Contracted Products [GLYCEROL ADULT 4G SUPPOS (MTP/COL) GLYCERINE]

Contract Number	40
Brand Name	GLYCEROL ADULT 4G SUPPOS (MTP/COL) GLYCERINE
Package Size	12'S
Formulary Category	A
Unit Price	0.39
Strength	4G
Max. Reimbursable / Month	12
Drug Contract Start Date	2022-06-02
Drug Contract End Date	2024-03-31
Restrict To Ophthalmologist
Restrict To Pulmonologist
Status Description	Add to Contract as Cat A
Max Repeats	6