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 32936 PREPARATION H 0.25% SUPPOS (GSK/COL) PHENYLEP 12'S A 1.17 0.25% 12 2022-04-01 2024-03-31 6
41 32936 PREPARATION H 0.25% SUPPOS (GSK) PH 12'S A 1.2323 0.25% 12 2024-04-01 2026-03-31 6