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 01027 NYSTATIN 100,000U/ML SUSP (HEA/RXP) 60ML A 0.10 100,000U/ML 180 2022-04-01 2024-03-31 0
41 0102T PMS-NYSTATIN 100,000U/ML SUSP (PMS/COL) 100ML A 0.0816 100,000U/ML 180 0
40 0102T PMS-NYSTATIN 100,000U/ML SUSP (PMS/COL) 100ML A 0.07 100,000U/ML 180 2022-04-01 2024-03-31 0
41 0102V NYSTATIN 100,000U/ML SUSP (HEA/ATB) 60ML A 0.096 100,000U/ML 180 0