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 3081Y IMMUNOREL 5% INJ (RLS/AHI) IMMUNOGLOBULIN 100ML BQ 657.29 5% 0 2022-04-01 2024-03-31 0
41 3081Y IMMUNOREL 5% INJ (RLS) IMMUNOGLOBUL (BQ) 100ML BQ 807.3422 5% 0 2024-04-01 2026-03-31 0
42 3081Y IMMUNOREL 5% INJ (RLS) IMMUNOGLOBUL 100ML BQ 807.34 5% 0 2026-04-01 No No 0
40 30827 PRIVIGEN 10% INJ (CSL/AHI) IMMUNOGLOBULIN 50ML BQ 951.41 10% 0 2022-04-01 2024-03-31 0
41 30827 PRIVIGEN 10% INJ (CSL) IMMUNOGLOBULIN (BQ) 50ML BQ 883.4553 10% 50 2024-04-01 2026-03-31 0
40 30828 PRIVIGEN 10% INJ (CSL/AHI) IMMUNOGLOBULIN 100ML BQ 1,413.53 10% 0 2022-04-01 2022-05-10 0
41 30828 PRIVIGEN 10% INJ (CSL) IMMUNOGLOBULIN (BQ) 100ML BQ 1766.9106 10% 50 2024-04-01 2026-03-31 0
42 3082B IMMUNOGLOBULIN 10% INJ (INP) 50ML VIAL BQ 538.83 10% 0 2026-04-01 No No 0
42 3082C NORMOGLOBIN 10% INJ (INC) IMMUNOGLOBULIN HUMAN 50ML VIAL BQ 615.86 10% 0 2026-04-01 No No 0