Displaying 5761 - 5780 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 B1514 XARELTO 10MG TAB (BSP) RIVAROXABAN (C) 10'S C 6.0537 10MG 30 2024-04-01 2026-03-31 0
42 B1514 XARELTO 10MG TAB (BSP) RIVAROXABAN 10'S C 2.77 10MG 30 2026-04-01 No No 0
40 B1516 ELIQUIS 2.5MG TAB (PFI/STO) APIXABAN 60'S C 3.66 2.5MG 0 2022-04-01 2024-03-31 0
41 B1516 ELIQUIS 2.5MG TAB (PFI) APIXABAN (B) 60'S B 2.9222 2.5MG 60 2024-04-01 2026-03-31 6
42 B1516 ELIQUIS 2.5MG TAB (PFI) APIXABAN 60'S B 2.92 2.5MG 60 2026-04-01 No No Change status from C to 6
41 B1517 XARELTO 2.5MG TAB (BSP) RIVAROXABAN (C) 28'S C 3.0289 2.5MG 60 2024-04-01 2026-03-31 6
42 B1517 XARELTO 2.5MG TAB (BSP) RIVAROXABAN 28'S C 1.59 2.5MG 60 2026-04-01 No No 6
40 B151A XARELTO 2.5MG TAB (BSP/AHI) RIVAROXABAN 56'S C 3.03 2.5MG 0 2022-04-01 2024-03-31 0
41 B151A XARELTO 2.5MG TAB (BSP) RIVAROXABAN (C) 56'S C 3.029 2.5MG 60 2024-04-01 2026-03-31 6
40 B151C XARELTO 2.5MG TAB (BSP/AHI) RIVAROXABAN 28'S C 3.03 2.5MG 0 2022-04-01 2024-03-31 0
41 B151C XARELTO 2.5MG TAB (BSP) RIVAROXABAN (C) 28'S C 3.029 2.5MG 60 2024-04-01 2026-03-31 6
42 B151C XARELTO 2.5MG TAB (BSP) RIVAROXABAN 28'S C 3.04 2.5MG 60 2026-04-01 No No 6
42 B151N APO-APIXABAN 2.5MG TAB (APO) 60'S B 0.45 2.5MG 60 2026-04-01 No No 6
42 B151Q APO-RIVAROXABAN 2.5MG TAB (APO) 60'S B 1.36 2.5MG 60 2026-04-01 No No 6
42 B151T PMS-RIVAROXABAN 10MG TAB (PMS) 100'S B 1.06 10MG 30 2026-04-01 2028-03-31 No No 0
40 B1521 PRADAX 110MG TAB (BOE/STO) DABIGATRAN 3X10 BQ 2.96 110MG 0 2022-04-01 2024-03-31 6
41 B1521 PRADAX 110MG TAB (BOE) DABIGATRAN (BQ) 3X10 BQ 3.2212 110MG 60 2024-04-01 2026-03-31 6
42 B1521 PRADAX 110MG TAB (BOE) DABIGATRAN 3X10 B 3.22 110MG 60 2026-04-01 No No Change status from C to 6
40 B1523 XARELTO 15MG TAB (BSP/AHI) RIVAROXABAN 28'S C 6.07 15MG 0 2022-04-01 2024-03-31 0
41 B1523 XARELTO 15MG TAB (BSP) RIVAROXABAN (C) 28'S C 6.0687 15MG 30 2024-04-01 2026-03-31 0