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 7691C INTERFERON ALPHA 2B 3MU INJ (RLS/AHI) 3MU VIAL C 49.72 3MU 0 2022-04-01 2024-03-31 0
41 7691C INTERFERON ALPHA 2B 3MU INJ (RLS) 3MU VIAL C 23.6494 3MU 0 2024-04-01 2026-03-31 0