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 2931W VASOPRESSIN 20U/ML INJ (SLS/AHI) 5X1ML BQ 18.54 20U/ML 0 2022-04-01 2024-03-31 0
41 2931W VASOPRESSIN 20U/ML INJ (SLS) (BQ) 5X1ML BQ 18.539 20U/ML 6 2024-04-01 2026-03-31 0
40 2931Y VASMED 20U/ML INJ (UBI/RXP) VASOPRESSIN 1ML AMP BQ 10.47 20U/ML 0 2022-04-01 2024-03-31 0