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 55511 THALIDOMIDE 50MG CAP (DIL/AHI) 30'S C 2.08 50MG 0 2022-04-01 2024-03-31 0
40 55521 THALIDOMIDE 100MG CAP (DIL/AHI) 30'S C 3.68 100MG 0 2022-04-01 2024-03-31 0
40 5552D THALIDOMIDE 100MG CAP (SLS/AHI) 30'S C 3.13 100MG 0 2022-04-01 2024-03-31 Add to Contract as Cat C 0
41 5552D THALIDOMIDE 100MG CAP (SLS) 30'S C 2.1167 100MG 0 2024-04-01 2026-03-31 0