Displaying 1 - 2 of 2
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 A0422 MYFORTIC 180MG CAP (NVS/COL) MYCOPHENOLIC ACI 120'S C 2.67 180MG 0 2022-04-01 2024-03-31 0
41 A0422 MYFORTIC 180MG CAP (NVS) MYCOPHENOLIC AC (C) 120'S C 2.673 180MG 240 2024-04-01 2026-03-31 6