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 72212 AVONEX 30MCG/ML INJ (BGN/PHA) INTERFERON BETA 1A 4X30MCG C 2,560.66 30MCG/ML 0 2022-04-01 2024-03-31 0
41 72212 AVONEX 30MCG/ML INJ (BGN) INTERFERON BETA 1A (BQ) 4X30MCG BQ 2611.8744 30MCG/ML 0 2024-04-01 2026-03-31 0