Displaying 3721 - 3740 of 5993
Contract Number Brand Code Brand Name Active Ingredient Trade Name Package Size Formulary Category Pkg Price Unit Price Unit Description Max. Reimbursable Quantity / Month Package Description Manufacturer Code Manufacturer Name Agent Code Agent Name Benefit Therapeutic Code Therapeutic Desc Drug Contract Start Date Drug Contract End Date Status Description Default Route Max Repeats Therapeutic Head Amend Date
42 5693FF VALOVERA 500MG TAB (JLP) VALACYCLOVIR VALACYCLOVIR VALOVERA 10X10 A 51.65 0.52 TAB 42 BLIS JLP JOHN LEE PHARMACEUTICALS AHI ARMSTRONG HEALTHCARE INC 081832 NUCLEOSIDES AND NUCLEOTIDES 2026-04-01 2028-03-31 ORAL 0 NUCLEOSIDES AND NUCLEOTIDES
40 5693S VALTREX 500MG TAB (GSK/COL) VALACYCLOVIR VALACYCLOVIR VALTREX 42'S C 251.61 5.99 TABLET 0 TAB GSK GLAXOSMITHKLINE COL COLLINS LTD 081832 NUCLEOSIDES AND NUCLEOTIDES 2022-04-01 2024-03-31 Oral 0 ANTI-INFECTIVE AGENTS
41 5693S VALTREX 500MG TAB (GSK) VALACYCLOVIR (C) VALACYCLOVIR VALTREX 42'S C 276.75 6.5893 TAB 42 BOX GSK GLAXOSMITHKLINE COL COLLINS LTD 081832 NUCLEOSIDES AND NUCLEOTIDES 2024-04-01 2026-03-31 ORAL 0 NUCLEOSIDES AND NUCLEOTIDES
42 5693S VALTREX 500MG TAB (GSK) VALACYCLOVIR VALACYCLOVIR VALTREX 42'S C 290.59 6.92 TAB 42 BLIS GSK GLAXOSMITHKLINE COL AVENTA BARBADOS 081832 NUCLEOSIDES AND NUCLEOTIDES 2026-04-01 2028-03-31 ORAL 0 NUCLEOSIDES AND NUCLEOTIDES
40 56944 ZOVIRAX 5% CR (GSK/COL) ACYCLOVIR ACYCLOVIR ZOVIRAX 5G C 20.93 20.93 CREAM 0 TUBE GSK GLAXOSMITHKLINE COL COLLINS LTD 081832 NUCLEOSIDES AND NUCLEOTIDES 2022-04-01 2024-03-31 TOPICAL 0 ANTI-INFECTIVE AGENTS
41 56944 ZOVIRAX 5% CR (GSK) ACYCLOVIR (C) ACYCLOVIR ZOVIRAX 5G C 23.02 23.0242 TUBE 2 BOX GSK GLAXOSMITHKLINE COL COLLINS LTD 081832 NUCLEOSIDES AND NUCLEOTIDES 2024-04-01 2026-03-31 TOPICAL 0 NUCLEOSIDES AND NUCLEOTIDES
42 56944 ZOVIRAX 5% CR (GSK) ACYCLOVIR ACYCLOVIR ZOVIRAX 5G C 25.50 25.50 TUBE 2 BOX GSK GLAXOSMITHKLINE COL AVENTA BARBADOS 081832 NUCLEOSIDES AND NUCLEOTIDES 2026-04-01 2028-03-31 TOPICAL 0 NUCLEOSIDES AND NUCLEOTIDES 2026-02-16
40 56949 CYCLOVAX 5% CR (REM/SBI) ACYCLOVIR ACYCLOVIR CYCLOVAX 10G A 3.07 3.07 CREAM 2 TUBE REM REMEDICA LTD SBI MASSY DISTRIBUTION (BDOS) LTD 081832 NUCLEOSIDES AND NUCLEOTIDES 2022-04-01 2024-03-31 TOPICAL 0 ANTI-INFECTIVE AGENTS
41 56949 CYCLOVAX 5% CR (REM) ACYCLOVIR ACYCLOVIR CYCLOVAX 10G A 3.07 3.0717 TUBE 2 BOX REM REMEDICA LTD SBI MASSY DISTRIBUTION (BDOS) LTD 081832 NUCLEOSIDES AND NUCLEOTIDES 2024-04-01 2026-03-31 TOPICAL 0 NUCLEOSIDES AND NUCLEOTIDES
