Displaying 1 - 4 of 4
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 5511AE SURE COMFORT 31GX5/16'' (ALM/PHA) INSULIN S 100'S A 0.23 10 2022-04-01 2024-03-31 6
41 5511AE SURE COMFORT 31GX5/16'' (ALM) INSULIN 100'S A 0.2365 10 2024-04-01 2026-03-31 6
40 5511AV FORSURE INSULIN SYRINGES 31GX1\2" (CSC/PHA) 100X1ML A 0.22 10 2022-04-01 2022-07-27 Delete from contract 6
41 5511AV FORSURE INSULIN SYRINGES 31GX1\2" (CSC 100X1ML A 0.1829 10 2024-04-01 2026-03-31 6