Displaying 3461 - 3480 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 5274AA LYRICA 150MG CAP (PFI) PREGABALIN 28'S C 3.66 150MG 120 2026-04-01 No No 6
41 5274N PREGASAFE 150MG CAP (MSN) PREGABALIN (B) 3X10 B 0.1812 150MG 120 2024-04-01 2026-03-31 6
40 5274P PREGABALIN 150MG TAB (MCP/AHI) 3X10 B 0.19 150MG 0 2022-04-01 2024-03-31 6
40 52761 LYRICA 300MG TAB (PFI/STO) PREGABALIN 28'S C 5.49 300MG 0 2022-04-01 2024-03-31 0
41 52761 LYRICA 300MG TAB (PFI) PREGABALIN (C) 28'S C 5.5347 300MG 60 2024-04-01 2026-03-31 6
40 52763 LYRICA 300MG TAB (PFI/SBI) PREGABALIN 28'S C 5.49 300MG 0 2022-04-01 2024-03-31 0
41 52763 LYRICA 300MG TAB (PFI) PREGABALIN (C) 28'S C 5.5347 300MG 60 2024-04-01 2026-03-31 6
40 52764 APO-PREGABALIN 300MG CAP (APO/COL) 100'S B 0.60 300MG 0 2022-04-01 2024-03-31 6
41 52765 PMS-PREGABALIN 300MG CAP (PMS) (B) 100'S B 0.318 300MG 60 2024-04-01 2026-03-31 6
42 52765 PMS-PREGABALIN 300MG CAP (PMS) 100'S C 0.24 300MG 60 2026-04-01 No No 6
40 52816 FUCITHALMIC 1% EYE DR (ANT/COL) FUSIDIC ACID 5G A 14.95 1% 1 2022-04-01 2024-03-31 0
42 52816 FUCITHALMIC 1% EYE DR (ANT) FUSIDIC ACID 5G A 8.83 1% 1 2026-04-01 No No 0
40 5281AA VISAG 0.1% EYE DR (LPO/COL) AZITHROMYCIN 2.5ML BQ 8.43 0.1% 0 2022-04-01 2024-03-31 6
41 5281AA VISAG 0.1% EYE DR (LPO) AZITHROMYCIN (BQ) 2.5ML BQ 8.4268 0.1% 1 2024-04-01 2026-03-31 0
42 5281AA VISAG 0.1% EYE DR (LPO) AZITHROMYCIN 2.5ML BQ 20.39 0.1% 1 2026-04-01 No No 0
40 5281BB MOXICIP 0.5% EYE DR (CIP/AHI) MOXIFLOXACIN 5ML BQ 10.60 0.5% 0 2022-04-01 2022-09-30 0
40 5281BK GATIF FORTE 0.3% DROPS (LPO/COL) GATIFLOXACIN 5ML C 9.51 0.3% 0 2022-04-01 2024-03-31 0
41 5281BK GATIF FORTE 0.3% EYE DR (LPO) GATIFLOXACIN (C) 5ML C 10.4655 0.3% 0 2024-04-01 2026-03-31 0
42 5281BU CIPROFLOXACIN 0.3% EYE DR (CIP) 10ML BQ 1.25 0.3% 0 2026-04-01 No No 0
40 5281BV APROCIN 0.3% EYE DR (ARP/AHI) CIPROFLOXACIN 10ML BH 8.15 0.3% 0 2022-04-01 2022-09-30 0