Displaying 1 - 5 of 5
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 77317 APO-HYDROXYQUINE 200MG TAB (APO/COL) 100'S A 0.35 200MG 120 2022-04-01 2024-03-31 6
42 77317 APO-HYDROXYQUINE 200MG TAB (APO) 100'S A 0.21 200MG 120 2026-04-01 No No 6
41 7731B HCQS 200MG TAB (IPC) HYDROXYCHLOROQUINE 100'S A 0.0652 200MG 120 2024-04-01 2026-03-31 6
40 7731J HCQS 200MG TAB (IPC/ATB) HYDROXYCHLOROQUINE 6X10 A 0.22 200MG 120 2022-04-01 2024-03-31 6
42 7731R HSQUIN 200MG TAB (JLP) HYDROXYCHLOROQUINE 100'S A 0.20 200MG 120 2026-04-01 No No 6