Displaying 1 - 7 of 7
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 5281BB MOXICIP 0.5% EYE DR (CIP/AHI) MOXIFLOXACIN 5ML BQ 10.60 0.5% 0 2022-04-01 2022-09-30 0
40 5281BX OPTIMOX 0.5% EYE DR (ARP/AHI) MOXIFLOXACIN 5ML BQ 8.70 0.5% 0 2022-04-01 2024-03-31 6
40 5281CD VIGAMOX 0.5% EYE DR (NVS/COL) MOXIFLOXACIN 3ML C 27.05 0.5% 0 2022-04-01 2024-03-31 0
41 5281CE VIGAMOX 0.5% EYE DR (NVS) MOXIFLOXACIN (C) 5ML C 45.396 0.5% 0 2024-04-01 2026-03-31 0
42 5281CE VIGAMOX 0.5% EYE DR (NVS) MOXIFLOXACIN 5ML C 45.40 0.5% 0 2026-04-01 No No 0
41 5281CF ENMOX 0.5% EYE DR (SHC) MOXIFLOXACIN (BQ) 5ML BQ 5.7085 0.5% 0 2024-04-01 2026-03-31 0
42 5281CR 4QUIN 0.5% EYE DR (ADO) MOXIFLOXACIN 5ML BQ 6.25 0.5% 0 2026-04-01 No No 0