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 53116 PENICILLAMINE 250MG CAP (SLS/AHI) 50'S A 3.01 250MG 180 2022-04-01 2024-03-31 6
41 53117 PENICILLAMINE 250MG CAP (JOL) 50'S A 1.4097 250MG 180 2024-04-01 2026-03-31 6