Displaying 181 - 200 of 673
| 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 | ||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 41 | 17241 | CONCERTA 27MG ER TAB (JAC) METHYLP (C) | STO | 2024-08-01 | 2024-12-31 | C | 30'S | 42 | 156.82 | 2024-08-01 | |||
| 41 | 17241 | CONCERTA 27MG ER TAB (JAC) METHYLPHENIDATE | STO | 2024-06-21 | 2024-07-31 | A | 30'S | 30 | 156.82 | 2024-06-18 | |||
| 41 | 17241 | CONCERTA 27MG ER TAB (JAC) METHYLPHENIDATE | STO | 2025-01-01 | 2025-01-31 | A | 30'S | 30 | 156.82 | 2024-12-31 | |||
| 41 | 2713N | CORTISOL 20MG TAB (ARP) PREDNISOLONE | AHI | 2024-04-01 | 2024-09-30 | A | 100'S | 90 | 8.21 | 2024-08-19 | |||
| 40 | 12011 | COSOPT 2%|0.5% EYE DR (MSD/STO) DORZOLA (C) | STO | 2022-04-01 | 2022-12-31 | C | 5ML | 24.76 | Delete from contract | 2022-12-31 | |||
| 40 | 7722BJ | CURAM 500MG | 125MG TAB (BCH/COL) AMOXICILLIN | CLAVULANIC ACID | COL | 2022-04-01 | 2024-03-31 | C | 80'S | 0 | 27.10 | Price Change | 2022-01-18 | ||
| 40 | 6132E | CYPROTERONE 100MG TAB (LDP/AHI) | AHI | 2022-04-01 | 2022-09-30 | A | 30'S | 90 | 44.85 | 2022-03-29 | |||
| 40 | 5231AD | DAKTARIN 2% CR (JAC/STO) MICONAZOLE | STO | 2022-04-01 | 2022-05-24 | C | 30G | 0 | 15.41 | Delete from contract | 2022-04-12 | ||
| 40 | 52352 | DAKTARIN 2% GEL (JAC/STO) MICONAZOLE | STO | 2022-04-01 | 2022-05-24 | BQ | 78G | 0 | 28.27 | Delete from contract | 2022-04-12 | ||
| 40 | A471S | DALTEPARIN 2500IU INJ (GLN/AHI) | AHI | 2022-04-01 | 2022-09-30 | B | 2500IU | 0 | 5.08 | 2022-03-29 | |||
| 40 | A472AD | DALTEPARIN 5000IU INJ (GLN/AHI) | AHI | 2022-04-01 | 2022-06-29 | B | 5000IU | 0 | 7.88 | 2022-03-29 | |||
| 40 | A472AD | DALTEPARIN 5000IU INJ (GLN/AHI) | AHI | 2022-06-30 | 2024-03-31 | B | 5000IU | 0 | 24.06 | Price Change | 2022-06-30 | ||
| 40 | 5921H | DANAZOL 200MG TAB (CIP/AHI) | AHI | 2022-04-01 | 2022-09-30 | C | 100'S | 0 | 645.85 | 2022-03-29 | |||
| 41 | B421H | DAPAGLIFLOZIN 5MG TAB (MCP) | AHI | 2024-04-01 | 2024-10-31 | A | 3X10 | 30 | 10.33 | 2024-09-19 | |||
| 41 | B421M | DAPAGLIFLOZIN 5MG TAB (MCP) | AHI | 2024-10-29 | 2026-03-31 | A | 100'S | 30 | 34.44 | 2024-09-20 | |||
| 41 | 0472J | DAPSONE 100MG TAB (GSK) | AHI | 2024-07-05 | 2026-03-31 | A | 1000'S | 90 | 141.35 | 2024-07-05 | |||
| 40 | 3962H | DEPAKENE 50MG/ML SYR (ABB/PHA) VALPROIC ACID | PHA | 2022-04-01 | 2023-03-31 | A | 240ML | 28.49 | Delete from contract | 2023-03-02 | |||
| 40 | 3961AV | DEPAKOTE 250MG TAB (ABB) VALPROIC ACID | SBI | 0000-00-00 | 0000-00-00 | A | 30 | 90 | $21.42 | CHANGE OF DISTRIBUTOR | 0000-00-00 | ||
| 40 | 3961AP | DEPAKOTE 250MG TAB (ABB/PHA) VALPROIC ACID | PHA | 2022-04-01 | 2023-03-31 | A | 30'S | 21.42 | Delete from contract | 2023-03-07 | |||
| 40 | 3965C | DEPAKOTE 500MG TAB (ABB) SODIUM VALPROIC | SBI | 0000-00-00 | 0000-00-00 | A | 30 | 90 | $45.65 | CHANGE OF DISTRIBUTOR | 0000-00-00 | ||