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 52217 APO-BACLOFEN 10MG TAB (APO/COL) 100'S A 0.06 10MG 180 2022-04-01 2024-03-31 6
41 5221AB APO-BACLOFEN 10MG TAB (APO) 100'S A 0.0625 10MG 180 2024-04-01 2026-03-31 6
41 5221AC BACLOFEN 10MG TAB (FSB) 10X10 A 0.0546 10MG 180 2024-04-01 2026-03-31 6
40 5221N PMS-BACLOFEN 10MG TAB (PMS/COL) 100'S A 0.07 10MG 180 2022-04-01 2024-03-31 6