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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 A7017 PILOCARPINE | TIMOLOL 2% | 0.5% EYE DR (FSB/ATB) 5ML A 5.76 2%|0.5% 1 2022-04-01 2024-03-31 Price Change 6
40 A7026 PILOCARPINE | TIMOLOL 4% | 0.5% EYE DR (FSB/ATB) 5ML A 7.04 4%|0.5% 1 2022-04-01 2024-03-31 Price Change 6