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
41 1691B THIORIDAZINE 10MG TAB (MAT) 100'S A 2.219 10MG 360 2024-04-01 2026-03-31 6
41 1692M THIORIDAZINE 25MG TAB (MAT) 100'S A 3.1206 25MG 360 2024-04-01 2026-03-31 6