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 4701F DROPSTAR 0.4% EYE DR (LPO/COL) SOD. HYALURONA 10ML A 7.61 0.4% 1 2022-04-01 2024-03-31 6
41 4701F DROPSTAR 0.4% EYE DR (LPO) SOD. HYALURON (C) 10ML C 8.3724 0.4% 1 2024-04-01 2026-03-31 6