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 21617 HYALASE 1500IU INJ (CPP/COL) HYALURONIDASE 1500IU BQ 42.95 1500IU 0 2022-04-01 2024-03-31 0
40 2161D HYALURONIDASE 1500IU INJ (SLS/AHI) 10X10ML BQ 11.19 1500IU 0 2022-04-01 2024-03-31 0
41 2161D HYALURONIDASE 1500IU INJ (SLS (BQ) 10X10ML BQ 11.2049 1500IU 0 2024-04-01 2026-03-31 0
41 2161E HYALURONIDASE 1500IU INJ (KWA) (BQ) 20MG AMP BQ 10.7917 1500IU 0 2024-04-01 2026-03-31 0