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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 2471F APO-LITHIUM CARB. 300MG CAP (APO/COL) 100'S A 0.14 300MG 120 2022-04-01 2024-03-31 6
41 2471T APO-LITHIUM CARB. 300MG CAP (APO) 100'S A 0.1405 300MG 120 2024-04-01 2026-03-31 6