Displaying 3721 - 3740 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 5693FF VALOVERA 500MG TAB (JLP) VALACYCLOVIR 10X10 A 0.52 500MG 42 2026-04-01 No No 0
40 5693S VALTREX 500MG TAB (GSK/COL) VALACYCLOVIR 42'S C 5.99 500MG 0 2022-04-01 2024-03-31 0
41 5693S VALTREX 500MG TAB (GSK) VALACYCLOVIR (C) 42'S C 6.5893 500MG 42 2024-04-01 2026-03-31 0
42 5693S VALTREX 500MG TAB (GSK) VALACYCLOVIR 42'S C 6.92 500MG 42 2026-04-01 No No 0
40 56944 ZOVIRAX 5% CR (GSK/COL) ACYCLOVIR 5G C 20.93 5% 0 2022-04-01 2024-03-31 0
41 56944 ZOVIRAX 5% CR (GSK) ACYCLOVIR (C) 5G C 23.0242 5% 2 2024-04-01 2026-03-31 0
42 56944 ZOVIRAX 5% CR (GSK) ACYCLOVIR 5G C 25.50 5% 2 2026-04-01 No No Price Change 0
40 56949 CYCLOVAX 5% CR (REM/SBI) ACYCLOVIR 10G A 3.07 5% 2 2022-04-01 2024-03-31 0
41 56949 CYCLOVAX 5% CR (REM) ACYCLOVIR 10G A 3.0717 5% 2 2024-04-01 2026-03-31 0
42 5694AF ACYCLOVIR 5% CR (HEA) 5G A 1.41 5% 2 2026-04-01 No No 0
42 5694AG ACYCLOVIR 5% CR (CIR) 10G A 3.67 5% 2 2026-04-01 No No 0
42 5694AH ACYCLOVIR 5% CR (HEA) 5G TUBE A 1.41 5% 2 2026-04-01 No No Add to Contract as Cat A 0
42 5694AJ ACYCLOVIR 5% CR (FSB) 5G A 1.09 5% 2 2026-04-01 No No Add to Contract as Cat A 0
42 5694AK ACYCLOVIR 5% CR (HEA) 5G A 1.41 5% 2 2026-04-01 No No Add to Contract as Cat A 0
40 5694G ACYCLOVIR 5% CR (HEA/RXP) 5G A 2.58 5% 2 2022-04-01 2024-03-31 0
40 5694U ACYCLOVIR 5% CR (KWA/ATB) 4G A 2.31 5% 2 2022-04-01 2024-03-31 0
40 5694Z ACYCLOVIR 5% CR (HEA/ATB) 5G A 2.58 5% 2 2022-07-12 2024-03-31 No No la 0
41 5694Z ACYCLOVIR 5% CR (HEA) 5G A 1.4679 5% 2 2024-04-01 2026-03-31 0
40 56955 ACYVIR 3% EYE OINT (ARP/AHI) ACYCLOVIR 5G A 8.02 3% 2 2022-04-01 2024-03-31 0
41 56956 OPTIVIRAL 3% EYE OINT (SPC) ACYCLOVIR 5G A 1.1417 3% 2 2024-04-01 2026-03-31 0