Displaying 5781 - 5800 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
42 B1523 XARELTO 15MG TAB (BSP) RIVAROXABAN 28'S C 3.04 15MG 30 2026-04-01 No No 0
40 B1524 PRADAX 110MG TAB (BOE/STO) DABIGATRAN 60'S BQ 2.96 110MG 0 2022-04-01 2024-03-31 6
41 B1524 PRADAX 110MG TAB (BOE) DABIGATRAN (BQ) 60'S BQ 3.2212 110MG 60 2024-04-01 2026-03-31 6
42 B1524 PRADAX 110MG TAB (BOE) DABIGATRAN 60'S B 3.22 110MG 60 2026-04-01 No No Change status from C to 6
40 B1525 XARELTO 15MG TAB (BSP/COL) RIVAROXABAN 28'S C 6.07 15MG 0 2022-04-01 2024-03-31 0
41 B1525 XARELTO 15MG TAB (BSP) RIVAROXABAN (C) 28'S C 6.0687 15MG 30 2024-04-01 2026-03-31 0
42 B1525 XARELTO 15MG TAB (BSP) RIVAROXABAN 28'S C 2.76 15MG 30 2026-04-01 No No 0
40 B1526 ELIQUIS 5MG TAB (PFI/STO) APIXABAN 60'S C 3.66 5MG 0 2022-04-01 2024-03-31 0
41 B1526 ELIQUIS 5MG TAB (PFI) APIXABAN (B) 60'S B 2.9222 5MG 60 2024-04-01 2026-03-31 6
42 B1526 ELIQUIS 5MG TAB (PFI) APIXABAN 60'S B 2.92 5MG 60 2026-04-01 No No Change status from C to 6
40 B1527 XARELTO 15MG TAB (BSP/AHI) RIVAROXABAN 14'S C 6.07 15MG 0 2022-04-01 2024-03-31 0
41 B1527 XARELTO 15MG TAB (BSP) RIVAROXABAN (C) 14'S C 6.0696 15MG 30 2024-04-01 2026-03-31 0
40 B1528 XARELTO 15MG TAB (BSP/COL) RIVAROXABAN 14'S C 6.07 15MG 0 2022-04-01 2024-03-31 0
41 B1528 XARELTO 15MG TAB (BSP) RIVAROXABAN (C) 14'S C 6.0696 15MG 30 2024-04-01 2026-03-31 0
42 B152AC DEBIJOHN 110MG CAP (JLP) DABIGATRAN 10X10 B 0.51 110MG 60 2026-04-01 No No 6
42 B152N APO-APIXABAN 5MG TAB (APO) 60'S B 0.54 5MG 60 2026-04-01 No No 6
42 B152S PMS-RIVAROXABAN 15MG TAB (PMS) 100'S B 1.06 15MG 30 2026-04-01 No No 0
40 B1531 PRADAX 150MG TAB (BOE/STO) DABIGATRAN 60'S BQ 2.96 150MG 0 2022-04-01 2024-03-31 6
41 B1531 PRADAX 150MG TAB (BOE) DABIGATRAN (BQ) 60'S BQ 3.2212 150MG 60 2024-04-01 2026-03-31 6
42 B1531 PRADAX 150MG TAB (BOE) DABIGATRAN 60'S B 3.22 150MG 60 2026-04-01 No No Change status from C to 6