Displaying 5701 - 5720 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 B0427 PANTOPRAZOLE 40MG INJ (CIP/AHI) 40MG VIAL B 2.61 40MG 0 2022-04-01 2022-09-30 0
42 B0427 PANTOPRAZOLE 40MG INJ (CIP) 40MG VIAL B 1.55 40MG 7 2026-04-01 No No 0
41 B042AN PANTOPRAZOLE 40MG INJ (FSB) (B) 40MG VIAL B 1.1417 40MG 7 2024-04-01 2026-03-31 0
40 B042AP NEXIUM 40MG INJ (AZN/COL) ESOMEPRAZOLE 10X5ML C 14.68 40MG 0 2022-04-01 2022-06-15 Delete from contract 0
40 B042AV PANSALVE 40MG INJ (EMC/COL) PANTOPRAZOLE 40MG VIAL B 1.17 40MG 0 2022-04-01 2024-03-31 0
40 B042AW EMEP 40MG INJ (ARP/AHI) ESOMEPRAZOLE 40MG VIAL C 7.94 40MG 0 2022-04-01 2024-03-31 0
41 B042AW EMEP 40MG INJ (ARP) ESOMEPRAZOLE (C) 40MG VIAL C 5.4366 40MG 0 2024-04-01 2026-03-31 0
40 B042BJ OMEPRAZOLE 40MG INJ (CHC/ATB) 40MG VIAL B 1.03 40MG 0 2022-04-01 2024-03-31 0
40 B042BL NEXIUM 40MG INJ (AZN/COL) PANTOPRAZOLE 5ML VIAL C 14.68 40MG 0 2022-05-04 2024-03-31 Package Size Change 0
41 B042BL NEXIUM 40MG INJ (AZN) PANTOPRAZOLE (B) 5ML VIAL B 14.3528 40MG 7 2024-04-01 2026-03-31 0
42 B042BL NEXIUM 40MG INJ (AZN) PANTOPRAZOLE 5ML VIAL C 14.35 40MG 7 2026-04-01 No No 0
41 B042BW OMEPRAZOLE 40MG INJ PWDR FOR SOLN (FSB) (B) 40MG VIAL B 1.1417 40MG 0 2024-04-01 2026-03-31 0
41 B042BX LASPRAZOLE 40MG INJ (LDP) PANTOPRAZOLE (B) 10X10ML B 2.6748 40MG 7 2024-04-01 2026-03-31 0
42 B042BZ PANTOPRAZOLE 40MG INJ (ZHL) 40MG VIAL B 2.45 40MG 7 2026-04-01 No No 0
42 B042CA PARIDEM 40MG INJ (EMC) PANTOPRAZOLE 40MG VIAL B 4.89 40MG 7 2026-04-01 No No 0
40 B0511 ISENTRESS 400MG TAB (MSD/STO) RALTEGRAVIR 60'S BL 18.56 400MG 0 2022-04-01 2024-03-31 0
41 B0511 ISENTRESS 400MG TAB (MSD) RALTEGRAVIR (BL) 60'S BL 15.2946 400MG 120 2024-04-01 2026-03-31 6
41 B0517 TIVICAY 50MG TAB (GSK) DOLUTEGRAVIR (C) 30'S C 26.0714 50MG 0 2024-04-01 2026-03-31 0
42 B0517 TIVICAY 50MG TAB (GSK) DOLUTEGRAVIR 30'S C 27.37 50MG 0 2026-04-01 No No 0
40 B051A ZEPDON 400MG TAB (CIP/AHI) RALTEGRAVIR 60'S BL 3.66 400MG 0 2022-04-01 2024-03-31 0