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 41817 REMICADE 100MG INJ (JAC/STO) INFLIXIMAB 20ML VIAL C 1,460.17 100MG 0 2022-04-01 2024-03-31 0
40 4181BK INFLIXIRIL 100MG INJ (RLS/AHI) INFLIXIMAB 100ML C 1,058.52 100MG 0 2022-04-01 2024-03-31 0