Displaying 4161 - 4180 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 61111 OVOL 40MG/ML DROPS (CDC/COL) SIMETHICONE 15ML A 6.80 40MG/ML 1 2022-04-01 2024-03-31 6
41 61111 OVOL 40MG/ML DROPS (CDC) SIMETHICONE 15ML A 6.9589 40MG/ML 1 2024-04-01 2026-03-31 6
42 61111 OVOL 40MG/ML DROPS (CDC) SIMETHICONE 15ML A 7.99 40MG/ML 1 2026-04-01 No No 6
40 61114 OVOL 40MG/ML DROPS (CDC/COL) SIMETHICONE 30ML C 8.56 40MG/ML 0 2022-04-01 2024-03-31 0
41 61114 OVOL 40MG/ML DROPS (CDC) SIMETHICONE (C) 30ML C 8.6715 40MG/ML 1 2024-04-01 2026-03-31 6
40 6111A SIMETHICONE 40MG/ML SYR (KWA/ATB) 30ML C 8.02 40MG/ML 0 2022-04-01 2024-03-31 0
40 61211 COMBIGAN 0.2% | 0.5% EYE DR (ALL/COL) BRIMONIDINE | TIMOLOL 5ML C 37.11 0.2%|0.5% 0 2022-04-01 2024-03-31 0
41 61211 COMBIGAN 0.2%|0.5% EYE DR (ALL) BRIMONIDINE|TIMOLOL (C) 5ML C 37.1051 0.2%|0.5% 1 2024-04-01 2026-03-31 6
42 61211 COMBIGAN 0.2%|0.5% EYE DR (ALL) BR (C) 5ML C 37.11 0.2%|0.5% 1 2026-04-01 No No 6
40 6121C BRIMONIDINE | TIMOLOL 0.2% | 0.5% EYE DR (FSB/ATB 10ML A 8.70 0.2%|0.5% 1 2022-04-01 2024-03-31 6
41 6121C BRIMONIDINE|TIMOLO 0.2%|0.5% EYE DR (FSB 10ML A 7.5569 0.2%|0.5% 1 2024-04-01 2026-03-31 6
41 6121F AB PRESS PRESERVATIVE FREE 0.2%|0.5% EYE DR (RLP) BRIMONIDIN 10ML A 12.7218 0.2%|0.5% 1 2024-04-01 2026-03-31 6
42 6121F AB PRESS PF 0.2%|0.5% EYE DR (RLP) BRIMONIDINE|TIMOLOL 10ML A 13.62 0.2%|0.5% 1 2026-04-01 No No 6
41 6121G BRIMODIN PLUS 0.2%|0.5% EYE DR (INC) BRIMONIDINE|TIMOLOL 5ML A 5.3823 0.2%|0.5% 1 2024-04-01 2026-03-31 6
40 61312 ANDROCUR 50MG TAB (BSP/AHI) CYPROTERONE 50'S C 1.71 50MG 0 2022-04-01 2024-03-31 0
41 61312 ANDROCUR 50MG TAB (BSP) CYPROTERONE (C) 50'S C 1.7125 50MG 180 2024-04-01 2026-03-31 6
40 6131F ANDROCUR 50MG TAB (BSP/COL) CYPROTERONE 50'S C 1.71 50MG 0 2022-04-01 2024-03-31 0
41 6131F ANDROCUR 50MG TAB (BSP) CYPROTERONE (C) 50'S C 1.7125 50MG 180 2024-04-01 2026-03-31 6
42 6131F ANDROCUR 50MG TAB (BSP) CYPROTERONE 50'S C 1.71 50MG 180 2026-04-01 No No 6
41 6131R AAP-CYPROTERONE 50MG TAB (APO) 100'S A $0.5371 50MG 180 6