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 0621B MERCAPTOPURINE 50MG TAB (SLS/AHI) 30'S A 1.52 50MG 60 2022-04-01 2024-03-31 6
41 0621B MERCAPTOPURINE 50MG TAB (SLS) 30'S A 1.5214 50MG 60 2024-04-01 2026-03-31 6
40 0621C PURINETHOL 50MG TAB (ASG/STO) MERCAPTOPURINE 25'S A 4.18 50MG 60 2022-04-01 2024-03-31 6
41 0621C PURINETHOL 50MG TAB (ASG) MERCAPTOP (C) 25'S C 4.3004 50MG 60 2024-04-01 2026-03-31 6