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 04935 HIPREX 1G TAB (PMA/AHI) HEXAMINE MANDELATE 20'S C 2.69 1G 0 2022-04-01 2024-03-31 0
41 04935 HIPREX 1G TAB (PMA) HEXAMINE MANDELATE 20'S C 1.862 1G 0 2024-04-01 2026-03-31 0