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 4181C ACTEMRA 20MG/ML INJ (ROC/AHI) TOCILIZUMAB 10ML VIAL C 706.76 20MG/ML 0 2022-04-01 2024-03-31 0
40 4181D ACTEMRA 20MG/ML INJ (ROC/AHI) TOCILIZUMAB 4ML VIAL C 282.71 20MG/ML 0 2022-04-01 2024-03-31 0
40 4181J ACTEMRA 162MG/0.9ML INJ (ROC/AHI) TOCILIZUMAB 4X0.9ML C 176.69 162MG/0.9ML 0 2022-04-01 2024-03-31 0