Displaying 1 - 7 of 7
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 2331J PILOCARPINE 2% EYE DR (MTP/COL) 10ML A 15.25 2% 1 2022-04-01 2024-03-31 Price Change 6
41 2331J PILOCARPINE 2% EYE DR (MTP) 10ML A 13.0751 2% 1 2024-04-01 2026-03-31 6
40 2332H PILOCARPINE 4% EYE DR (MTP/COL) 10ML C 16.74 4% 0 2022-04-01 2024-03-31 Price Change 0
41 2332H PILOCARPINE 4% EYE DR (MTP) (C) 10ML C 14.4887 4% 1 2024-04-01 2025-01-28 6
41 2332H PILOCARPINE 4% EYE DR (MTP) (C) 10ML C 21.56 4% 1 2024-04-11 2026-03-31 6
40 23361 PILOCARPINE MINIMS 2% EYE DR (CAM/STO) 20X0.5ML B 4.74 2% 0 2022-04-01 2024-03-31 6
41 23362 PILOCARPINE MINIMS 2% EYE DR (CAM) (B) 20X0.5ML B 4.8305 2% 0 2024-04-01 2026-03-31 0