Displaying 1 - 9 of 9
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 5281BY T-MYCIN 0.3% EYE DR (ARP) TOBRAMYCI (BH) 5ML BH 5.4366 0.3% 2 2024-04-01 2026-03-31 6
40 5281CB TOBREX 0.3% EYE DR (NVS/COL) TOBRAMYCIN 5ML C 23.30 0.3% 0 2022-04-01 2024-03-31 0
41 5281CB TOBREX 0.3% EYE DR (NVS) TOBRAMYCIN (C) 5ML C 16.3099 0.3% 2 2024-04-01 2026-03-31 6
40 5281P GOTABIOTIC 0.3% EYE DR (LPO/COL) TOBRAMY 5ML BH 7.34 0.3% 0 2022-04-01 2024-03-31 6
41 5281P GOTABIOTIC 0.3% EYE DR (LPO) TOBRAMYCIN (BH) 5ML BH 7.421 0.3% 2 2024-04-01 2026-03-31 6
40 5282F T-MYCIN 0.3% OINT (ARP/AHI) TOBRAMYCIN 3G BH 10.00 0.3% 0 2022-04-01 2022-09-30 0
41 5282F T-MYCIN 0.3% OINT (ARP) TOBRAMYCIN (BH) 3G BH 5.3823 0.3% 2 2024-04-01 2026-03-31 6
40 5282G TOBREX 0.3% EYE OINT (NVS/COL) TOBRAMYCIN 3.5G BH 15.49 0.3% 0 2022-04-01 2024-03-31 6
41 5282G TOBREX 0.3% EYE OINT (NVS) TOBRAMYC (C) 3.5G C 15.4944 0.3% 2 2024-04-01 2026-03-31 6