Displaying 2341 - 2360 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 3633AG METOCLOPRAMIDE 5MG/ML IV/IM INJ (MO 10X2ML B 0.65 5MG/ML IV/IM 0 2026-04-01 No No 0
41 3633AV METOCLOPRAMIDE 5MG/ML IV/IM INJ (FSB) (B) 10X2ML B 0.4322 5MG/ML IV/IM 0 2024-04-01 2026-03-31 0
40 3653AJ RYNASE AQ 64MCG NASAL SP (CAR/COL) BUDESONIDE 240 DOSES A 15.98 64MCG 1 2022-04-01 2024-03-31 6
41 3653AJ RYNASE AQ 64MCG NASAL SP (CAR) BUDESONID 240 DOSES A 16.2556 64MCG 1 2024-04-01 2026-03-31 6
42 3653AJ RYNASE AQ 64MCG NASAL SP (CAR) BUDESONID 240 DOSES A 16.26 64MCG 1 2026-04-01 No No 6
40 3653BJ AVAMYS 27.5MCG NASAL SP (GSK/COL) FLUTICASONE 120 DOSES C 25.14 27.5MCG 0 2022-04-01 2024-03-31 0
41 3653BJ AVAMYS 27.5MCG NASAL SP (GSK) FLUTICASON (C) 120 DOSES C 26.6668 27.5MCG 1 2024-04-01 2026-03-31 6
42 3653BJ AVAMYS 27.5MCG NASAL SP (GSK) FLUTICASONE 120 DOSES C 29.33 27.5MCG 1 2026-04-01 No No 6
40 3653BK RYNASE AQ 32MCG NASAL SP (CAR/COL) BUDESONIDE 120 DOSES C 8.15 32MCG 0 2022-04-01 2024-03-31 0
41 3653BK RYNASE AQ 32MCG NASAL SP (CAR) BUDESONID (C) 120 DOSES C 8.4268 32MCG 1 2024-04-01 2026-03-31 6
40 3653C NASASONE MF 50MCG NASAL SP (CAR/COL) MOMETASO 140 DOSES C 9.65 50MCG 0 2022-04-01 2024-03-31 0
41 3653C NASASONE MF 50MCG NASAL SP (CAR) MOMETAS 140 DOSES A 9.2423 50MCG 1 2024-04-01 2026-03-31 6
42 3653C NASASONE MF 50MCG NASAL SP (CAR) MOMETAS 140 DOSES C 9.24 50MCG 1 2026-04-01 No No 6
42 3653CD BUDESONIDE 64MCG NASAL SP (CIR) 200 DOSES A 14.43 64MCG 1 2026-04-01 No No 6
40 3653CE FLUTICASONE 27.5MCG NASAL SP (CIR/AHI) 200 DOSES A 14.68 27.5MCG 1 2022-04-01 2022-09-30 6
41 3653CE FLUTICASONE 27.5MCG NASAL SP (CIR) 200 DOSES A 14.1353 27.5MCG 1 2024-04-01 2026-03-31 6
40 3653CF FLUTICASONE 50MCG NASAL SP (CIR/AHI) 200 DOSES A 14.08 50MCG 1 2022-04-01 2024-03-31 6
41 3653CF FLUTICASONE 50MCG NASAL SP (CIR) 200 DOSES A 15.277 50MCG 1 2024-04-01 2026-03-31 6
40 3653CK MOMETASONE 50MCG NASAL SP (BCH/COL) 140 DOSES A 9.08 50MCG 1 2022-04-01 2024-03-31 Add to Contract as Cat A 6
40 3653CS FLUTICASONE 27.5MCG NASAL SP (ARP/AHI) 120 DOSES A 12.99 27.5MCG 1 2022-04-01 2024-03-31 6