C 135.7259 604MG/ML 0 2024-04-01 2026-03-31 0