Displaying 1 - 4 of 4
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 6581R ZOLADEX 10.8MG KIT (AZN/COL) GOSERELIN 10.8MG KIT C 611.62 10.8MG 0 2022-04-01 2024-03-31 0
41 6581R ZOLADEX 10.8MG KIT (AZN) GOSERELIN (C) 10.8MG KIT C 611.6229 10.8MG 0 2024-04-01 2026-03-31 0
40 6581S ZOLADEX 3.6MG KIT (AZN/COL) GOSERELIN 3.6MG KIT C 205.51 3.6MG 0 2022-04-01 2024-03-31 0
41 6581S ZOLADEX 3.6MG KIT (AZN) GOSERELIN (C) 3.6MG KIT C 205.5053 3.6MG 0 2024-04-01 2026-03-31 0