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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 34915 LAVIT-6 50MG TAB (LDP/AHI) PYRIDOXINE 100'S B 0.18 50MG 0 2022-04-01 2024-03-31 0
41 34915 LAVIT-6 50MG TAB (LDP) PYRIDOXINE 100'S B 0.1775 50MG 150 2024-04-01 2026-03-31 6