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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 7911AA APO-CYCLOBENZAPRINE 10MG TAB (APO/COL) 500'S A 0.54 10MG 42 2022-04-01 2024-03-31 Package Size Change 6
41 7911AB APO-CYCLOBENZAPRINE 10MG TAB (APO) 500'S A 0.5438 10MG 42 2024-04-01 2026-03-31 6