Displaying 3041 - 3060 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
41 4582A BERIATE 500IU INJ (CSL) FACTOR VIII (BQ) 10ML VIAL BQ 244.6492 500IU 12 2024-04-01 2026-03-31 0
40 4582P HEMOREL A 500IU INJ (RLS/AHI) FACTOR VIII 500IU VIAL BQ 330.28 500IU 0 2022-04-01 2024-03-31 0
41 4582P HEMOREL A 500IU INJ (RLS) FACTOR VI (BQ) 500IU VIAL BQ 305.8115 500IU 12 2024-04-01 2026-03-31 0
42 4582P HEMOREL A 500IU INJ (RLS) FACTOR VI 500IU VIAL BQ 309.48 500IU 12 2026-04-01 No No 0
41 4582Q XYNTHA 500IU INJ (PFI) FACTOR VIII (C) 500IU VIAL C 1065.882 500IU 12 2024-04-01 2026-03-31 0
42 4582T BERIATE 500IU INJ (CSL) FACTOR VIII 500IU VIAL BQ 244.65 500IU 12 2026-04-01 No No Add to Contract 0
40 46121 IMOVAX POLIO (AVP/COL) POLIOMYELITIS 1 DOSE B 24.46 80AU 0 2022-04-01 2024-03-31 0
41 46121 IMOVAX POLIO (AVP) POLIOMYELITIS 1 DOSE B 24.4649 80AU 1 2024-04-01 2024-10-21 0
40 4621BC XANAX 0.5MG TAB (PFI/SBI) ALPRAZOLAM 100'S C 0.47 0.5MG 0 2022-04-01 2024-03-31 0
41 4621BC XANAX 0.5MG TAB (PFI) ALPRAZOLAM (C) 100'S C 0.4836 0.5MG 30 2024-04-01 2026-03-31 6
42 4621CQ XANAX 0.5MG TAB (PFI) ALPRAZOLAM (C) 10X10 C 0.48 0.5MG 30 2026-04-01 No No 6
40 4621L XANAX 0.5MG TAB (PFI/STO) ALPRAZOLAM 100'S C 0.47 0.5MG 0 2022-04-01 2024-03-31 0
41 4621L XANAX 0.5MG TAB (PFI) ALPRAZOLAM (C) 100'S C 0.4836 0.5MG 30 2024-04-01 2026-03-31 6
40 4621R APO-ALPRAZ 0.5MG TAB (APO/COL) 1000'S A 0.04 0.5MG 30 2022-04-01 2024-03-31 6
42 4621R APO-ALPRAZ 0.5MG TAB (APO) 1000'S A 0.05 0.5MG 30 2026-04-01 No No 6
41 4621V APO-ALPRAZ 0.5MG TAB (APO) 1000'S A 0.0377 0.5MG 30 2024-04-01 2026-03-31 6
40 4622S LORAZEPAM 2MG/ML INJ (KWA/ATB) 10X1ML B 3.82 2MG/ML 0 2022-04-01 2024-03-31 0
41 4622S LORAZEPAM 2MG/ML INJ (KWA) (B) 10X1ML B 3.0907 2MG/ML 1 2024-04-01 2026-03-31 0
40 4622U LORAZEPAM 2MG/ML INJ (FSB/ATB) 1ML VIAL B 4.02 2MG/ML 0 2022-05-27 2024-03-31 Price Change 0
40 46241 APO-ALPRAZ 0.25MG TAB (APO/COL) 100'S A 0.05 0.25MG 30 2022-04-01 2024-03-31 6