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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 62614 N-MYCIN 5% EYE DR (ARP/AHI) NATAMYCIN 5ML BQ 20.99 5% 0 2022-04-01 2024-03-31 6
41 62615 NATACIN 5% EYE DR (AKU) NATAMYCIN 5ML BQ 5.5182 5% 0 2024-04-01 2026-03-31 0