Displaying 1 - 8 of 8
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
41 62115 DORMICUM 5MG/ML INJ (ROC) MIDAZOLAM (B) 5X3ML B 3.8057 5MG/ML 0 2024-04-01 2026-03-31 0
40 6211D MIDAZOLAM 5MG/ML INJ (RTM/PHA) 10X3ML B 2.62 5MG/ML 0 2022-04-01 2024-03-31 PRICE CHANGE 0
41 6211D MIDAZOLAM 5MG/ML INJ (RTM) (B) 10X3ML B 2.485 5MG/ML 0 2024-04-01 2025-01-28 0
41 6211D MIDAZOLAM 5MG/ML INJ (RTM) (B) 10X3ML B 3.65 5MG/ML 0 2024-05-25 2026-03-31 0
41 62121 DORMICUM 5MG/ML INJ (ROC) MIDAZOLAM (C) 5X10ML C 10.3296 5MG/ML 0 2024-04-01 2026-03-31 0
41 6212N MIDAZOLAM 5MG/ML INJ (KWA) (B) 10ML VIAL B 4.0775 5MG/ML 0 2024-04-01 2026-03-31 0
40 6212P MIDAZOLAM 5MG/ML INJ (BRA/COL) 20X10ML B 3.36 5MG/ML 0 2022-04-01 2024-03-31 0
41 6212P MIDAZOLAM 5MG/ML INJ (BRA) (B) 20X10ML B 4.6565 5MG/ML 0 2024-04-01 2026-03-31 0