Displaying 2061 - 2080 of 5993
Contract Number Brand Code Brand Name Package Size Formulary Category Unit Price Strength Max. Reimbursable / Month Drug Contract Start Date Drug Contract End Date Restrict To Ophthalmologist Restrict To Pulmonologist Status Description Max Repeats
42 2991T SYNTHROID 0.1MG TAB (ABB) LEVOTHYROXINE 30'S A 0.24 0.1MG 60 2026-04-01 No No 6
42 2991V EUTIROX NF 100MCG TAB (MEK) LEVOTHYROXINE 1000'S A 0.08 100MCG 30 2026-04-01 No No 6
40 29931 EUTIROX 25MCG TAB (MEK/COL) THYROXINE 50'S A 0.26 25MCG 90 2022-04-01 2024-03-31 6
41 29931 EUTIROX 25MCG TAB (MEK) THYROXINE 50'S A 0.2637 25MCG 90 2024-04-01 2026-03-31 6
40 2993A SYNTHROID 25MCG TAB (ABB/PHA) THYROXINE 30'S C 0.19 25MCG 0 2022-04-01 2024-03-31 0
40 2993A SYNTHROID 25MCG TAB (ABB/PHA) THYROXINE (C) 30'S C 0.1903 25MCG 2022-04-01 2023-03-31 No No Delete from contract 0
41 2993C SYNTHROID 25MCG TAB (ABB) THYROXINE 30'S A 0.1993 25MCG 90 2024-04-01 2026-03-31 6
42 2993C SYNTHROID 25MCG TAB (ABB) THYROXINE 30'S A 0.18 25MCG 90 2026-04-01 No No 6
42 2993E EUTIROX NF 25MCG TAB (MEK) LEVOTHYROXINE 50'S A 0.27 25MCG 90 2026-04-01 No No 6
40 29941 EUTIROX 50MCG TAB (MEK/COL) THYROXINE 50'S A 0.32 50MCG 90 2022-04-01 2024-03-31 6
41 29941 EUTIROX 50MCG TAB (MEK) THYROXINE 50'S A 0.3197 50MCG 90 2024-04-01 2026-03-31 6
40 29948 SYNTHROID 50MCG TAB (ABB/PHA) THYROXINE 30'S C 0.24 50MCG 0 2022-04-01 2024-03-31 0
40 29948 SYNTHROID 50MCG TAB (ABB/PHA) THYROXINE (C) 30'S C 0.243 50MCG 2022-04-01 2023-03-31 No No Delete from contract 0
41 2994C SYNTHROID 50MCG TAB (ABB) THYROXINE 30'S A 0.2546 50MCG 90 2024-04-01 2026-03-31 6
42 2994C SYNTHROID 50MCG TAB (ABB) LEVOTHYROXINE 30'S A 0.23 50MCG 90 2026-04-01 No No 6
42 2994G EUTIROX NF 50MCG TAB (MEK) LEVOTHYROXINE 50'S A 0.33 50MCG 90 2026-04-01 2028-03-31 No No 6
40 29951 EUTIROX 75MCG TAB (MEK/COL) THYROXINE 50'S A 0.37 75MCG 90 2022-04-01 2024-03-31 6
41 29951 EUTIROX 75MCG TAB (MEK) THYROXINE 50'S A 0.3708 75MCG 90 2024-04-01 2026-03-31 6
40 29957 SYNTHROID 75MCG TAB (ABB/PHA) THYROXINE 30'S C 0.25 75MCG 0 2022-04-01 2024-03-31 0
40 29957 SYNTHROID 75MCG TAB (ABB/PHA) THYROXINE (C) 30'S C 0.2463 75MCG 2022-04-01 2023-03-31 No No Delete from contract 0