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 B2244 LANTUS SOLOSTAR 100U/ML INJ (SFA/COL) GLARGIN 3ML VIAL A 27.18 100U/ML 5 2022-04-01 2024-03-31 6
40 B2246 LANTUS 100U/ML INJ (SFA/COL) GLARGINE 10ML VIAL A 67.96 100U/ML 5 2022-04-01 2024-03-31 6
40 B2248 TOUJEO 450IU INJ (SFA/COL) GLARGINE 1.5ML VIAL C 68.09 300U/ML 0 2022-04-01 2024-03-31 0