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 4073X POENTIMOL 0.5% EYE DR (LPO/COL) TIMOLOL 5ML C 5.44 0.5% 0 2022-04-01 2024-03-31 Add to Contract as Cat C 0
40 4074AG TIMOLOL 0.25% EYE DR (FSB/ATB) 10ML A 1.60 0.25% 1 2022-04-01 2024-03-31 Price Change 6
41 4074AG TIMOLOL 0.25% EYE DR (FSB) 10ML A 1.6582 0.25% 1 2024-04-01 2026-03-31 6