Displaying 1 - 3 of 3
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 5131L DUOTRAV 0.5% | 0.004% EYE DR (NVS/COL) TIMOLOL | 2.5ML C 32.46 0.5%|0.004% 0 2022-04-01 2024-03-31 0
41 5131L DUOTRAV 0.5%|0.004% EYE DR (NVS) TI (C) 2.5ML C 32.4568 0.5%|0.004% 1 2024-04-01 2026-03-31 6
41 5131P T BET PRES. FREE 0.5%|0.004% EYE DR (AKU) TIMOLOL|TRAVOPROST (C) 3ML C 11.417 0.5%|0.004% 1 2024-04-01 2026-03-31 6