Displaying 1 - 2 of 2
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 0013BH DPH ELIXIR 2.5MG/ML SYR (FED/RXP) DIPHENHYDRA 120ML A 0.03 2.5MG/ML 120 2022-04-01 2022-05-11 Delete from contract 6
40 0013BL DPH ELIXIR 2.5MG/ML SYR (FED/ATB) DIPHENHYDRA 120ML A 0.03 2.5MG/ML 120 2022-05-11 2024-03-31 Change Local Agent 6