Displaying 1 - 9 of 9
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 2683AJ HYDROCORTISONE 1% CR (KWA/ATB) 15G A 3.26 1% 2 2022-04-01 2022-09-30 0
41 2683AJ HYDROCORTISONE 1% CR (KWA) 15G A 3.561 1% 2 2024-04-01 2026-03-31 0
41 2683AS MECORT 1% CR (MPI) HYDROCORTISONE 15G A 2.9086 1% 2 2024-04-01 2026-03-31 0
40 2683L HYDROSONE 1% CR (CAR/COL) HYDROCORTISONE 15G A 5.16 1% 2 2022-04-01 2024-03-31 0
41 2683L HYDROSONE 1% CR (CAR) HYDROCORTISONE (C) 15G C 5.5997 1% 2 2024-04-01 2026-03-31 0
41 26843 HYDROCORTISONE 1% OINT (GPC) 15G A 3.1261 1% 2 2024-04-01 2026-03-31 0
40 26848 HYDROCORTISONE 1% OINT (KWA/ATB) 15G A 3.26 1% 2 2022-04-01 2022-09-30 0
41 26848 HYDROCORTISONE 1% OINT (KWA) 15G A 3.561 1% 2 2024-04-01 2026-03-31 0
40 2684L HYDROSONE 1% OINT (CAR/COL) HYDROCORTISONE 15G A 5.16 1% 2 2022-04-01 2024-03-31 0