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
42 0081AB AMBISONE LIPOSOMAL 50MG INJ (GIL) A 50MG VIAL BQ 581.72 50MG 21 2026-04-01 No No 0
40 0081AG AMPHOTIN 50MG INJ (UBI/RXP) AMPHOTERICIN B 50MG VIAL BQ 19.71 50MG 0 2022-04-01 2024-03-31 0
40 0081AJ AMPHIZOME 50MG INJ (FSB/ATB) AMPHOTERICIN B 5ML BQ 24.46 50MG 0 2022-04-01 2024-03-31 0