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 46121 IMOVAX POLIO (AVP/COL) POLIOMYELITIS 1 DOSE B 24.46 80AU 0 2022-04-01 2024-03-31 0
41 46121 IMOVAX POLIO (AVP) POLIOMYELITIS 1 DOSE B 24.4649 80AU 1 2024-04-01 2024-10-21 0