Displaying 1 - 7 of 7
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 50831 NEBIDO 250MG/ML INJ (BSP/COL) TESTOSTERONE 4ML VIAL BQ 108.73 250MG/ML 0 2022-04-01 2024-03-31 0
40 50833 NEBIDO 250MG/ML INJ (BSP/AHI) TESTOSTERONE 4ML VIAL BQ 108.73 250MG/ML 0 2022-04-01 2024-03-31 0
42 50837 PRIMOTESTON 250MG/ML INJ (BSP) TESTOSTER 250MG AMP BQ 33.14 250MG/ML 4 2026-04-01 No No 0
42 50838 PRIMOTESTON 250MG/ML INJ (BSP) TESTOSTER 250MG AMP BQ 36.43 250MG/ML 4 2026-04-01 No No 0
40 5083C TESTOSTERONE 250MG/ML INJ (RTM/PHA) 10X1ML BQ 14.08 250MG/ML 0 2022-04-01 2024-03-31 0
41 5083C TESTOSTERONE 250MG/ML INJ (RTM) (BQ) 10X1ML BQ 15.7337 250MG/ML 4 2024-04-01 2026-03-31 6
41 5083D SOSTENON 250MG/ML INJ (ASG) TESTOSTERONE (BQ) 250MG PFS BQ 34.1693 250MG/ML 4 2024-04-01 2026-03-31 6