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
41 23012 OXYBUPROCAINE MINIMS 0.4% EYE DR (CAM) (B) 20X0.5ML B 4.1264 0.4% 4 2024-04-01 2026-03-31 0
40 23016 OXYBUPROCAINE MINIMS 0.4% EYE DR (CAM/STO) 20X0.5ML B 4.74 0.4% 0 2022-04-01 2024-03-31 6