Displaying 1 - 9 of 9
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 5751H APO-PRAZO 1MG TAB (APO/COL) 100'S B 0.07 1MG 0 2022-04-01 2024-03-31 0
42 5751H APO-PRAZO 1MG TAB (APO) 100'S B 0.07 1MG 120 2026-04-01 No No 6
41 5751X APO-PRAZO 1MG TAB (APO) (B) 100'S B 0.068 1MG 120 2024-04-01 2026-03-31 6
40 5752J APO-PRAZO 2MG TAB (APO/COL) 100'S B 0.08 2MG 0 2022-04-01 2024-03-31 0
42 5752J APO-PRAZO 2MG TAB (APO) 100'S B 0.08 2MG 120 2026-04-01 No No 6
41 5752Y APO-PRAZO 2MG TAB (APO) (B) 100'S B 0.0832 2MG 120 2024-04-01 2026-03-31 6
41 5753AB APO-PRAZO 5MG TAB (APO) (B) 100'S B 0.1386 5MG 120 2024-04-01 2026-03-31 6
40 5753J APO-PRAZO 5MG TAB (APO/COL) 100'S B 0.14 5MG 0 2022-04-01 2024-03-31 0
42 5753J APO-PRAZO 5MG TAB (APO) 100'S B 0.14 5MG 120 2026-04-01 No No 6