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 0381Q RIFAMPICIN 300MG CAP (MCP/AHI) 10X10 A 0.69 300MG 60 2022-04-01 2024-03-31 6
40 0383J RIFAMPICIN 150MG CAP (MCP/AHI) 10X10 A 0.42 150MG 120 2022-04-01 2024-03-31 6