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
41 1261F SEVOFLURANE SOLN (BAX) (BQ) 250ML BQ 197.8668 100% 30 2024-04-01 2026-03-31 0
40 1261L ULTANE (4456-02) (ABB/PHA) SEVOFLURANE 250ML BQ 265.04 100% 0 2022-04-01 2024-03-31 0
41 1261L ULTANE (4456-02) (ABB) SEVOFLURANE (BQ) 250ML BQ 264.7376 100% 30 2024-04-01 2026-03-31 0