Displaying 1 - 6 of 6
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
42 46319 DESIRE 82G GEL (HEA) GLYCERINE 82G B 3.23 1 2026-04-01 No No Price Change 0
42 4631AC LUBRI-EZE GEL TUBE (INF) LUBRICATING JELLY 30G B 2.69 1% 1 2026-04-01 No No 0
42 4631AD DESIRE JELLY (HEA) LUBRICATING JELLY 82G B 3.23 0 2026-04-01 No No Add to Contract as Cat B 0
42 4631AE DESIRE GEL (HEA) GLYCERINE 82G B 3.23 0 2026-04-01 No No Add to Contract as Cat B 0
40 4631B AQUAGEL (ECO/COL) LUBRICATING JELLY 82G B 3.29 0 2022-04-01 2024-03-31 0
40 4631Y DESIRE JELLY (HEA/RXP) LUBRICATING JELLY 82G B 3.26 0 2022-04-01 2024-03-31 0