Displaying 1 - 2 of 2
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 4141LB INDOMETHACIN MK 25MG CAP (BON/COL) INDOMETHAC 100'S BQ 0.08 25MG 0 2022-04-01 2024-03-31 6
41 4141RN INDOMETHACIN 25MG CAP (GPC) (BQ) 1000'S BQ 0.0841 25MG 0 2024-04-01 2026-03-31 0