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 0012AB ALLEGRA 120MG TAB (SFA/COL) FEXOFENADINE 10'S C 0.95 120MG 0 2022-04-01 2024-03-31 0
40 0012AQ ALLEGRA 180MG TAB (SFA/COL) FEXOFENADINE 10'S C 1.02 180MG 0 2022-04-01 2024-03-31 0
41 0012FR AXOFEN 120MG TAB (ARP/AHI) FEXOFENADINE 30'S C 0.7756 120MG 0 0
40 0013G ALLEGRA 6MG/ML SUSP (SFA/COL) FEXOFENADINE 150ML C 0.09 6MG/ML 0 2022-04-01 2024-03-31 0