Displaying 3061 - 3080 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 46241 APO-ALPRAZ 0.25MG TAB (APO) ALPRAZO 100'S A 0.05 0.25MG 30 2026-04-01 No No 6
41 4624D APO-ALPRAZ 0.25MG TAB (APO) 100'S A 0.0487 0.25MG 30 2024-04-01 2026-03-31 6
42 4624E ALPRAZOLAM 0.25MG TAB (FSB) 100'S A 0.05 0.25MG 30 2026-04-01 No No Add to Contract as Cat A 6
40 46251 APO-ALPRAZ 1MG TAB (APO/COL) 100'S A 0.08 1MG 30 2022-04-01 2024-03-31 6
42 46251 APO-ALPRAZ 1MG TAB (APO) ALPRAZOLAM 100'S A 0.08 1MG 30 2026-04-01 No No 6
40 46255 APO-LORAZEPAM 1MG TAB (APO/COL) 1000'S A 0.04 1MG 240 2022-04-01 2024-03-31 6
42 46255 APO-LORAZEPAM 1MG TAB (APO) LORAZEP 1000'S A 0.04 1MG 240 2026-04-01 No No 6
40 46259 LORIVAN 1MG TAB (REM/SBI) LORAZEPAM 100x10 A 0.03 1MG 240 2022-04-01 2024-03-31 6
41 46259 LORIVAN 1MG TAB (REM) LORAZEPAM 100X10 A 0.0332 1MG 240 2024-04-01 2026-03-31 6
40 4625B LORIVAN 1MG TAB (REM/SBI) LORAZEPAM 10x10 C 0.05 1MG 0 2022-04-01 2024-03-31 0
41 4625B LORIVAN 1MG TAB (REM) LORAZEPAM 10X10 A 0.0313 1MG 240 2024-04-01 2026-03-31 6
42 4625B LORIVAN 1MG TAB (REM) LORAZEPAM 10X10 A 0.04 1MG 240 2026-04-01 No No 6
41 4625D APO-ALPRAZ 1MG TAB (APO) ALPRAZOLAM 100'S A 0.0832 1MG 30 2024-04-01 2026-03-31 6
41 4625E APO-LORAZEPAM 1MG TAB (APO) LORAZEP 1000'S A 0.0388 1MG 240 2024-04-01 2026-03-31 6
42 46319 DESIRE 82G GEL (HEA) GLYCERINE 82G B 3.23 1 2026-04-01 No No Price Change 0
41 4631AA LUBRICATING JELLY (CHC) (B) 120G B 4.8658 0 2024-04-01 2026-03-31 0
41 4631AB LUBRICATING JELLY (KWA) (B) 120G B 5.5454 1% 0 2024-04-01 2026-03-31 0
42 4631AC LUBRI-EZE GEL TUBE (INF) LUBRICATING JELLY 30G B 2.69 1% 1 2026-04-01 No No 0
42 4631AD DESIRE JELLY (HEA) LUBRICATING JELLY 82G B 3.23 0 2026-04-01 No No Add to Contract as Cat B 0
42 4631AE DESIRE GEL (HEA) GLYCERINE 82G B 3.23 0 2026-04-01 No No Add to Contract as Cat B 0