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 57618 STAFEN 1MG TAB (ARP/AHI) KETOTIFEN 10X10 A 0.15 1MG 60 2022-04-01 2024-03-31 6
41 57618 STAFEN 1MG TAB (ARP) KETOTIFEN 10X10 A 0.0862 1MG 60 2024-04-01 2026-03-31 6
40 5762G KETOTIFEN MK 0.2MG/ML SYR (BON/COL) KETOTIFEN 100ML A 0.04 0.2MG/ML 100 2022-04-01 2024-03-31 6
41 5762K KETOTAG 0.2MG/ML SYR (GLP) KETOTIFEN 60ML A 0.068 0.2MG/ML 100 2024-04-01 2026-03-31 6