Displaying 281 - 300 of 948
| 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 | 4631N | DESIRE JELLY (HEA/ATB) LUBRICATING JELLY(B) | ATB | 2022-12-07 | 2024-03-31 | B | 82G | 3.26 | Change Local Agent | 2022-11-25 | |||
| 42 | 46319 | DESIRE 82G GEL (HEA) GLYCERINE | AHI | 2026-04-01 | B | 82G | 1 | 3.23 | Price Change | 2025-10-31 | |||
| 42 | 4631AD | DESIRE JELLY (HEA) LUBRICATING JELLY | CWS | 2026-04-01 | B | 82G | 0 | 3.23 | Add to Contract as Cat B | 2026-01-26 | |||
| 41 | 2491AD | DEXAMET. SOD. PHOS. 4MG/ML IV/IM INJ (RTM) | PHA | 2024-04-01 | 2026-03-31 | BQ | 10X1ML | 0 | 14.92 | 2024-02-08 | |||
| 40 | 20553 | DEXTROSE 10% (CSC/PHA) | PHA | 2022-04-01 | 2022-06-15 | B | 250ML | 0 | 2.65 | Price Change | 2021-11-10 | ||
| 40 | 20553 | DEXTROSE 10% (CSC/PHA) | PHA | 2022-06-16 | 2024-03-31 | B | 250ML | 0 | 3.02 | Price Change | 2022-06-15 | ||
| 40 | 20578 | DEXTROSE 10% (CSC/PHA) PLASTIC BAG | PHA | 2022-04-01 | 2022-06-15 | B | 1 LITRE | 0 | 4.50 | Price Change | 2021-11-10 | ||
| 40 | 20578 | DEXTROSE 10% (CSC/PHA) PLASTIC BAG | PHA | 2022-04-16 | 2024-03-31 | B | 1 LITRE | 0 | 5.01 | Price Change | 2022-06-15 | ||
| 40 | 2053A | DEXTROSE 5% (CSC/PHA) | PHA | 2022-04-01 | 2022-06-15 | B | 500ML | 0 | 2.50 | Price Change | 2021-11-10 | ||
| 40 | 2053A | DEXTROSE 5% (CSC/PHA) | PHA | 2022-06-16 | 2024-03-31 | B | 500ML | 0 | 2.80 | Price Change | 2022-06-15 | ||
| 40 | 2054C | DEXTROSE 5% (CSC/PHA) | PHA | 2022-04-01 | 2022-06-15 | B | 1 LITRE | 0 | 3.95 | Price Change | 2021-11-10 | ||
| 40 | 2054C | DEXTROSE 5% (CSC/PHA) | PHA | 2022-06-16 | 2022-07-18 | B | 1 LITRE | 0 | 4.20 | Price Change | 2022-06-15 | ||
| 40 | 2054C | DEXTROSE 5% (CSC/PHA) | PHA | 2022-07-19 | 2024-03-31 | B | 1 LITRE | 0 | 3.98 | Price Change | 2022-07-18 | ||
| 40 | 20523 | DEXTROSE 5% INJ (CSC/PHA) | PHA | 2022-04-01 | 2022-06-15 | B | 250ML | 0 | 2.65 | Price Change | 2021-11-10 | ||
| 40 | 20523 | DEXTROSE 5% INJ (CSC/PHA) | PHA | 2022-06-16 | 2024-03-31 | B | 250ML | 0 | 3.02 | Price Change | 2022-06-15 | ||
| 40 | 37882 | DEXTROSE | SODIUM CHLORIDE 5% | 0.45% INJ (CSC/PHA) | PHA | 2022-04-01 | 2022-06-15 | B | 500ML | 0 | 2.50 | Price Change | 2021-11-10 | ||
| 40 | 37882 | DEXTROSE | SODIUM CHLORIDE 5% | 0.45% INJ (CSC/PHA) | PHA | 2022-06-16 | 2024-03-31 | B | 500ML | 0 | 2.80 | Price Change | 2022-06-15 | ||
| 40 | 37896 | DEXTROSE | SODIUM CHLORIDE 5% | 0.45% INJ (CSC/PHA) | PHA | 2022-04-01 | 2022-06-15 | B | 1 LITRE | 0 | 3.30 | Price Change | 2021-11-10 | ||
| 40 | 37896 | DEXTROSE | SODIUM CHLORIDE 5% | 0.45% INJ (CSC/PHA) | PHA | 2022-06-16 | 2022-07-18 | B | 1 LITRE | 0 | 4.14 | Price Change | 2022-06-15 | ||
| 40 | 37896 | DEXTROSE | SODIUM CHLORIDE 5% | 0.45% INJ (CSC/PHA) | PHA | 2022-07-19 | 2024-03-31 | B | 1 LITRE | 0 | 3.92 | Price Change | 2022-07-18 | ||