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 3921CH BRILINTA 90MG TAB (AZN/COL) TICAGRELOR 60'S C 2.04 90MG 0 2022-04-01 2024-03-31 0
41 3921CH BRILINTA 90MG TAB (AZN) TICAGRELOR (C) 60'S C 2.0387 90MG 60 2024-04-01 2026-03-31 0
42 3921CH BRILINTA 90MG TAB (AZN) TICAGRELOR 60'S C 2.03 90MG 60 2026-04-01 No No 0
42 3921EA BRIREM 90MG TAB (REM) TICAGRELOR 14X4 B 0.49 90MG 60 2026-04-01 No No 0