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 B2221 HUMULIN-R 100U/ML INJ (LIL/STO) INSULIN RAPID 10ML VIAL A 14.92 100U/ML 5 2022-04-01 2024-03-31 6
40 B2222 HUMULIN-R CARTRIDGE INJ (LIL/STO) INSULIN RA 5X3ML C 8.66 100U/ML 2022-07-11 2024-03-31 Add to Contract as Cat C
40 B2223 NOVOLIN-R 100U/ML INJ (NOV/COL) INSULIN RAPID 10ML VIAL A 11.96 100U/ML 5 2022-04-01 2024-03-31 6