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 5281BK GATIF FORTE 0.3% DROPS (LPO/COL) GATIFLOXACIN 5ML C 9.51 0.3% 0 2022-04-01 2024-03-31 0
41 5281BK GATIF FORTE 0.3% EYE DR (LPO) GATIFLOXACIN (C) 5ML C 10.4655 0.3% 0 2024-04-01 2026-03-31 0
40 5281CC APO-GATIFLOXACIN 0.3% EYE DR (APO/COL) 5ML BQ 9.51 0.3% 1 2022-04-01 2024-03-31 6