Displaying 1 - 3 of 3
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 05027 AAP-NITROFURANTOIN 100MG TAB (APO/COL) 100'S A 0.18 100MG 56 2022-04-01 2024-03-31 0
40 0502H PMS-NITROFURANTOIN 100MG TAB (PMS/COL) 100'S C 0.49 100MG 0 2022-04-01 2024-03-31 0
41 0502J AAP-NITROFURANTOIN 100MG TAB (APO) 100'S A 0.1821 100MG 56 2024-04-01 2026-03-31 0