Displaying 1 - 3 of 3
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 78013 APO-OXYBUTYNIN 5MG TAB (APO/COL) 100'S C 0.18 5MG 0 2022-04-01 2024-03-31 0
40 7801E PMS-OXYBUTYNIN 5MG TAB (PMS/COL) 100'S A 0.07 5MG 120 2022-04-01 2024-03-31 6
41 7801Q APO-OXYBUTYNIN 5MG TAB (APO) 100'S A 0.0693 5MG 120 2024-04-01 2026-03-31 6