Displaying 541 - 560 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 | A102D | LABETALOL 100MG TAB (LDP/AHI) | AHI | 2022-04-01 | 2022-09-30 | A | 100'S | 90 | 67.93 | 2022-03-29 | |||
| 42 | A101X | LABETALOL 5MG/ML INJ (FSB) | STO | 2026-04-01 | B | 20ML VIAL | 0 | 4.43 | Add to Contract as Cat B | 2026-03-05 | |||
| 40 | 0225H | LACLOXA 500MG INJ (LDP/AHI) CLOXACILLIN | AHI | 2022-04-01 | 2022-09-30 | B | 500MG VIAL | 0 | 15.41 | 2022-03-29 | |||
| 41 | 2841GC | LAFINE 500MG XR TAB (LDP) METFORMIN XR | AHI | 2024-04-01 | 2024-06-06 | A | 500'S | 120 | 34.88 | 2024-04-25 | |||
| 41 | 2841GN | LAFINE 500MG XR TAB (LDP) METFORMIN XR | AHI | 2024-04-25 | 2026-03-31 | A | 100'S | 120 | 6.99 | 2024-04-25 | |||
| 40 | 2961AB | LANOSTERONE 5MG TAB (LDP/AHI) NORETHISTERONE | AHI | 2022-04-01 | 2022-09-30 | A | 100'S | 90 | 12.37 | 2022-03-29 | |||
| 41 | B2244 | LANTUS SOLOSTAR 100U/ML INJ (SFA) INSULIN GLARGINE | COL | 2024-04-01 | 2026-03-31 | A | 3ML VIAL | 2 | 27.18 | 2024-04-01 | |||
| 40 | 0692J | LASTIGMINE 2.5MG/ML INJ (LDP/AHI) | AHI | 2022-04-01 | 2022-09-30 | BQ | 5X1ML | 0 | 16.99 | 2022-03-29 | |||
| 40 | 0694C | LASTIGMINE PLUS 2.5MG/ML INJ (LDP/AHI) | AHI | 2022-04-01 | 2022-09-30 | BQ | 5X5ML | 0 | 26.10 | 2022-03-29 | |||
| 42 | 3961BH | LEEPORATE 133.2MG|58MG CR TAB (JLP) SODIUM VALPROATE|VALPROI | AHI | 2026-04-01 | A | 10X10 | 150 | 12.64 | Add to Contract as Cat A | 2026-01-30 | |||
| 40 | 6432H | LEUCOVORIN 50MG INJ (SLS/AHI) | AHI | 2022-04-01 | 2022-09-30 | BQ | 5ML | 0 | 12.45 | 2022-03-29 | |||
| 40 | 5172T | LEVAM 8MG/ML SYR (FED/ATB) | ATB | 2022-04-01 | 2022-05-11 | C | 30ML | 0 | 3.15 | Delete from contract | 2022-05-11 | ||
| 40 | 5172T | LEVAM 8MG/ML SYR (FED/ATB) | ATB | 2022-05-11 | 2024-03-31 | C | 30ML | 0 | 3.15 | Change Local Agent | 2022-05-11 | ||
| 41 | B071F | LEVETIRACETAM 500MG TAB (REM) (B) | SBI | 2024-04-01 | 2024-05-14 | B | 100'S | 120 | 39.12 | 2024-04-02 | |||
| 41 | 6711MC | LEVOFLOXACIN 500MG TAB (MCP) | AHI | 2024-04-01 | 2026-03-31 | BQ | 10X10 | 14 | 41.67 | 2024-03-25 | |||
| 40 | 3021Y | LIDOCAINE 1% INJ (BRA/COL) | COL | 2022-04-01 | 2024-03-31 | B | 20X10ML | 0 | 11.31 | Package Size Change | 2022-03-18 | ||
| 40 | 3021X | LIDOCAINE 1% INJ (CIR/AHI) | AHI | 2022-04-01 | 2024-03-31 | B | 50ML VIAL | 0 | 4.70 | Add to Contract as Cat B | 2021-12-16 | ||
| 40 | 30247 | LIDOCAINE 2% GEL (CAD/PHA) | PHA | 2022-07-19 | 2024-03-31 | B | 30G | 0 | 3.18 | Price Change | 2022-07-18 | ||
| 41 | 5201GL | LIFESTYLE MIXED RIDER (ANS) CONDOM | SBI | 2024-04-01 | 2024-07-22 | C | 3'S | 0 | 1.0601 | 2024-07-22 | |||
| 41 | 5201GL | LIFESTYLE MIXED RIDER (ANS) CONDOM | SBI | 2024-07-23 | 2026-03-31 | C | 3'S | 0 | 1.24 | 2024-07-22 | |||