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 4331AN XELJANZ 5MG TAB (PFI/STO) TOFACITINIB 60'S C 39.56 5MG 0 2022-04-01 2024-03-31 0
41 4331AN XELJANZ 5MG TAB (PFI) TOFACITINIB (C) 60'S C 39.5571 5MG 0 2024-04-01 2026-03-31 0
42 4331AN XELJANZ 5MG TAB (PFI) TOFACITINIB 60'S C 39.56 5MG 0 2026-04-01 No No 0