Displaying 1 - 4 of 4
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 23516 PHENYLEPHRINE MINIMS 10% EYE DR (CAM/STO) 20X0.5ML B 4.74 10% 0 2022-04-01 2024-03-31 6
41 23518 PHENYLEPHRINE MINIMS 10% EYE DR (CAM) (BQ) 20X0.5ML BQ 4.1264 10% 0 2024-04-01 2026-03-31 0
40 23541 PHENYLEPHRINE MINIMS 2.5% EYE DR (CAM/STO) 20X0.5ML B 4.74 2.5% 0 2022-04-01 2024-03-31 6
41 23548 PHENYLEPHRINE MINIMS 2.5% EYE DR (CAM) (BQ) 20X0.5ML BQ 4.1264 2.5% 0 2024-04-01 2026-03-31 0