Displaying 4221 - 4240 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
41 64212 NEORAL 100MG/ML SOLN (NVS) CYCLOSPORIN 50ML BQ 475.7067 100MG/ML 0 2024-04-01 2026-03-31 0
42 64212 NEORAL 100MG/ML SOLN (NVS) CYCLOSPORIN 50ML BQ 475.71 100MG/ML 0 2026-04-01 No No 0
40 64225 NEORAL 25MG TAB (NVS/COL) CYCLOSPORIN 50'S BQ 2.70 25MG 0 2022-04-01 2024-03-31 6
41 64225 NEORAL 25MG TAB (NVS) CYCLOSPORIN (BQ) 50'S BQ 2.7036 25MG 0 2024-04-01 2026-03-31 0
42 64225 NEORAL 25MG TAB (NVS) CYCLOSPORIN 50'S BQ 2.70 25MG 0 2026-04-01 No No 0
40 6422B NEORAL 100MG TAB (NVS/COL) CYCLOSPORIN 50'S BQ 10.60 100MG 0 2022-04-01 2024-03-31 6
41 6422B NEORAL 100MG TAB (NVS) CYCLOSPORIN (BQ) 50'S BQ 10.5977 100MG 0 2024-04-01 2026-03-31 0
42 6422B NEORAL 100MG TAB (NVS) CYCLOSPORIN 50'S BQ 10.60 100MG 0 2026-04-01 No No 0
40 64231 RESTASIS 0.05% EYE (ALL/COL) CYCLOSPORIN 30X0.4ML C 2.27 0.05% 0 2022-04-01 2024-03-31 0
41 64231 RESTASIS 0.05% EYE DR (ALL) CYCLOSP (C) 30X0.4ML C 2.2653 0.05% 0 2024-04-01 2026-03-31 0
42 64231 RESTASIS 0.05% EYE DR (ALL) CYCLOSPORIN 30X0.4ML C 2.27 0.05% 0 2026-04-01 No No 0
41 64235 CLOSPORIL 0.1% EYE DR (LPO) CYCLOSPORIN (C) 5ML C 10.0578 0.1% 0 2024-04-01 2026-03-31 0
42 64235 CLOSPORIL 0.1% EYE DR (LPO) CYCLOSPORIN 5ML C 16.31 0.1% 0 2026-04-01 No No 0
41 6432D FOLINIC ACID 50MG INJ (ZUV) CALCIUM FOLI (BQ) 50MG VIAL BQ 5.5726 50MG 0 2024-04-01 2026-03-31 0
42 6432D FOLINIC ACID 50MG INJ (ZUV) CALCIUM FOLI 50MG VIAL BQ 4.65 50MG 0 2026-04-01 No No 0
40 6432G LEUCOVORIN 50MG INJ (SLS/AHI) 10ML VIAL BQ 22.29 50MG 0 2022-04-01 2024-03-31 0
40 6432H LEUCOVORIN 50MG INJ (SLS/AHI) 5ML BQ 12.45 50MG 0 2022-04-01 2022-09-30 0
42 64356 FOLINIC ACID 15MG TAB (ZUV) 10'S BQ 1.68 15MG 0 2026-04-01 No No 0
40 64358 LEUCOVORIN 15MG TAB (SLS/AHI) 20'S BQ 4.76 15MG 0 2022-04-01 2024-03-31 0
41 64358 LEUCOVORIN 15MG TAB (SLS) 20'S BQ 4.8943 15MG 0 2024-04-01 2026-03-31 0