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 B041EW APO-LANSOPRAZOLE 30MG CAP (APO/COL) 100'S C 0.20 30MG 0 2022-04-01 2024-03-31 0
41 B041NP APO-LANSOPRAZOLE 15MG CAP (APO) (C) 100'S C 0.1068 15MG 0 2024-04-01 2026-03-31 0
41 B041NT APO-LANSOPRAZOLE 30MG CAP (APO) (C) 100'S C 0.2031 30MG 0 2024-04-01 2026-03-31 0