Displaying 1 - 2 of 2
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 4181G HERCEPTIN 600MG SC INJ (ROC/AHI) TRASTUZUMAB 5ML VIAL C 3,982.34 600MG 0 2022-04-01 2024-03-31 0
41 4181G HERCEPTIN 600MG SC INJ (ROC) TRASTUZUMAB (C) 5ML VIAL C 3982.3447 600MG 0 2024-04-01 2026-03-31 0