Displaying 301 - 320 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 | 3785G | DEXTROSE | SODIUM CHLORIDE 5% | 0.9% INJ (CSC/PHA) | PHA | 2022-04-01 | 2022-06-15 | B | 500ML | 0 | 2.85 | Price Change | 2021-11-10 | ||
| 40 | 3785G | DEXTROSE | SODIUM CHLORIDE 5% | 0.9% INJ (CSC/PHA) | PHA | 2022-06-16 | 2024-03-31 | B | 500ML | 0 | 3.79 | Price Change | 2022-06-15 | ||
| 40 | 3786F | DEXTROSE | SODIUM CHLORIDE 5% | 0.9% INJ (CSC/PHA) | PHA | 2022-04-01 | 2022-06-18 | B | 1 LITRE | 0 | 3.15 | Price Change | 2021-11-10 | ||
| 40 | 3786F | DEXTROSE | SODIUM CHLORIDE 5% | 0.9% INJ (CSC/PHA) | PHA | 2022-06-19 | 2022-07-18 | B | 1 LITRE | 0 | 4.23 | Price Change | 2022-06-15 | ||
| 40 | 3786F | DEXTROSE | SODIUM CHLORIDE 5% | 0.9% INJ (CSC/PHA) | PHA | 2022-07-19 | 2024-03-31 | B | 1 LITRE | 0 | 4.00 | Price Change | 2022-07-18 | ||
| 40 | 2832AT | DIAMICROM MR 60MG TAB (SER/COL) GLICLAZIDE | COL | 2022-04-01 | 2024-03-31 | A | 30'S | 60 | 7.18 | Contract Extended | 2022-03-21 | ||
| 40 | 28321 | DIAMICRON MR 60MG TAB (SER/STO) GLICLAZIDE | STO | 2022-04-01 | 2024-03-31 | A | 30'S | 60 | 7.18 | contract extended | 2022-05-27 | ||
| 42 | 375D1 | DIANEAL (5B9866) 1.5% SOLN (BAX) DIALYSIS SOLN | STO | 2026-04-01 | 2028-03-31 | BQ | 6X2L | 0 | 208.41 | Delete from contract | 2026-01-28 | ||
| 42 | 375D6 | DIANEAL (5B9866) 1.5% SOLN (BAX) DIALYSIS SOLN | AHI | 2026-04-01 | BQ | 6X2 LITRE | 0 | 208.41 | Add to Contract as Cat B | 2026-01-29 | |||
| 42 | 375E1 | DIANEAL (5B9876) 2.5% SOLN (BAX) DIALYSIS SOLN | STO | 2026-04-01 | 2028-03-31 | BQ | 6X2L | 0 | 208.41 | Delete from contract | 2026-01-28 | ||
| 42 | 375E7 | DIANEAL (5B9876) 2.5% SOLN (BAX) DIALYSIS SOLN | AHI | 2026-04-01 | BQ | 6X2 LITRE | 0 | 208.41 | Add to Contract as Cat B | 2026-01-29 | |||
| 42 | 375F1 | DIANEAL (5B9896) 4.25% SOLN (BAX) DIALYSIS SOLN | STO | 2026-04-01 | BQ | 6X2L | 0 | 208.41 | Delete from contract | 2026-01-28 | |||
| 42 | 375F6 | DIANEAL (5B9896) 4.25% SOLN (BAX) DIALYSIS SOLN | AHI | 2026-04-01 | BQ | 6X2 LITRE | 0 | 208.41 | Add to Contract as Cat B | 2026-01-29 | |||
| 42 | 375A1 | DIANEAL (L5B5193) 1.5% INJ (BAX) DIALYSIS SOLN | STO | 2026-04-01 | BQ | 2X5 LITRES | 100 | 64.75 | Delete from contract | 2026-01-28 | |||
| 42 | 375A4 | DIANEAL (L5B5193) 1.5% INJ (BAX) DIALYSIS SOLN | AHI | 2026-04-01 | BQ | 2X5 LITRES | 100 | 64.75 | Add to Contract as Cat B | 2026-01-29 | |||
| 40 | 375A1 | DIANEAL (L5B5193) 1.5% INJ (BAX/STO) DIALYSIS SOLN | STO | 2022-04-01 | 2024-03-31 | B | 2X5 LITRES | 0 | 36.04 | Add to Contract as Cat B | 2021-12-30 | ||
| 42 | 375B1 | DIANEAL (L5B5194) 2.5% SOLN (BAX) DIALYSIS SOLN | STO | 2026-04-01 | BQ | 2X5 LITRES | 0 | 64.75 | Delete from contract | 2026-01-28 | |||
| 42 | 375B3 | DIANEAL (L5B5194) 2.5% SOLN (BAX) DIALYSIS SOLN | AHI | 2026-04-01 | BQ | 2X5 LITRES | 0 | 64.75 | Add to Contract as Cat B | 2026-01-29 | |||
| 42 | 375C1 | DIANEAL (L5B5195) 4.25% SOLN (BAX) DIALYSIS SOLN | STO | 2026-04-01 | 2028-03-31 | BQ | 2X5 LITRES | 0 | 67.69 | Delete from contract | 2026-01-28 | ||
| 42 | 375C3 | DIANEAL (L5B5195) 4.25% SOLN (BAX) DIALYSIS SOLN | AHI | 2026-04-01 | BQ | 2X5 LITRES | 0 | 67.69 | Add to Contract as Cat B | 2026-01-29 | |||