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 16715 PERPHENAZINE 4MG TAB (KWA/ATB) 50X10 A 1.36 4MG 180 2022-04-01 2022-09-30 6
40 16716 AAP-PERPHENAZINE 4MG TAB (APO/COL) PERPHENAZI 100'S A 0.41 4MG 180 2022-04-01 2024-03-31 6
41 16717 AAP-PERPHENAZINE 4MG TAB (APO) PERP 100'S A 0.4159 4MG 180 2024-04-01 2026-03-31 6