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 9991AZ GLYCERINE & MAG SULPH PASTE (HAL/COL) 50G B 6.14 0 2022-04-01 2024-03-31 0
41 9991AZ GLYCERINE & MAG SULPH PASTE (HAL) (B) 50G B 6.7143 1 2024-04-01 2026-03-31 0