Displaying 1 - 3 of 3
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 2411B HYPROMELLOSE 0.3% EYE DR (ASL/PHA) 10ML A 3.75 0.3% 1 2022-04-01 2024-03-31 6
41 2411B HYPROMELLOSE 0.3% EYE DR (ASL) 10ML A 7.6385 0.3% 1 2024-04-01 2026-03-31 6
40 4701B REFRESH TEARS 0.5% EYE DR (ALL/COL) HYPROMELL 15ML C 11.55 0.5% 0 2022-04-01 2024-03-31 0