Displaying 1 - 7 of 7
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
41 00915 GRISEOFULVIN 125MG TAB (REM/SBI) 10x10 A 0.1408 125MG 60 6
40 00915 GRISEOFULVIN 125MG TAB (REM/SBI) 10x10 A 0.17 125MG 60 2022-04-01 2024-03-31 6
41 00923 GRISEOFULVIN 500MG TAB (REM/SBI) 10X10 A 0.2743 500MG 60 6
40 00923 GRISEOFULVIN 500MG TAB (REM/SBI) 10X10 A 0.28 500MG 60 2022-04-01 2024-03-31 6
41 00939 GRISEOFULVIN 25MG/ML SUSP (SUE/AHI) 120ML A 0.1309 25MG/ML 500 6
40 00939 GRISEOFULVIN 25MG/ML SUSP (SUE/AHI) 120ML A 0.12 25MG/ML 500 2022-04-01 2024-03-31 6
40 0093A FLUVIN 25MG/ML SUSP (RYV/ALW) GRISEOFULVIN 100ML A 0.12 25MG/ML 500 2022-04-01 2024-03-31 6