Displaying 4721 - 4740 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 7621Z MICROGYNON-30 30MCG | 150MCG TAB (BSP/COL) ETHI 21'S B 4.49 30MCG|150MCG 0 2022-04-01 2024-03-31 0
41 7621Z MICROGYNON-30 30MCG|150MCG TAB (BSP) ETH (B) 21'S B 4.4852 30MCG|150MCG 3 2024-04-01 2026-03-31 6
42 7621Z MICROGYNON-30 30MCG|150MCG TAB (BSP) ETHINYL ESTRADIOL|LEVON 21'S BC 3.04 30MCG|150MCG 3 2026-04-01 No No 0
40 76712 ACTILYSE 50MG INJ (BOE/STO) ALTEPLASE 2X50MG BQ 2,408.97 50MG 0 2022-04-01 2024-03-31 0
41 76712 ACTILYSE 50MG INJ (BOE) ALTEPLASE (BQ) 2X50MG BQ 2653.6143 50MG 0 2024-04-01 2026-03-31 0
42 76712 ACTILYSE 50MG INJ (BOE) ALTEPLASE 2X50MG BQ 2,653.62 50MG 0 2026-04-01 No No 0
40 7691C INTERFERON ALPHA 2B 3MU INJ (RLS/AHI) 3MU VIAL C 49.72 3MU 0 2022-04-01 2024-03-31 0
41 7691C INTERFERON ALPHA 2B 3MU INJ (RLS) 3MU VIAL C 23.6494 3MU 0 2024-04-01 2026-03-31 0
42 7691D RELIFERON 300MU/0.5ML INJ (RLS) INTERFERON ALPHA 2B 3MU VIAL BQ 24.14 300MU/0.5ML 0 2026-04-01 No No 0
41 77013 GOTABIOTIC F 0.1%|0.3% EYE DR (LPO) DEXAMETHASONE|TOBRAMYCIN (C) 5ML C 7.5841 0.1%|0.3% 0 2024-04-01 2026-03-31 0
40 7701D DEXAMETHASONE/TOBRAMYCIN EYE DR (CIR/AHI) 5ML BQ 5.16 0.1%|0.3% 0 2022-04-01 2024-03-31 6
41 7701D DEXAMETHASONE|TOBRAMYCIN 0.1%|0.3% EYE DR (CIR) (BQ) 5ML BQ 5.1648 0.1%|0.3% 0 2024-04-01 2026-03-31 0
40 7701E DEXAMETHASONE/TOBRAMYCIN EYE DR (KWA/ATB) 5ML BQ 5.41 0.1%|0.3% 0 2022-04-01 2024-03-31 6
40 7701H TOBRADEX 0.1% | 0.3% EYE DR (NVS/COL) DEXAMETHA 5ML C 21.09 0.1%|0.3% 0 2022-04-01 2024-03-31 0
41 7701H TOBRADEX 0.1%|0.3% EYE DR (NVS) DEXAMETHASONE|TOBRAMYCIN (C) 5ML C 23.7853 0.1%|0.3% 0 2024-04-01 2026-03-31 0
42 7701H TOBRADEX 0.1%|0.3% EYE DR (NVS) DEXAMETHASONE|TOBRAMYCIN 5ML C 23.79 0.1%|0.3% 0 2026-04-01 No No 0
41 7701J TOBAGRAM D 0.1%|0.3% EYE DR (HAN) DEXAMETHASONE|TOBRAMYCIN (BQ) 10ML BQ 4.2678 0.1%|0.3% 0 2024-04-01 2026-03-31 0
42 7701J TOBAGRAM D 0.1%|0.3% EYE DR (HAN) DEXAMETHASONE|TOBRAMYCIN 10ML BQ 4.29 0.1%|0.3% 0 2026-04-01 No No 0
40 77022 GOTABIOTIC F EYE OINT (LPO/COL) DEXAMETHASON 3.5G C 11.69 0.1%|0.3% 0 2022-04-01 2024-03-31 0
41 77022 GOTABIOTIC F EYE OINT (LPO) DEXAMETHASO (C) 3.5G C 12.8577 0.1%|0.3% 0 2024-04-01 2026-03-31 0