Displaying 1 - 8 of 8
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 19412 URS-11 STRP (TED/COL) DIAGNOSTIC URINE 100'S B 28.54 0 2022-04-01 2024-03-31 0
41 19412 URS-11 STRP (TED) DIAGNOSTIC URINE (B) 100'S B 40.7749 0 2024-04-01 2026-03-31 0
40 19415 MEDI-TEST COMBI 10 STRP (SCN/PHA) DIAGNOSTIC URINE 100'S B 15.22 0 2022-04-01 2022-07-18 0
40 19415 MEDI-TEST COMBI 10 STRP (SCN/PHA) DIAGNOSTIC URINE 100'S B 20.44 0 2022-07-19 2024-03-31 Price Change 0
41 19415 MEDI-TEST COMBI 10 STRP (SCN) DIAGNOSTIC URINE (B) 100'S B 25.1 0 2024-04-01 2026-03-31 0
40 1941B MULTISTIX 10SG STRP (BYC/AHI) DIAGNOSTIC URINE 100'S C 62.52 0 2022-04-01 2024-03-31 0
41 1941B MULTISTIX 10SG STRP (BYC) DIAGNOSTIC URINE (C) 100'S C 62.5215 0 2024-04-01 2026-03-31 0
40 1941G MEDI-TEST COMBI-10 STRP (SCN/PHA) DIAGNOSTIC URINE 50'S B 15.22 0 2022-04-01 2024-03-31 0