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 6732Z CONTRAPAQUE 300MG/ML INJ (UNI/AHI) IOHEXOL 50ML BQ 42.70 300MG/ML 0 2022-04-01 2024-03-31 0
40 6734AQ CONTRAPAQUE 350MG/ML INJ (UNI/AHI) IOHEXOL 50ML BQ 43.06 350MG/ML 0 2022-04-01 2024-03-31 0
40 6735E XULVARIO 350MG/ML INJ (UNI/AHI) IOHEXOL 100ML BQ 55.62 350MG/ML 0 2022-04-01 2024-03-31 0