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 A6614 MAXALT 10MG TAB (MSD/STO) RIZATRIPTAN 6'S C 8.32 10MG 0 2022-04-01 2024-03-31 0
41 A6614 MAXALT 10MG TAB (MSD) RIZATRIPTAN (C) 6'S C 8.3996 10MG 14 2024-04-01 2026-03-31 6
41 A661BA PMS-RIZATRIPTAN 10MG TAB (PMS) 6'S A 3.5338 10MG 14 2024-04-01 2026-03-31 6