Displaying 1 - 2 of 2
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 B2212 APIDRA SOLOSTAR 100IU/ML INJ (SFA/COL) GLULIS 3ML VIAL A 19.71 100IU/ML 4 2022-04-01 2024-03-31 6
40 B2213 APIDRA 100U/ML INJ (SFA/COL) GLULISINE 10ML VIAL A 54.37 100U/ML 5 2022-04-01 2024-03-31 6