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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 1521D AAP-PRIMIDONE 250MG TAB (APO/COL) PRIMIDONE 100'S A 0.28 250MG 120 2022-04-01 2024-03-31 6
41 1521F APO-PRIMIDONE 250MG TAB (APO) 100'S A 0.2879 250MG 120 2024-04-01 2026-03-31 6