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 13911 SUFREXAL 2% GEL (JAC/STO) KETANSERIN 78G C 49.80 2% 0 2022-04-01 2024-03-31 0
41 13911 SUFREXAL 2% GEL (JAC) KETANSERIN 78G C 49.7997 2% 0 2024-04-01 2026-03-31 0