Displaying 5821 - 5840 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 B2214 NOVORAPID FLEXPENS 100U/ML INJ (NOV) INSULIN ASPART 5X3ML A 17.67 100U/ML 2 2026-04-01 No No Amend Protocol Quantity 6
40 B2216 HUMALOG 100U/ML INJ (LIL/STO) LISPRO 10ML VIAL A 60.94 100U/ML 5 2022-04-01 2024-03-31 6
41 B2216 HUMALOG 100U/ML INJ (LIL) LISPRO 10ML VIAL A 59.6944 100U/ML 5 2024-04-01 2026-03-31 6
40 B2217 HUMALOG DISP. PEN 100U/ML INJ (LIL/STO) LISPR 5X3ML C 22.43 100U/ML 0 2022-04-01 2024-03-31 0
41 B2217 HUMALOG DISP. PEN 100U/ML INJ (LIL) LISP (C) 5X3ML C 24.5573 100U/ML 5 2024-04-01 2026-03-31 6
40 B2218 HUMALOG CARTRIDGE INJ (LIL/STO) LISPRO 5X3ML C 20.11 100U/ML 0 2022-04-01 2024-03-31 0
41 B2218 HUMALOG CARTRIDGE 100U/ML INJ (LIL) INSULIN LISPRO (C) 5X3ML C 21.0561 100U/ML 5 2024-04-01 2026-03-31 6
40 B2221 HUMULIN-R 100U/ML INJ (LIL/STO) INSULIN RAPID 10ML VIAL A 14.92 100U/ML 5 2022-04-01 2024-03-31 6
41 B2221 HUMULIN-R 100U/ML INJ (LIL) INSULIN SHORT ACTING 10ML VIAL A 20.3602 100U/ML 5 2024-04-01 2026-03-31 6
40 B2222 HUMULIN-R CARTRIDGE INJ (LIL/STO) INSULIN RA 5X3ML C 8.66 100U/ML 2022-07-11 2024-03-31 Add to Contract as Cat C
41 B2222 HUMULIN-R CARTRIDGE 100U/ML INJ (LIL) INSULIN SHORT ACTING (C) 5X3ML C 10.9114 100U/ML 5 2024-04-01 2026-03-31 6
40 B2223 NOVOLIN-R 100U/ML INJ (NOV/COL) INSULIN RAPID 10ML VIAL A 11.96 100U/ML 5 2022-04-01 2024-03-31 6
41 B2223 NOVOLIN-R 100U/ML INJ (NOV) INSULIN SHORT ACTING 10ML VIAL A 11.9606 100U/ML 5 2024-04-01 2026-03-31 6
42 B2223 NOVOLIN-R 100U/ML INJ (NOV) INSULIN REGULAR 10ML VIAL A 11.96 100U/ML 5 2026-04-01 No No 6
40 B2231 HUMULIN-N 100U/ML INJ (LIL/STO) INSULIN ISOPH 10ML VIAL A 14.92 100U/ML 5 2022-04-01 2024-03-31 6
41 B2231 HUMULIN-N 100U/ML INJ (LIL) INSULIN ISOP 10ML VIAL A 20.3602 100U/ML 5 2024-04-01 2026-03-31 6
40 B2232 NOVOLIN-N 100U/ML INJ (NOV/COL) INSULIN ISOPH 10ML VIAL A 11.96 100U/ML 5 2022-04-01 2024-03-31 6
41 B2232 NOVOLIN-N 100U/ML INJ (NOV) INSULIN ISOP 10ML VIAL A 11.9606 100U/ML 5 2024-04-01 2026-03-31 6
42 B2232 NOVOLIN-N 100U/ML INJ (NOV) INSULIN ISOPHANE 10ML VIAL A 11.96 100U/ML 5 2026-04-01 No No 6
40 B2234 HUMILIN-N CARTRIDGE 100U/ML INJ (LIL/STO) ISO 5X3ML C 11.88 100U/ML 2022-07-11 2024-03-31 Add to Contract as Cat C