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 58022 IMMUNINE 600IU INJ (BAX/STO) FACTOR IX 600IU VIAL BQ 608.58 600IU 0 2022-04-01 2024-03-31 0
41 58022 IMMUNINE 600IU INJ (BAX) FACTOR IX 600IU VIAL BQ 634.3481 600IU 0 2024-04-01 2026-03-31 0
42 58022 IMMUNINE 600IU INJ (BAX) FACTOR IX 600IU VIAL BQ 634.35 600IU 0 2026-04-01 No No 0