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 B2216 HUMALOG 100U/ML INJ (LIL/STO) LISPRO 10ML VIAL A 60.94 100U/ML 5 2022-04-01 2024-03-31 6
40 B2217 HUMALOG DISP. PEN 100U/ML INJ (LIL/STO) LISPR 5X3ML C 22.43 100U/ML 0 2022-04-01 2024-03-31 0
40 B2218 HUMALOG CARTRIDGE INJ (LIL/STO) LISPRO 5X3ML C 20.11 100U/ML 0 2022-04-01 2024-03-31 0