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 4701T ACRYLARM 0.2% GEL (LPO/COL) POLYACRYLIC ACID 10G B 11.15 0.2% 1 2022-04-01 2024-03-31 6
41 4701T ACRYLARM 0.2% GEL (LPO) POLYACRYLIC ACID (B) 10G B 12.2596 0.2% 1 2024-04-01 2026-03-31 6