Displaying 5001 - 5020 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 A3223 PAXIL 20MG TAB (GSK/COL) PAROXETINE 30'S C 3.05 20MG 0 2022-04-01 2024-03-31 0
41 A3223 PAXIL 20MG TAB (GSK) PAROXETINE (C) 30'S C 3.3499 20MG 42 2024-04-01 2026-03-31 6
42 A3223 PAXIL 20MG TAB (GSK) PAROXETINE 30'S C 3.52 20MG 42 2026-04-01 No No 6
40 A3224 APO-CITALOPRAM 20MG TAB (APO/COL) 30'S A 0.23 20MG 30 2022-04-01 2024-03-31 6
40 A322AA APO-SERTRALINE 50MG CAP (APO/COL) 100'S A 0.12 50MG 30 2022-04-01 2024-03-31 6
40 A322AF ZOLOFT 50MG TAB (PFI/STO) SERTRALINE 14'S C 1.39 50MG 0 2022-04-01 2024-03-31 0
41 A322AF ZOLOFT 50MG TAB (PFI) SERTRALINE (C) 14'S C 1.4058 50MG 42 2024-04-01 2026-03-31 6
40 A322AQ PAXIL CR 25MG TAB (GSK/COL) PAROXETINE 30'S BP 3.05 25MG 0 2022-04-01 2024-03-31 6
41 A322AQ PAXIL 25MG CR TAB (GSK) PAROXETINE 30'S BP 3.2294 25MG 42 2024-04-01 2026-03-31 6
42 A322AQ PAXIL 25MG CR TAB (GSK) PAROXETINE 30'S C 3.39 25MG 42 2026-04-01 No No 6
40 A322AY ZOLOFT 100MG TAB (PFI/STO) SERTRALINE 14'S C 2.09 100MG 0 2022-04-01 2024-03-31 0
41 A322AY ZOLOFT 100MG TAB (PFI) SERTRALINE (C) 14'S C 2.1067 100MG 42 2024-04-01 2026-03-31 6
40 A322BB PAXIL CR 12.5MG CAP (GSK/COL) PAROXETINE 30'S BP 1.61 12.5MG 0 2022-04-01 2024-03-31 6
41 A322BB PAXIL 12.5MG CR CAP (GSK) PAROXETINE (BP) 30'S BP 1.7134 12.5MG 0 2024-04-01 2026-03-31 0
41 A322BT VENLAFAXINE 150MG SR TAB (CIP) (BP) 100'S BP 1.2575 150MG 0 2024-04-01 2026-03-31 0
42 A322BT VENLAFAXINE 150MG SR TAB (CIP) 100'S BP 1.28 150MG 0 2026-04-01 No No 0
41 A322BU VENLAFAXINE 75MG SR TAB (CIP) (BP) 100'S BP 0.6442 75MG 0 2024-04-01 2026-03-31 0
42 A322BU VENLAFAXINE 75MG SR TAB (CIP) 100'S BP 0.72 75MG 0 2026-04-01 No No 0
40 A322CJ APO-SERTRALINE 100MG CAP (APO/COL) 100'S A 0.19 100MG 30 2022-04-01 2024-03-31 6
42 A322CJ APO-SERTRALINE 100MG CAP (APO) 100'S A 0.19 100MG 42 2026-04-01 No No 6