Displaying 181 - 200 of 486
| Contract Number | Brand Code | Drug | LAgent Code | Drug Contract Start Date | Drug Contract End Date | Formulary Category | Package Size | Protocol Monthly Max | Package Price | Contract Changed | Change Date | ||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 40 | A501G | DIOVAN 160 MG (NVS/COL) | COL | 2024-03-31 | A | 14'S | 30 | 9.08 | 2023-08-17 | ||||
| 40 | A5026 | DIOVAN 320MG (NVS/COL) | COL | 2024-03-31 | B | 14 | 30 | 9.74 | 2023-08-17 | ||||
| 40 | 3921CQ | DIPYRIDAMOLE 25MG TAB (LDP/AHI) | AHI | 2022-04-01 | 2024-03-31 | BQ | 100'S | 120 | 49.72 | Add to Contract as Cat B | 2022-03-10 | ||
| 40 | 3921CM | DIPYRIDAMOLE 50MG TAB (LDP/AHI) | AHI | 2022-04-01 | 2024-03-31 | BQ | 100'S | 120 | 49.72 | Add to Contract as Cat B | 2022-03-10 | ||
| 40 | 3921CS | DIPYRIDAMOLE 75MG TAB (LDP/AHI) | AHI | 2022-04-01 | 2024-03-31 | BQ | 100'S | 120 | 49.72 | Add to Contract as Cat B | 2022-03-10 | ||
| 40 | 7621BC | DIXI 35 2MG C/35MCG E TAB (ABB/PHA) CYPROTERO (C) | PHA | 2022-04-01 | 2023-03-31 | C | 21'S | 12.07 | Delete from contract | 2023-03-02 | |||
| 40 | 1612A | DOCETAXEL 80MG INJ (EBA/COL) | COL | 2022-04-01 | 2024-03-31 | C | 80MG VIAL | 0 | 68.58 | Price Change | 2022-01-18 | ||
| 40 | B051B | DOLUTEGRAVIR 50MG TAB (APL/ATB) | ATB | 2022-04-12 | 2024-03-31 | BL | 30'S | 0 | 10.66 | Add to Contract as Cat B | 2022-04-12 | ||
| 40 | 4463N | DONEPEZIL 5MG TAB (CIP/AHI) | AHI | 2022-11-29 | 2024-03-31 | A | 4X7'S | 30 | 8.05 | Add to Contract as Cat A | 2022-11-29 | ||
| 40 | A5916 | DOXORUBICIN 50MG SOLN FOR INJ (EBA/COL) | COL | 2022-04-01 | 2024-03-31 | BQ | 50MG VIAL | 0 | 34.93 | Price Change | 2022-01-18 | ||
| 40 | 5521CJ | DOXYCYCLINE 100MG TAB (FSB/ATB) | ATB | 2022-04-01 | 2024-03-31 | A | 3X10 | 14 | 2.85 | Add to Contract as Cat A | 2021-12-03 | ||
| 40 | 5521BV | DOXYCYCLINE 100MG TAB (GPC/ATB) | ATB | 2022-04-01 | 2022-09-30 | A | 100'S | 14 | 6.52 | 2022-03-30 | |||
| 40 | 0013BL | DPH ELIXIR 2.5MG/ML SYR (FED/ATB) DIPHENHYDRA | ATB | 2022-05-11 | 2024-03-31 | A | 120ML | 120 | 4.08 | Change Local Agent | 2022-05-11 | ||
| 40 | 0013BH | DPH ELIXIR 2.5MG/ML SYR (FED/RXP) DIPHENHYDRA | RXP | 2022-04-01 | 2022-05-11 | A | 120ML | 120 | 4.08 | Delete from contract | 2022-05-11 | ||
| 40 | 4211BC | ECONAZOLE | HYDROCORTISONE 1% | 1% CR (KWA/ATB) | ATB | 2022-04-01 | 2022-09-30 | A | 15G | 2 | 4.08 | 2022-03-30 | |||
| 40 | A322KV | EFFEXOR XR 150MG CAP (PFI/SBI) VENLAFAXINE | SBI | 2022-04-01 | 2024-03-31 | C | 14'S | 0 | 67.80 | Price Change | 2022-04-01 | ||
| 40 | A322GA | EFFEXOR XR 150MG CAP (PFI/STO) VENLAFAXINE | STO | 2022-04-01 | 2022-08-23 | C | 14'S | 0 | 67.80 | Delete from contract | 2022-07-12 | ||
| 40 | A322KX | EFFEXOR XR 150MG CAP (PFI/STO) VENLAFAXINE | STO | 2022-07-12 | 2024-03-31 | C | 28'S | 0 | 135.59 | Package Size Change | 2022-07-12 | ||
| 40 | A322GB | EFFEXOR XR 75MG CAP (PFI/STO) VENLAFAXINE | STO | 2022-04-01 | 2022-08-23 | C | 14'S | 0 | 67.80 | Delete from contract | 2022-07-12 | ||
| 40 | A322KY | EFFEXOR XR 75MG CAP (PFI/STO) VENLAFAXINE | STO | 2022-07-12 | 2024-03-31 | C | 28'S | 0 | 135.59 | Package Size Change | 2022-07-12 | ||