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 09815 GALFER 305MG CAP (THR/SBI) FERROUS FUMARATE 250'S C 0.08 305MG 0 2022-04-01 2024-03-31 0
40 09818 GALFER 305MG CAP (THR/SBI) FERROUS FUMARATE 100'S C 0.10 305MG 0 2022-04-01 2024-03-31 0
40 0981AT FERROUS FUMARATE 200MG TAB (MBL/AHI) 100'S A 0.05 200MG 90 2022-04-01 2022-09-30 6
40 09824 GALFER 28MG/ML SYR (THR/SBI) FERROUS FUMARATE 300ML A 0.05 28MG/ML 300 2022-04-01 2024-03-31 6