Displaying 5021 - 5040 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 A322CL ZOLOFT 100MG TAB (PFI/SBI) SERTRALINE 14'S C 2.09 100MG 0 2022-04-01 2024-03-31 0
41 A322CL ZOLOFT 100MG TAB (PFI) SERTRALINE (C) 14'S C 2.1067 100MG 42 2024-04-01 2026-03-31 6
40 A322CM ZOLOFT 50MG TAB (PFI/SBI) SERTRALINE 14'S C 1.39 50MG 0 2022-04-01 2024-03-31 0
41 A322CM ZOLOFT 50MG TAB (PFI) SERTRALINE (C) 14'S C 1.4058 50MG 42 2024-04-01 2026-03-31 6
42 A322EN PMS-CITALOPRAM 20MG TAB (PMS) 100'S A 0.12 20MG 42 2026-04-01 No No 6
40 A322FC APO-PAROXETINE 20MG TAB (APO/COL) 100'S A 0.25 20MG 30 2022-04-01 2024-03-31 6
42 A322FC APO-PAROXETINE 20MG TAB (APO) 100'S A 0.25 20MG 42 2026-04-01 No No 6
40 A322FQ LEXAPRO 10MG TAB (LUN/COL) ESCITALOPRAM 28'S C 3.24 10MG 0 2022-04-01 2024-03-31 0
40 A322FZ PRISTIQ 50MG TAB (PFI/STO) DESVENLAFAXINE 28'S C 3.41 50MG 0 2022-04-01 2024-03-31 0
41 A322FZ PRISTIQ 50MG TAB (PFI) DESVENLAFAXINE (C) 28'S C 3.4445 50MG 0 2024-04-01 2026-03-31 0
42 A322FZ PRISTIQ 50MG TAB (PFI) DESVENLAFAXI 28'S C 3.44 50MG 0 2026-04-01 No No 0
40 A322GA EFFEXOR XR 150MG CAP (PFI/STO) VENLAFAXINE 14'S C 4.84 150MG 0 2022-04-01 2022-08-23 Delete from contract 0
40 A322GB EFFEXOR XR 75MG CAP (PFI/STO) VENLAFAXINE 14'S C 4.84 75MG 0 2022-04-01 2022-08-23 Delete from contract 0
40 A322HL FLUOXETINE 20MG CAP (APL/AHI) 100'S A 0.11 20MG 120 2022-04-01 2024-03-31 6
42 A322HX APO-ESCITALOPRAM 10MG TAB (APO) ESC 100'S C 0.15 10MG 0 2026-04-01 No No 0
40 A322JN FLUNIL 20MG TAB (INP/AAL) FLUOXETINE 30'S C 0.20 20MG 0 2022-04-01 2024-03-31 0
41 A322JN FLUNIL 20MG TAB (INP) FLUOXETINE 30'S A 0.0797 20MG 42 2024-04-01 2026-03-31 6
40 A322JQ APO-ESCITALOPRAM 20MG TAB (APO/COL) 30'S C 0.30 20MG 0 2022-04-01 2024-03-31 0
40 A322JR APO-ESCITALOPRAM 10MG TAB (APO/COL) 30'S C 0.15 10MG 0 2022-04-01 2024-03-31 0
40 A322JU CIPRAMIL 20MG TAB (LUN/COL) CITALOPRAM 14'S C 3.44 20MG 0 2022-04-01 2024-03-31 0