Displaying 1 - 4 of 4
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 42312 SILVER NITRATE 95% STICK (HAL/COL) 12'S B 9.05 95% 0 2022-04-01 2024-03-31 0
41 42312 SILVER NITRATE 95% STICK (HAL) (B) 12'S B 7.7676 95% 2 2024-04-01 2026-03-31 0
40 42313 SILVER NITRATE 95% STICK (BRH/PHA) 1'S B 8.29 95% 0 2022-04-01 2024-03-31 0
41 42313 SILVER NITRATE 95% STICK (BRH) (B) 1'S B 9.6772 95% 2 2024-04-01 2026-03-31 0