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 48411 IMOVANE 7.5MG TAB (SFA/COL) ZOPICLONE 20'S C 0.23 7.5MG 0 2022-04-01 2024-03-31 0
40 48412 APO-ZOPICLONE 7.5MG TAB (APO/COL) 500'S A 0.19 7.5MG 30 2022-04-01 2024-03-31 6
40 4841F ZOPICON 7.5MG TAB (INP/AAL) ZOPICLONE 100'S A 0.19 7.5MG 30 2022-04-01 2024-03-31 6