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 03248 GENOPTIC 0.3% EYE DR (ASL/PHA) GENTAMICIN 5ML BQ 4.08 0.3% 1 2022-04-01 2024-03-31 6
41 03248 GENOPTIC 0.3% EYE DR (ASL) GENTAMICIN 5ML BQ 7.3395 0.3% 1 2024-04-01 2026-03-31 0
40 03267 GENTAMICIN 0.3% EYE OINT (AKI/AHI) 3.5G C 156.87 0.3% 0 2022-04-01 2024-03-31 0