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 6561D MESAGUT 400MG TAB (ARP/AHI) MESALAZINE 30'S BQ 0.56 400MG 0 2022-04-01 2024-03-31 6
40 6561G PENTASA 500MG TAB (FER/STO) MESALAZINE 50'S BQ 1.78 500MG 0 2022-04-01 2024-03-31 Package Size Change 6
41 6561G PENTASA 500MG TAB (FER) MESALAZINE 50'S BQ 1.9099 500MG 0 2024-04-01 2026-03-31 0