Displaying 1 - 5 of 5
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 61111 OVOL 40MG/ML DROPS (CDC/COL) SIMETHICONE 15ML A 6.80 40MG/ML 1 2022-04-01 2024-03-31 6
41 61111 OVOL 40MG/ML DROPS (CDC) SIMETHICONE 15ML A 6.9589 40MG/ML 1 2024-04-01 2026-03-31 6
40 61114 OVOL 40MG/ML DROPS (CDC/COL) SIMETHICONE 30ML C 8.56 40MG/ML 0 2022-04-01 2024-03-31 0
41 61114 OVOL 40MG/ML DROPS (CDC) SIMETHICONE (C) 30ML C 8.6715 40MG/ML 1 2024-04-01 2026-03-31 6
40 6111A SIMETHICONE 40MG/ML SYR (KWA/ATB) 30ML C 8.02 40MG/ML 0 2022-04-01 2024-03-31 0