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 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