Displaying 4661 - 4680 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 7581N APO-PIOGLITAZONE 15MG TAB (APO) (C) 100'S C 0.4159 15MG 0 2024-04-01 2026-03-31 0
40 7582A APO-PIOGLITAZONE 30MG TAB (APO/COL) 100'S C 0.41 30MG 0 2022-04-01 2024-03-31 0
40 7582M ACCORD PIOGLITAZONE 30 MG TAB (INP/AAL) PIOGL 28'S C 0.43 30 MG 0 2022-04-01 2024-03-31 0
41 7582N APO-PIOGLITAZONE 30MG TAB (APO) (C) 100'S C 0.4159 30MG 0 2024-04-01 2026-03-31 0
41 7583B APO-PIOGLITAZONE 45MG TAB (APO) (C) 100'S C 0.2292 45MG 0 2024-04-01 2026-03-31 0
40 76121 MIRENA 52MG IUD (BSP/AHI) LEVONORGESTREL 1'S C 271.83 52MG 0 2022-04-01 2024-03-31 0
41 76121 MIRENA 52MG IUD (BSP) LEVONORGESTREL (C) 1'S C 271.8324 52MG 0 2024-04-01 2026-03-31 0
42 76121 MIRENA 52MG IUD (BSP) LEVONORGESTREL 1'S B 163.10 52MG 0 2026-04-01 No No 0
40 76122 MIRENA 52MG IUD (BSP/COL) LEVONORGESTREL 1'S C 271.83 52MG 0 2022-04-01 2024-03-31 0
41 76122 MIRENA 52MG IUD (BSP) LEVONORGESTREL (C) 1'S C 271.8324 52MG 0 2024-04-01 2026-03-31 0
42 76122 MIRENA 52MG IUD (BSP) LEVONORGESTREL 1'S B 148.42 52MG 0 2026-04-01 No No 0
40 76124 JAYDESS 13.5MG IUD (BSP/COL) LEVONORGESTREL 1'S C 258.24 13.5MG 0 2022-04-01 2024-03-31 0
41 76124 JAYDESS 13.5MG IUD (BSP) LEVONORGESTREL (C) 1'S C 258.2408 13.5MG 0 2024-04-01 2026-03-31 0
40 76125 JAYDESS 13.5MG IUD (BSP/AHI) LEVONORGESTREL 1'S C 258.24 13.5MG 0 2022-04-01 2024-03-31 0
41 76125 JAYDESS 13.5MG IUD (BSP) LEVONORGES (C) 1'S C 258.2408 13.5MG 0 2024-04-01 2026-03-31 0
40 76219 FEMIANE 20MCG | 75MCG TAB (BSP/AHI) ETHINYLESTRADIOL | GESTODENE 21'S C 14.41 20MCG|75MCG 0 2022-04-01 2024-03-31 0
40 7621AC YAZ 3MG | 0.02MG TAB (BSP/AHI) DROSPIRENONE | ETHINYLESTRADIOL 28'S C 19.03 3MG|0.02MG 0 2022-04-01 2024-03-31 0
40 7621AE YAZ 3MG | 0.02MG TAB (BSP/COL) DROSPIRENONE | ETHINYL ESTRADIOL 28'S C 19.03 3MG|0.02MG 0 2022-04-01 2024-03-31 0
41 7621AE YAZ 3MG|0.02MG TAB (BSP) DROSPIRENONE|ETHINYL ESTRADIOL (C) 28'S C 19.0283 3MG|0.02MG 0 2024-04-01 2026-03-31 0
42 7621AE YAZ 3MG|0.02MG TAB (BSP) DROSPIRENONE|ETHINYL ESTRADIOL 28'S C 17.32 3MG|0.02MG 0 2026-04-01 No No 0