Displaying 2401 - 2420 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 | 3701BA | ACCU-CHEK INSTANT GLUC (PRI/STO) DIAGNOSTIC | 50'S | A | 42.30 | 1 | 2022-04-01 | 2024-03-31 | 6 | |||||
| 41 | 3701BA | ACCU-CHEK INSTANT GLUC (PRI) DIAGNOSTIC | 50'S | A | 42.2971 | 1 | 2024-04-01 | 2026-03-31 | 6 | |||||
| 42 | 3701BA | ACCU-CHEK INSTANT GLUC (PRI) DIAGNOSTIC | 50'S | A | 42.30 | 1 | 2026-04-01 | 2028-03-31 | No | No | 6 | |||
| 40 | 3701BE | SELECT FLEX PLUS GLUC (JOH/AAL) DIAGNOSTIC B | 50'S | A | 39.42 | 1 | 2022-04-01 | 2024-03-31 | 6 | |||||
| 41 | 3701BE | SELECT FLEX PLUS GLUC (JOH) DIAGNO | 50'S | A | 39.2254 | 1 | 2024-04-01 | 2026-03-31 | 6 | |||||
| 42 | 3701BE | SELECT FLEX PLUS GLUC (JOH) DIAGNO | 50'S | A | 40.39 | 1 | 2026-04-01 | 2028-03-31 | No | No | 6 | |||
| 40 | 3701U | SKY ERA GLUC (TTC/COL) DIAGNOSTIC BLOOD GLUC | 50'S | A | 38.00 | 1 | 2022-04-01 | 2024-03-31 | 6 | |||||
| 41 | 3701U | SKY ERA GLUC (TTC) DIAGNOSTIC BLOOD GLU | 50'S | A | 38.0022 | 1 | 2024-04-01 | 2026-03-31 | 6 | |||||
| 42 | 3701U | SKY ERA GLUC (TTC) DIAGNOSTIC BLOOD GLU | 50'S | A | 38.00 | 1 | 2026-04-01 | 2028-03-31 | No | No | 6 | |||
| 40 | 3701V | LIFESCAN ONE TOUCH ULTRA GLUC (JOH/AAL) DIAG | 50'S | A | 39.42 | 1 | 2022-04-01 | 2024-03-31 | 6 | |||||
| 40 | 3721B | DT ADULT (SII/COL) DIPHTHERIA/TETANUS | 1 DS VIAL | B | 13.32 | ≤2IU|≥40IU | 0 | 2022-04-01 | 2024-03-31 | 0 | ||||
| 41 | 3721B | DT ADULT ≤2IU|≥40IU INJ (SII) DIPHTHERIA TOXOID|TETANUS TOXO (B) | 1 DS VIAL | B | 13.3198 | ≤2IU|≥40IU | 0 | 2024-04-01 | 2026-03-31 | 0 | ||||
| 40 | 37314 | ADACEL TDaP INJ (AVP/COL) DIP/TET/PERT ACELL | 1 DOSE | B | 41.59 | 2.5MCG|2IU|20IU | 0 | 2022-04-01 | 2024-03-31 | 0 | ||||
| 41 | 37314 | ADACEL TDaP INJ (AVP) DIP/TET/PERT ACEL (B) | 1 DOSE | B | 39.1439 | 2.5MCG|2IU|20IU | 0 | 2024-04-01 | 2024-10-21 | 0 | ||||
| 40 | 37318 | BOOSTRIX PFS 8MCG | 2.5LF | 5LF INJ (GSK/COL) ACELLULAR PERTUSSIS | DIPHTHERIA T More ... | 1 DOSE | B | 55.45 | 8MCG|2.5LF|5LF | 0 | 2022-04-01 | 2024-03-31 | 0 | ||||
| 41 | 37318 | BOOSTRIX PFS 8MCG|2.5LF|5LF INJ (GSK) ACELLULAR PERTUSSIS|DI (B) | 1 DOSE | B | 58.7702 | 8MCG|2.5LF|5LF | 0 | 2024-04-01 | 2026-03-31 | 0 | ||||
| 42 | 37318 | BOOSTRIX PFS 8MCG|2.5LF|5LF INJ (GSK) ACELLULAR PERTUSSIS|DI | 1 DOSE | B | 59.01 | 8MCG|2.5LF|5LF | 0 | 2026-04-01 | No | No | 0 | |||
| 40 | 37419 | OSMITROL 10% INJ (BAX/STO) MANNITOL | 500ML | B | 12.75 | 10% | 0 | 2022-04-01 | 2024-03-31 | Add to Contract as Cat B | 0 | |||
| 41 | 37419 | OSMITROL 10% INJ (BAX) MANNITOL | 500ML | BQ | 14.5702 | 10% | 0 | 2024-04-01 | 2026-03-31 | 0 | ||||
| 40 | 3742E | OSMITROL (2D5632Q) 20% INJ (BAX/STO) MANNITOL | 250ML | BQ | 13.86 | 20% | 0 | 2022-04-01 | 2024-03-31 | 0 | ||||