Displaying 1 - 6 of 6
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 32934 PROCTO-GLYVENOL 40MG | 400MG SUPPOS (GSK/COL) LIDOCAINE | TRIBENOSIDE 5'S A 0.95 40MG|400MG 5 2022-04-01 2024-03-31 0
41 32934 PROCTO-GLYVENOL 40MG|400MG SUPPOS (GSK) LIDOCAINE|TRIBENOSID 5'S A 0.9949 40MG|400MG 5 2024-04-01 2026-03-31 6
42 32934 PROCTO-GLYVENOL 40MG|400MG SUPPOS (GSK) LIDOCAINE|TRIBENOSID 5'S A 1.04 40MG|400MG 5 2026-04-01 No No 6
40 3294B PROCTO-GLYVENOL CR (GSK/COL) TRIBENOSIDE 30G A 7.50 40MG|400MG 1 2022-04-01 2024-03-31 0
41 3294B PROCTO-GLYVENOL CR (GSK) TRIBENOSIDE 30G A 7.6113 40MG|400MG 1 2024-04-01 2026-03-31 0
42 3294B PROCTO-GLYVENOL 40MG|400MG CR (GSK) LIDOCAINE|TRIBENOSIDE 30G A 7.99 40MG|400MG 1 2026-04-01 No No 6