Displaying 1 - 4 of 4
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 23611 TROPICAMIDE MINIMS 1% EYE DR (CAM) (B) 20X0.5ML B 4.1264 1% 20 2024-04-01 2026-03-31 0
40 23613 TROPICAMIDE MINIMS 1% EYE DR (CAM/STO) 20X0.5ML B 4.74 1% 0 2022-04-01 2024-03-31 6
40 2362G TROPICAMIDE 1% EYE DR (AKI/AHI) 15ML A 39.20 1% 1 2022-04-01 2024-03-31 0
41 2362J TROPICAMIDE 1% EYE DR (AKI) 15ML A 44.064 1% 1 2024-04-01 2026-03-31 0