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 4701AU SYSTANE BALANCE 0.6% EYE DR (ALC/AHI) PROPYLE 10ML C 19.03 0.6% 0 2022-04-01 2024-03-31 0
41 4701AU SYSTANE BALANCE 0.6% EYE DR (ALC) PROPYL (C) 10ML C 21.6922 0.6% 1 2024-04-01 2026-03-31 0