Displaying 1 - 3 of 3
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 B0511 ISENTRESS 400MG TAB (MSD/STO) RALTEGRAVIR 60'S BL 18.56 400MG 0 2022-04-01 2024-03-31 0
41 B0511 ISENTRESS 400MG TAB (MSD) RALTEGRAVIR (BL) 60'S BL 15.2946 400MG 120 2024-04-01 2026-03-31 6
40 B051A ZEPDON 400MG TAB (CIP/AHI) RALTEGRAVIR 60'S BL 3.66 400MG 0 2022-04-01 2024-03-31 0