Displaying 5361 - 5380 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 | A681GW | BIKTARVY 50MG|200MG|25MG TAB (GIL) BICTEGRAVIR|EMTRICITABINE (BL) | 30'S | BL | 9.6944 | 50MG|200MG|25MG | 60 | 2024-04-01 | 2026-03-31 | 6 | ||||
| 42 | A681GW | BIKTARVY 50MG|200MG|25MG TAB (GIL) BICTEGRAVIR|EMTRICITABINE | 30'S | BL | 9.69 | 50MG|200MG|25MG | 60 | 2026-04-01 | No | No | 0 | |||
| 40 | A681GX | GENVOYA 150MG | 150MG | 200MG | 10MG TAB (GIL/COL) COBICSTAT | ELVITEGRAVIR | EM More ... | 30'S | BL | 10.73 | 150MG|150MG|200MG|10MG | 0 | 2022-04-01 | 2024-03-31 | 0 | ||||
| 41 | A681GX | GENVOYA 150MG|150MG|200MG|10MG TAB (GIL) COBICSTAT|ELVITEGRA (BL) | 30'S | BL | 10.7329 | 150MG|150MG|200MG|10MG | 60 | 2024-04-01 | 2026-03-31 | 6 | ||||
| 42 | A681GX | GENVOYA 150MG|150MG|200MG|10MG TAB (GIL) COBICSTAT|ELVITEGRA | 30'S | BL | 10.73 | 150MG|150MG|200MG|10MG | 60 | 2026-04-01 | No | No | Price Change | 0 | ||
| 40 | A681HB | ZOVILAM 150MG | 300MG TAB (MAT/AHI) LAMIVUDINE | ZIDOVUDINE | 60'S | BL | 0.35 | 150MG|300MG | 0 | 2022-04-01 | 2024-03-31 | 0 | ||||
| 41 | A681HB | ZOVILAM 150MG|300MG TAB (MAT) LAMIVUDINE|ZIDOVUDINE (BL) | 60'S | BL | 0.5029 | 150MG|300MG | 60 | 2024-04-01 | 2026-03-31 | 6 | ||||
| 40 | A681HC | EFAVIRENZ | EMTRICITABINE | TENOFOVIR 600MG | 200MG | 300MG TAB (MCP/AHI) | 30'S | BL | 0.73 | 600MG|200MG|300MG | 0 | 2022-04-01 | 2024-03-31 | 0 | ||||
| 41 | A681HC | EFAVIRENZ|EMTRICITABINE|TENOFOVIR 600MG|200MG|300MG TAB (MCP (BL) | 30'S | BL | 0.6397 | 600MG|200MG|300MG | 60 | 2024-04-01 | 2026-03-31 | 6 | ||||
| 42 | A681HC | EFAVIRENZ|EMTRICITABINE|TENOFOVIR 600MG|200MG|300MG TAB (MCP | 30'S | BL | 0.54 | 600MG|200MG|300MG | 60 | 2026-04-01 | No | No | 0 | |||
| 42 | A681HD | ATAZANAVIR|RITONAVIR 300MG|100MG TA | 30'S | BL | 2.04 | 300MG|100MG | 60 | 2026-04-01 | No | No | 0 | |||
| 40 | A681HE | ABACAVIR | LAMIVUDINE 600MG | 300MG TAB (MAT/AHI) | 30'S | BL | 2.12 | 600MG|300MG | 0 | 2022-04-01 | 2024-03-31 | 0 | ||||
| 40 | A681HG | DUOVIR 150MG | 300MG TAB (CIP/AHI) LAMIVUDINE | ZIDOVUDINE | 60'S | BL | 0.89 | 150MG|300MG | 0 | 2022-04-01 | 2024-03-31 | 0 | ||||
| 40 | A681HJ | EMTRICITABINE | TENOFOVIR 200MG | 300MG TAB (MCP/AHI) | 30'S | BL | 0.53 | 200MG|300MG | 0 | 2022-04-01 | 2024-03-31 | 0 | ||||
| 41 | A681HJ | EMTRICITABINE|TENOFOVIR 200MG|300MG TAB (MCP) (BL) | 30'S | BL | 0.4413 | 200MG|300MG | 60 | 2024-04-01 | 2026-03-31 | 6 | ||||
| 42 | A681HJ | EMTRICITABINE|TENOFOVIR 200MG|300MG TAB (MCP) | 30'S | BL | 0.36 | 200MG|300MG | 60 | 2026-04-01 | No | No | 0 | |||
| 40 | A681HK | LOPINAVIR | RITONAVIR 200MG | 50MG TAB (MAT/AHI) | 120'S | BL | 0.71 | 200MG|50MG | 0 | 2022-04-01 | 2024-03-31 | 0 | ||||
| 40 | A681HL | EMTRICITABINE | TENOFOVIR 200MG | 300MG TAB (MAT/AHI) | 30'S | BL | 0.97 | 200MG|300MG | 0 | 2022-04-01 | 2024-03-31 | 0 | ||||
| 41 | A681HL | EMTRICITABINE|TENOFOVIR 200MG|300MG TAB (MAT) (BL) | 30'S | BL | 0.9224 | 200MG|300MG | 60 | 2024-04-01 | 2026-03-31 | 6 | ||||
| 42 | A681HL | EMTRICITABINE|TENOFOVIR 200MG|300MG TAB (MAT) | 30'S | BL | 0.92 | 200MG|300MG | 60 | 2026-04-01 | No | No | 0 | |||