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 3791M HISTAL DC 4MG/60MG TAB (CAR/COL) CHLORPHENIR 150'S C 0.33 4MG|60MG 0 2022-04-01 2024-03-31 0
41 3792E HISTAL DC 0.4MG/ML|6MG/ML SYR (CAR/COL) CHLORPHENIRAMINE|PSEUDOEPHEDRINE 2 LITRES C 0.0367 0.4MG/ML|6MG/ML 0 0
40 3792E HISTAL DC 0.4MG/ML | 6MG/ML SYR (CAR/COL) CHLORPHENIRAMINE | PSEUDOEPHEDRINE 2 LITRES C 0.03 0.4MG/ML|6MG/ML 0 2022-04-01 2024-03-31 0