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
41 5861D SPORANOX 100MG CAP (JAC/STO) ITRACONAZOLE 60'S C 3.1147 100MG 0 0
40 5861D SPORANOX 100MG CAP (JAC/STO) ITRACONAZOLE 60'S C 3.11 100MG 0 2022-04-01 2024-03-31 0
40 5861HB ITRACONAZOLE 100MG TAB (KWA/ATB) 10'S A 0.47 100MG 60 2022-04-01 2024-03-31 3
41 5861KG ITRACONAZOLE 100MG CAP (RYV/ATB) 30'S A 0.4503 100MG 12