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 37419 OSMITROL 10% INJ (BAX/STO) MANNITOL 500ML B 12.75 10% 0 2022-04-01 2024-03-31 Add to Contract as Cat B 0
41 37419 OSMITROL 10% INJ (BAX) MANNITOL 500ML BQ 14.5702 10% 0 2024-04-01 2026-03-31 0
40 3742E OSMITROL (2D5632Q) 20% INJ (BAX/STO) MANNITOL 250ML BQ 13.86 20% 0 2022-04-01 2024-03-31 0
41 3742E OSMITROL (2D5632Q) 20% INJ (BAX) MANNITOL 250ML BQ 19.9797 20% 0 2024-04-01 2026-03-31 0