Displaying 3221 - 3240 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 50838 PRIMOTESTON 250MG/ML INJ (BSP) TESTOSTER 250MG AMP BQ 36.43 250MG/ML 4 2026-04-01 No No 0
40 5083C TESTOSTERONE 250MG/ML INJ (RTM/PHA) 10X1ML BQ 14.08 250MG/ML 0 2022-04-01 2024-03-31 0
41 5083C TESTOSTERONE 250MG/ML INJ (RTM) (BQ) 10X1ML BQ 15.7337 250MG/ML 4 2024-04-01 2026-03-31 6
41 5083D SOSTENON 250MG/ML INJ (ASG) TESTOSTERONE (BQ) 250MG PFS BQ 34.1693 250MG/ML 4 2024-04-01 2026-03-31 6
41 51115 PROPYLTHIOURACIL 50MG TAB (MCP) 10X10 A 0.2025 50MG 270 2024-04-01 2026-03-31 6
40 51118 PROPYLTHIOURACIL 50MG TAB (HAL/COL) 100'S A 0.25 50MG 270 2022-04-01 2024-03-31 6
41 51118 PROPYLTHIOURACIL 50MG TAB (HAL) (C) 100'S C 0.252 50MG 270 2024-04-01 2026-03-31 6
42 5111A PROPYLTHIOURACIL 50MG TAB (HAL) 56'S A 0.26 50MG 270 2026-04-01 No No 6
40 51311 XALACOM 0.005% /0.5% EYE DR (PFI/STO) LATANOP 2.5ML C 28.68 0.005%|0.5% 0 2022-04-01 2024-03-31 0
40 51311 XALACOM 0.005% /0.5% EYE DR (PFI/STO) LATANOP 2.5ML C 37.89 0.005%|0.5% 0 2022-07-27 2024-03-31 Price Change 0
41 51311 XALACOM 0.005%|0.5% EYE DR (PFI) LATANOPROST|TIMOLOL (C) 2.5ML C 34.5771 0.005%|0.5% 1 2024-04-01 2026-03-31 Yes 6
40 51313 LOUTEN T 0.005% | 0.5% EYE DR (LPO/COL) LATANOP 2.5ML A 13.05 0.005%|0.5% 1 2022-04-01 2024-03-31 6
41 51313 LOUTEN T 0.005%|0.5% EYE DR (LPO) LATANO 2.5ML A 14.3528 0.005%|0.5% 1 2024-04-01 2026-03-31 Yes 6
42 51313 LOUTEN T 0.005%|0.5% EYE DR (LPO) LATANOPROST|TIMOLOL 2.5ML C 17.67 0.005%|0.5% 1 2026-04-01 No No 6
40 51316 XALACOM 0.005% /0.5% EYE DR (PFI/SBI) LATANOP 2.5ML C 37.90 0.005%|0.5% 0 2022-04-01 2024-03-31 Price Change 0
41 51316 XALACOM 0.005%|0.5% EYE DR (PFI) LATANOPROST|TIMOLOL (C) 2.5ML C 34.5771 0.005%|0.5% 1 2024-04-01 2026-03-31 Yes 6
42 5131BL LATANOPROST|TIMOLOL EYE DR (MTP) 2.5ML A 8.86 0.005%|0.5% 1 2026-04-01 No No 6
40 5131L DUOTRAV 0.5% | 0.004% EYE DR (NVS/COL) TIMOLOL | 2.5ML C 32.46 0.5%|0.004% 0 2022-04-01 2024-03-31 0
41 5131L DUOTRAV 0.5%|0.004% EYE DR (NVS) TI (C) 2.5ML C 32.4568 0.5%|0.004% 1 2024-04-01 2026-03-31 6
42 5131L DUOTRAV 0.5%|0.004% EYE DR (NVS) TI 2.5ML C 32.46 0.5%|0.004% 1 2026-04-01 No No 6