Displaying 2361 - 2380 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
40 3653CT NASONEX 50MCG NASAL SP (MSD/STO) MOMETASONE 120 DOSES C 17.07 50MCG 0 2022-04-01 2024-03-31 0
41 3653CT NASONEX 50MCG NASAL SP (MSD) MOMETA (C) 120 DOSES C 17.2614 50MCG 1 2024-04-01 2026-03-31 6
42 3653CT NASONEX 50MCG NASAL SP (MSD) MOMET (C) 120 DOSES C 17.26 50MCG 1 2026-04-01 No No 6
41 3653CW APO-MOMETASONE 50MCG NASAL SP (APO) 140 DOSES A 7.8288 50MCG 1 2024-04-01 2026-03-31 6
42 3653DG NEOTISON 27.5MCG NASAL SP (INC) FLUTICASONE 120 DOSES A 8.97 27.5MCG 1 2026-04-01 No No 6
42 3653DK FLUBREATH 50MCG NASAL SP (JLP) FLUTICASONE 120 DOSES A 4.57 50MCG 1 2026-04-01 No No 6
42 3653DL NAZERELIEF 50MCG NASAL SP (JLP) MOMETASONE 100 DOSES A 2.20 50MCG 1 2026-04-01 No No 6
40 3653P FLIXONASE 50MCG NASAL SP (GSK/COL) FLUTICASON 120 DOSES A 12.91 50MCG 1 2022-04-01 2024-03-31 6
41 3653P FLIXONASE 50MCG NASAL SP (GSK) FLUTICASO 120 DOSES A 13.6732 50MCG 1 2024-04-01 2024-07-25 6
40 3653T NASACORT AQ 55MCG NASAL SP (SFA/COL) TRIAMCIN 120 DOSES A 12.23 55MCG 1 2022-04-01 2024-03-31 6
40 36551 BRIXIA 0.05% EYE DR (LPO/COL) AZELASTINE 6ML A 6.25 0.05% 1 2022-04-01 2024-03-31 6
41 36551 BRIXIA 0.05% EYE DR (LPO) AZELASTINE 6ML A 6.8774 0.05% 1 2024-04-01 2026-03-31 6
42 36551 BRIXIA 0.05% EYE DR (LPO) AZELASTINE 6ML A 19.03 0.05% 1 2026-04-01 No No 6
40 36613 LIPOFUNDIN 20% INJ (BRA/COL) SOYA BEAN OIL 500ML BQ 34.39 20% 0 2022-04-01 2024-03-31 0
41 36613 LIPOFUNDIN 20% INJ (BRA) SOYA BEAN OIL 500ML BQ 41.2642 20% 0 2024-04-01 2026-03-31 0
42 36613 LIPOFUNDIN 20% INJ (BRA) SOYA BEAN OIL 500ML BQ 65.24 20% 0 2026-04-01 No No 0
40 3681G NALOXONE 0.4MG/ML INJ (RTM/PHA) 10X1ML BQ 4.925 0.4MG/ML 2022-04-01 2024-03-31 No No Add to Contract as Cat B
41 3681G NALOXONE 0.4MG/ML INJ (RTM) (B) 10X1ML B 5.7302 0.4MG/ML 0 2024-04-01 2026-03-31 0
42 3681G NALOXONE 0.4MG/ML INJ (RTM) 10X1ML B 4.08 0.4MG/ML 0 2026-04-01 No No 0
41 3681Q N-XONE 0.4MG/ML INJ (VEV) NALOXONE (B) 10X1ML B 4.7299 0.4MG/ML 0 2024-04-01 2026-03-31 0