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
40 05216 ACTINOMYCIN D 500MCG INJ (KWA/ATB) 500MCG VIA BQ 36.70 500MCG 0 2022-04-01 2024-03-31 0
40 05217 DACTINOTEC 500MCG INJ (UBI/RXP) ACTINOMYCIN D 500MCG BQ 31.26 500MCG 0 2022-04-01 2024-03-31 0
40 05218 ACTINOMYCIN D 500MCG INJ (CHC/ATB) 500MCG VIA BQ 33.16 500MCG 0 2022-04-01 2024-03-31 0
41 05219 ACTINOMYCIN D 500MCG INJ (ZUV) (BQ) 500MCG BQ 14.7061 500MCG 10 2024-04-01 2026-03-31 6