Displaying 3081 - 3100 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 | 4631B | AQUAGEL (ECO/COL) LUBRICATING JELLY | 82G | B | 3.29 | 0 | 2022-04-01 | 2024-03-31 | 0 | |||||
| 40 | 4631N | DESIRE JELLY (HEA/ATB) LUBRICATING JELLY(B) | 82G | B | 3.26 | 2022-12-07 | 2024-03-31 | No | No | Change Local Agent | 0 | |||
| 41 | 4631N | DESIRE JELLY (HEA) LUBRICATING JELLY (B) | 82G | B | 3.3164 | 0 | 2024-04-01 | 2026-03-31 | 0 | |||||
| 40 | 4631Y | DESIRE JELLY (HEA/RXP) LUBRICATING JELLY | 82G | B | 3.26 | 0 | 2022-04-01 | 2024-03-31 | 0 | |||||
| 40 | 47014 | REFRESH LIQUIGEL 1% EYE DR (ALL/COL) HYPROMEL | 15ML | A | 11.55 | 1% | 1 | 2022-04-01 | 2024-03-31 | 6 | ||||
| 41 | 47014 | REFRESH LIQUIGEL 1% EYE DR (ALL) HYPROME (B) | 15ML | B | 11.5529 | 1% | 1 | 2024-04-01 | 2026-03-31 | 6 | ||||
| 42 | 47014 | REFRESH LIQUIGEL 1% EYE DR (ALL) HYPROME | 15ML | B | 11.55 | 1% | 1 | 2026-04-01 | No | No | 6 | |||
| 40 | 4701AP | TEARS NATURALE FORTE EYE DR (ALC/AHI) DEXTRAN | GLYCERINE | HYPROMELLOSE | 15ML | C | 13.32 | 0.1%|0.2%|0.9% | 0 | 2022-04-01 | 2024-03-31 | 0 | ||||
| 40 | 4701AQ | TEARS NATURALE II 0.1% | 0.3% EYE DR (ALC/AHI) DEXTRAN | HYPROMELLOSE | 15ML | C | 12.67 | 1MG/ML|3MG/ML | 0 | 2022-04-01 | 2024-03-31 | 0 | ||||
| 41 | 4701AQ | TEARS NATURALE II 0.1%|0.3% EYE DR (ALC) DEXTRAN|HYPROMELLOS (C) | 15ML | C | 17.8866 | 1MG/ML|3MG/ML | 1 | 2024-04-01 | 2026-03-31 | 6 | ||||
| 42 | 4701AQ | TEARS NATURALE II 0.1%|0.3% EYE DR (ALC) DEXTRAN 70|HYPROMEL | 15ML | C | 16.31 | 0.1%|0.3% | 0 | 2026-04-01 | No | No | 0 | |||
| 40 | 4701AR | SYSTANE 0.4% | 0.3% EYE DR (ALC/AHI) POLYETHYLENE GLYCOL 400 | PROPYLENE GLYCOL | 15ML | C | 17.75 | 0.4%|0.3% | 0 | 2022-04-01 | 2024-03-31 | 0 | ||||
| 41 | 4701AR | SYSTANE 0.4%|0.3% EYE DR (ALC) POLYETHYLENE GLYCOL 400|PROPY (C) | 15ML | C | 20.2515 | 0.4%|0.3% | 1 | 2024-04-01 | 2026-03-31 | 6 | ||||
| 42 | 4701AR | SYSTANE 0.4%|0.3% EYE DR (ALC) POLYETHYLENE GLYCOL 400|PROPY | 15ML | C | 18.89 | 0.4%|0.3% | 1 | 2026-04-01 | No | No | 6 | |||
| 40 | 4701AS | SYSTANE GEL DROPS 0.4% | 0.3% EYE DR (ALC/AHI) | 10ML | C | 16.26 | 0.4%|0.3% | 0 | 2022-04-01 | 2024-03-31 | 0 | ||||
| 41 | 4701AS | SYSTANE GEL DROPS 0.4%|0.3% EYE DR (ALC) (C) | 10ML | C | 18.539 | 0.4%|0.3% | 1 | 2024-04-01 | 2026-03-31 | 6 | ||||
| 42 | 4701AS | SYSTANE GEL DROPS 0.4%|0.3% EYE DR | 10ML | C | 17.67 | 0.4%|0.3% | 1 | 2026-04-01 | No | No | 6 | |||
| 40 | 4701AT | SYSTANE ULTRA 0.4% | 0.3% EYE DR (ALC/AHI) POLYETHYLENE GLYCOL 400 | PROPYLENE G More ... | 10ML | C | 12.64 | 0.4%|0.3% | 0 | 2022-04-01 | 2024-03-31 | 0 | ||||
| 41 | 4701AT | SYSTANE ULTRA 0.4%|0.3% EYE DR (ALC) POLYETHYLENE GLYCOL 400 (C) | 10ML | C | 15.3313 | 0.4%|0.3% | 1 | 2024-04-01 | 2026-03-31 | 6 | ||||
| 42 | 4701AT | SYSTANE ULTRA 0.4%|0.3% EYE DR (ALC) POLYETHYLENE GLYCOL 400 | 10ML | C | 15.33 | 0.4%|0.3% | 1 | 2026-04-01 | No | No | 6 | |||