Displaying 5301 - 5320 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
41 A661AZ APO-SUMATRIPTAN 100MG TAB (APO) (C) 6'S C 1.332 100MG 0 2024-04-01 2026-03-31 0
41 A661BA PMS-RIZATRIPTAN 10MG TAB (PMS) 6'S A 3.5338 10MG 14 2024-04-01 2026-03-31 6
42 A661BA PMS-RIZATRIPTAN 10MG TAB (PMS) 6'S A 3.15 10MG 14 2026-04-01 No No 6
41 A661BD APO-ELETRIPTAN 40MG TAB (APO) (C) 6'S C 3.6969 40MG 0 2024-04-01 2026-03-31 0
42 A661BE RELPAX 40MG TAB (PFI) ELETRIPTAN HYDROBROMIDE 2'S C 12.10 40MG 0 2026-04-01 No No 0
40 A661D RELPAX 40MG TAB (PFI/STO) ELETRIPTAN HBR 2'S C 11.99 40MG 0 2022-04-01 2024-03-31 0
41 A661D RELPAX 40MG TAB (PFI) ELETRIPTAN HBR (C) 2'S C 12.0966 40MG 0 2024-04-01 2026-03-31 0
40 A661R RELPAX 40MG TAB (PFI/SBI) ELETRIPTAN HBR 2'S C 11.99 40MG 0 2022-04-01 2024-03-31 0
41 A661R RELPAX 40MG TAB (PFI) ELETRIPTAN HBR (C) 2'S C 12.0966 40MG 0 2024-04-01 2026-03-31 0
40 A661X APO-SUMATRIPTAN 50MG TAB (APO/COL) 6'S C 0.74 50MG 0 2022-04-01 2024-03-31 0
42 A661X APO-SUMATRIPTAN 50MG TAB (APO) 6'S C 0.76 50MG 0 2026-04-01 No No 0
40 A661Y APO-SUMATRIPTAN 100MG TAB (APO/COL) 6'S C 1.31 100MG 0 2022-04-01 2024-03-31 0
42 A661Y APO-SUMATRIPTAN 100MG TAB (APO) 6'S C 1.33 100MG 0 2026-04-01 No No 0
40 A6711 SINGULAIR 5MG TAB (MSD/STO) MONTELUKAST 30'S C 1.58 5MG 0 2022-04-01 2024-03-31 0
41 A6711 SINGULAIR 5MG TAB (MSD/STO) MONTELUKAST (C) 30'S C 1.592 5MG 30 2024-04-01 2026-03-31 6
42 A6711 SINGULAIR 5MG TAB (MSD/STO) MONTELUKAST 30'S C 1.59 5MG 30 2026-04-01 No No 6
40 A6712 SINGULAIR 10MG TAB (MSD/STO) MONTELUKAST 30'S C 1.58 10MG 0 2022-04-01 2024-03-31 0
41 A6712 SINGULAIR 10MG TAB (MSD) MONTELUKAST (C) 30'S C 1.592 10MG 30 2024-04-01 2026-03-31 6
42 A6712 SINGULAIR 10MG TAB (MSD) MONTELUKAST 30'S C 1.59 10MG 30 2026-04-01 No No 6
40 A6715 SINGULAIR 4MG TAB (MSD/STO) MONTELUKAST 30'S C 1.58 4MG 0 2022-04-01 2024-03-31 0