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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 2593AD APO-SUCRALFATE 1G TAB (APO/COL) 100'S A 0.46 1G 120 2022-04-01 2024-03-31 6
42 2593DU SUCRALFATE 1G TAB (MAT) 100'S A 0.84 1G 120 2026-04-01 No No 6