Displaying 5041 - 5060 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 A322JV VENLAFAXINE SR 75MG CAP (APL/AHI) VENLAFAXINE 1000'S BP 0.52 75MG 0 2022-04-01 2022-09-30 6
40 A322JY VENLAFAXINE SR 150MG TAB (WAT/AHI) VENLAFAXIN 90'S BP 0.71 150MG 0 2022-04-01 2022-09-30 0
40 A322KD LEXAPRO 20MG TAB (LUN/COL) ESCITALOPRAM 14'S C 6.40 20MG 0 2022-04-01 2024-03-31 0
40 A322KE EFFEXOR XR 75MG CAP (PFI/SBI) VENLAFAXINE 14'S C 4.84 75MG 0 2022-04-01 2024-03-31 0
40 A322KN FLUOXETINE 20MG TAB (APL/AHI) 1000'S A 0.12 20MG 120 2022-09-20 2024-03-31 Package Size Change 6
40 A322KR VENLAFAXINE ER 150MG CAP (APL/AHI) VENLAFAXIN 90'S BP 0.77 150MG 0 2022-04-01 2024-03-31 6
40 A322KS VENLAFAXINE ER 75MG CAP (APL/AHI) VENLAFAXINE 30'S BP 0.63 75MG 0 2022-04-01 2024-03-31 6
40 A322KV EFFEXOR XR 150MG CAP (PFI/SBI) VENLAFAXINE 14'S C 4.84 150MG 0 2022-04-01 2024-03-31 Price Change 0
40 A322KX EFFEXOR XR 150MG CAP (PFI/STO) VENLAFAXINE 28'S C 4.84 150MG 0 2022-07-12 2024-03-31 Package Size Change
41 A322KX EFFEXOR XR 150MG XR CAP (PFI) VENLAFAXINE (C) 28'S C 4.8862 150MG 0 2024-04-01 2026-03-31 0
40 A322KY EFFEXOR XR 75MG CAP (PFI/STO) VENLAFAXINE 28'S C 4.84 75MG 0 2022-07-12 2024-03-31 Package Size Change
41 A322KY EFFEXOR XR 75MG XR CAP (PFI) VENLAFAXINE (C) 28'S C 4.8862 75MG 0 2024-04-01 2026-03-31 0
41 A322LA APO-CITALOPRAM 20MG TAB (APO) 30'S A 0.2311 20MG 42 2024-04-01 2026-03-31 6
41 A322LB APO-ESCITALOPRAM 10MG TAB (APO) ESC (C) 100'S C 0.1498 10MG 0 2024-04-01 2026-03-31 0
41 A322LC APO-FLUOXETINE 20MG TAB (APO) 100'S A 0.0777 20MG 42 2024-04-01 2026-03-31 6
41 A322LD APO-PAROXETINE 20MG TAB (APO) 100'S A 0.2542 20MG 42 2024-04-01 2026-03-31 6
41 A322LE APO-SERTRALINE 50MG CAP (APO) SERTRALINE 100'S A 0.1215 50MG 42 2024-04-01 2026-03-31 6
41 A322LF APO-SERTRALINE 100MG CAP (APO) 100'S A 0.1941 100MG 42 2024-04-01 2026-03-31 6
41 A322LK APO-ESCITALOPRAM 20MG TAB (APO) (C) 100'S C 0.2996 20MG 0 2024-04-01 2026-03-31 0
41 A322LU EFFEXOR 75MG XR CAP (PFI) VENLAFAXINE (C) 28'S C 4.8862 75MG 0 2024-04-01 2026-03-31 0