Displaying 5201 - 5220 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 A481E ISOSORBIDE MONONITRATE 10MG TAB (WAT/AHI) 100'S A 0.56 10MG 90 2022-04-01 2024-03-31 6
41 A481E ISOSORBIDE MONONITRATE 10MG TAB (WAT) 100'S A 0.7494 10MG 90 2024-04-01 2026-03-31 6
41 A481F ISOSORBIDE MONONITRATE 10MG TAB (WAT) 56'S A 0.7495 10MG 90 2024-12-19 2026-03-31 6
40 A482F ISOSORBIDE MONONITRATE 20MG TAB (WAT/AHI) 100'S A 0.56 20MG 90 2022-04-01 2024-03-31 6
40 A4839 MONOREM 60MG TAB (REM/SBI) ISOSORBIDE MONONIT 3x10 A 0.16 60MG 60 2022-04-01 2024-03-31 6
41 A4839 MONOREM 60MG TAB (REM) ISOSORBIDE MONONI 3x10 A 0.1921 60MG 60 2024-04-01 2026-03-31 6
42 A4839 MONOREM 60MG TAB (REM) ISOSORBIDE MONONI 3x10 A 0.25 60MG 60 2026-04-01 No No 6
40 A483B APO-ISMN 60MG TAB (APO/COL) 100'S A 0.18 60MG 60 2022-04-01 2024-03-31 6
42 A483B APO-ISMN 60MG TAB (APO) 100'S A 0.18 60MG 60 2026-04-01 No No 6
40 A483F ISOSORBIDE MONONITRATE 60MG TAB (KWA/ATB) 3X10 A 0.14 60MG 60 2022-04-01 2022-09-30 6
41 A483L APO-ISMN 60MG TAB (APO) 100'S A 0.1824 60MG 60 2024-04-01 2026-03-31 6
42 A483N ISODIT 60MG SR TAB (JLP) ISOSORBIDE MONONITRATE 20X10 A 0.08 60MG 60 2026-04-01 No No 6
40 A4921 ALPHAGAN P 0.1% EYE DR (ALL/COL) BRIMONIDINE 10ML C 45.94 0.1% 0 2022-04-01 2024-03-31 0
41 A4921 ALPHAGAN P 0.1% EYE DR (ALL) BRIMONIDINE (C) 10ML C 45.9397 0.1% 1 2024-04-01 2026-03-31 6
42 A4921 ALPHAGAN P 0.1% EYE DR (ALL) BRIMONIDINE 10ML C 45.94 0.1% 1 2026-04-01 No No 6
42 A492AA BRENT LS 0.1% EYE DR (HAN) BRIMONIDINE 10ML A 6.58 0.1% 1 2026-04-01 No No 6
42 A492AB BRIMONIDINE 0.1% EYE DR (FSB) 10ML A 2.17 0.1% 1 2026-04-01 No No Add to Contract as Cat A 6
40 A492B BRIMONIDINE 0.1% EYE DR (FSB/ATB) 10ML A 6.80 0.1% 1 2022-04-01 2024-03-31 6
41 A492B BRIMONIDINE 0.1% EYE DR (FSB) 10ML A 6.8502 0.1% 1 2024-04-01 2026-03-31 6
41 A492FT BRIMONIDINE 0.1% EYE DR (CHC) 10ML A 2.664 0.1% 1 2024-04-01 2026-03-31 6