Displaying 1 - 8 of 8
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 5062AB REHYDRATION SALTS (CIP/AHI) 30'S A 0.60 10 2022-04-01 2024-03-31 0
40 5062AD REHYDRATION SALTS PWDR (HEA/RXP) 30'S A 0.62 10 2022-04-01 2024-03-31 0
41 5062AF PROLYTE ORS PWDR (CIP) REHYDRATION SALTS 40'S A 0.598 10 2024-04-01 2026-03-31 0
41 5062AK DEX-LITOS PWDR (LAF) REHYDRATION SALTS (C) 25'S C 1.2504 0 2024-04-01 2026-03-31 0
41 5062AL DEX-LITOS PWDR (LAF) REHYDRATION SALTS (C) 50'S C 1.2776 0 2024-04-01 2026-03-31 0
41 5062AM DEX-LITOS PWDR (LAF) REHYDRATION SALTS (C) 25 SACH C 1.2504 0 2024-04-01 2026-03-31 0
41 5062AN DEX-LITOS PWDR (LAF) REHYDRATION SALTS (C) 50 SACH C 1.2776 0 2024-04-01 2026-03-31 0
41 5062AP REHYDRATION SALTS ORANGE PWDR (MPI) 100'S A 0.3257 10 2024-04-01 2026-03-31 0