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 42524 BNT 3.5MG | 10,000IU CR (CAR/COL) NEOMYCIN | POLY 15G A 5.38 3.5MG/G|10,000IU/G 2 2022-04-01 2024-03-31 0
41 42524 BNT 3.5MG|10,000IU CR (CAR) NEOMYCIN|POL 15G A 5.5454 3.5MG/G|10,000IU/G 2 2024-04-01 2026-03-31 0