Displaying 1 - 5 of 5
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 05027 AAP-NITROFURANTOIN 100MG TAB (APO/COL) 100'S A 0.18 100MG 56 2022-04-01 2024-03-31 0
42 05027 AAP-NITROFURANTOIN 100MG TAB (APO) 100'S A 0.18 100MG 56 2026-04-01 No No 0
40 0502H PMS-NITROFURANTOIN 100MG TAB (PMS/COL) 100'S C 0.49 100MG 0 2022-04-01 2024-03-31 0
41 0502J AAP-NITROFURANTOIN 100MG TAB (APO) 100'S A 0.1821 100MG 56 2024-04-01 2026-03-31 0
42 0502M URIFON 100MG SR TAB (JLP) NITROFURANTOIN 10X10 A 0.16 100MG 28 2026-04-01 No No 0