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
41 B2258 HUMALOG 75%|25% INJ (LIL) INSULIN ISOPHANE|INSULIN REGULAR (C) 5X3ML C 26.9386 75%|25% 0 2024-04-01 2026-03-31 0
41 B225D HUMALOG KWIKPEN 75%|25% INJ (LIL) INSULIN ISOPHANE|INSULIN R (C) 5X3ML C 27.8574 75%|25% 0 2024-04-01 2026-03-31 6