Displaying 2581 - 2600 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 4043A BSS (BAG) SOLN (ALC) BALANCED SALT 500ML BQ 32.10 10 2026-04-01 No No 0
40 40517 POENCANIA 0.5% EYE DR (LPO/COL) PROPARACAINE 10ML A 8.43 0.5% 1 2022-04-01 2024-03-31 6
41 4051C P-CAINE 0.5% EYE DR (SHC) PROPARACAINE 5ML A 3.1261 0.5% 1 2024-04-01 2026-03-31 6
42 4051C P-CAINE 0.5% EYE DR (SHC) PROPARACAINE 5ML A 3.26 0.5% 1 2026-04-01 No No 6
40 40613 ALLEREX 0.05% | 0.04% EYE DR (ASL/PHA) ANTAZOLI 10ML A 5.79 0.05%|0.04% 1 2022-04-01 2024-03-31 6
41 40613 ALLEREX 0.05%|0.04% EYE DR (ASL) ANTAZOL 10ML A 8.8074 0.05%|0.04% 1 2024-04-01 2026-03-31 6
42 40613 ALLEREX 0.05%|0.04% EYE DR (ASL) ANTAZOLINE|TETRAHYDROZOLINE 10ML A 8.13 0.05%|0.04% 1 2026-04-01 No No 6
41 4061F OPTICOOL 0.05%|0.12% EYE DR (SHC) NAPHAZOLINE|PHENYLEPHRINE 10ML A 3.5882 0.05%|0.12% 1 2024-04-01 2026-03-31 0
42 4061H ANTAZOLINE|NAPHAZOLINE 0.5%|0.05% EYE DR (FSB) 10ML A 6.14 0.5%|0.05% 1 2026-04-01 No No Add to Contract as Cat A 6
40 40712 TIMOLOL EX 0.25% EYE DR (FSB/ATB) 5ML A 1.09 0.25% 1 2022-04-01 2024-03-31 Price Change 6
42 40713 OPTIMOL 0.25% EYE DR (ASL) TIMOLOL 5ML A 8.15 0.25% 2 2026-04-01 2028-03-31 No No 6
40 4073X POENTIMOL 0.5% EYE DR (LPO/COL) TIMOLOL 5ML C 5.44 0.5% 0 2022-04-01 2024-03-31 Add to Contract as Cat C 0
40 4074AG TIMOLOL 0.25% EYE DR (FSB/ATB) 10ML A 1.60 0.25% 1 2022-04-01 2024-03-31 Price Change 6
41 4074AG TIMOLOL 0.25% EYE DR (FSB) 10ML A 1.6582 0.25% 1 2024-04-01 2026-03-31 6
42 4074AH TIMOLOL 0.25% EYE DR (FSB) 10ML A 1.36 0.25% 1 2026-04-01 No No Add to Contract as Cat A 6
40 40919 GLYCEROL ADULT 4G SUPPOS (MTP/COL) GLYCERINE 12'S A 0.39 4G 12 2022-06-02 2024-03-31 Add to Contract as Cat A 6
40 4091R GLYCERINE ADULT 2G SUPPOS (FLE/AHI) GLYCERINE 12'S A 0.21 2G 12 2022-04-01 2024-03-31 6
42 4091S GLYCEROL 4G SUPPOS (MTP) GLYCERINE 12'S A 0.79 4G 12 2026-04-01 No No 6
40 4092H GLYCERINE PAED 1G SUPPOS (FLE/AHI) GLYCERINE 12'S A 0.24 1G 12 2022-04-01 2024-03-31 0
42 4092J GLYCEROL 1G SUPPOS (MTP) GLYCERINE 12'S A 0.66 1G 12 2026-04-01 No No 0