42 5694AF ACYCLOVIR 5% CR (HEA) ACYCLOVIR ACYCLOVIR 5G A 1.41 1.41 TUBE 2 TUBE HEA HEALTH 2000 INC AHI ARMSTRONG HEALTHCARE INC 081832 NUCLEOSIDES AND NUCLEOTIDES 2026-04-01 2028-03-31 TOPICAL 0 NUCLEOSIDES AND NUCLEOTIDES
42 5694AG ACYCLOVIR 5% CR (CIR) ACYCLOVIR ACYCLOVIR 10G A 3.67 3.67 TUBE 2 TUBE CIR CIRON PHARMA CWS CAPSULE WHOLESALE 0818 ANTIVIRALS 2026-04-01 2028-03-31 TOPICAL 0 ANTIVIRALS
42 5694AH ACYCLOVIR 5% CR (HEA) ACYCLOVIR ACYCLOVIR 5G TUBE A 1.41 1.41 TUBE 2 TUBE HEA HEALTH 2000 INC CWS CAPSULE WHOLESALE 081832 NUCLEOSIDES AND NUCLEOTIDES 2026-04-01 2028-03-31 TOPICAL 0 NUCLEOSIDES AND NUCLEOTIDES 2026-01-26
42 5694AJ ACYCLOVIR 5% CR (FSB) ACYCLOVIR ACYCLOVIR 5G A 1.09 1.09 TUBE 2 FSB FLAGSHIP BIOTECH STO BRYDEN STOKES LTD 081832 NUCLEOSIDES AND NUCLEOTIDES 2026-04-01 2028-03-31 TOPICAL 0 NUCLEOSIDES AND NUCLEOTIDES 2026-03-05
42 5694AK ACYCLOVIR 5% CR (HEA) ACYCLOVIR ACYCLOVIR 5G A 1.41 1.41 TUBE 2 HEA HEALTH 2000 INC STO BRYDEN STOKES LTD 081832 NUCLEOSIDES AND NUCLEOTIDES 2026-04-01 2028-03-31 TOPICAL 0 NUCLEOSIDES AND NUCLEOTIDES 2026-02-27
40 5694G ACYCLOVIR 5% CR (HEA/RXP) ACYCLOVIR ACYCLOVIR 5G A 2.58 2.58 CREAM 2 TUBE HEA HEALTH 2000 INC RXP RX PRO INC 081832 NUCLEOSIDES AND NUCLEOTIDES 2022-04-01 2024-03-31 TOPICAL 0 ANTI-INFECTIVE AGENTS
40 5694U ACYCLOVIR 5% CR (KWA/ATB) ACYCLOVIR ACYCLOVIR 4G A 2.31 2.31 CREAM 2 TUBE KWA KWALITY PHARMACEUTICALS ATB ANSA TRADING BARBADOS LTD 081832 NUCLEOSIDES AND NUCLEOTIDES 2022-04-01 2024-03-31 TOPICAL 0 ANTI-INFECTIVE AGENTS
40 5694Z ACYCLOVIR 5% CR (HEA/ATB) ACYCLOVIR ACYCLOVIR 5G A 2.58 2.58 CREAM 2 HEA HEALTH 2000 INC ATB ANSA TRADING BARBADOS LTD 81832 NUCLEOSIDES AND NUCLEOTIDES 2022-07-12 2024-03-31 la Topical 0 NUCLEOSIDES AND NUCLEOTIDES 2022-11-25
41 5694Z ACYCLOVIR 5% CR (HEA) ACYCLOVIR ACYCLOVIR 5G A 1.47 1.4679 TUBE 2 BOX HEA HEALTH 2000 INC ATB ANSA TRADING BARBADOS LTD 081832 NUCLEOSIDES AND NUCLEOTIDES 2024-04-01 2026-03-31 Topical 0 NUCLEOSIDES AND NUCLEOTIDES
40 56955 ACYVIR 3% EYE OINT (ARP/AHI) ACYCLOVIR ACYCLOVIR ACYVIR 5G A 8.02 8.02 EYE OINTMENT 2 TUBE ARP ARISTOPHARMA LTD AHI ARMSTRONG HEALTHCARE INC 520420 EENT ANTIVIRALS 2022-04-01 2024-03-31 OPHTHALMIC 0 EYE, EAR, NOSE AND THROAT PREPARATIONS
41 56956 OPTIVIRAL 3% EYE OINT (SPC) ACYCLOVIR ACYCLOVIR OPTIVIRAL 5G A 1.14 1.1417 TUBE 2 TUBE SPC SELVOK PHARMACEUTICALS CO PSB PHARMACEUTICAL SOLUTIONS BARBA 520420 EENT ANTIVIRALS 2024-04-01 2026-03-31 OPHTHALMIC 0 EENT ANTIVIRALS