Displaying 5941 - 5960 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 B4624 SYNJARDY 12.5MG|1G (BOE) EMPAGLIFLOZIN|METFORMIN 60'S A 1.12 12.5MG|1G 60 2026-04-01 No No 6
41 B4625 DAPAGLIFLOZIN|METFORMIN 10MG|1G TAB (KWA) 30'S A 0.3325 10MG|1G 30 2024-04-01 2026-03-31 6
42 B462D DAPAGLIFLOZIN|METFORMIN 10MG|1G XR TAB (ZHL) 3X10 A 0.27 10MG|1G 30 2026-04-01 No No 6
40 B4811 VYMADA 24MG | 26MG TAB (NVS/COL) SACUBITRIL | VALSARTAN 28'S B 2.52 24MG|26MG 0 2022-04-01 2024-03-31 6
41 B4811 VYMADA 24MG|26MG TAB (NVS) SACUBITRIL|VALSARTAN (B) 28'S B 2.33 24MG|26MG 60 2024-04-01 2026-03-31 6
42 B4811 VYMADA 24MG|26MG TAB (NVS) SACUBITRIL|VALSARTAN 28'S B 1.75 24MG|26MG 60 2026-04-01 No No 6
40 B4812 VYMADA 49MG | 51MG TAB (NVS/COL) SACUBITRIL | VALSARTAN 28'S B 2.52 49MG|51MG 0 2022-04-01 2024-03-31 6
41 B4812 VYMADA 49MG|51MG TAB (NVS) SACUBITRIL|VALSARTAN (B) 28'S B 2.33 49MG|51MG 60 2024-04-01 2026-03-31 6
42 B4812 VYMADA 49MG|51MG TAB (NVS) SACUBITRIL|VALSARTAN 28'S B 1.75 49MG|51MG 60 2026-04-01 No No 6
40 B4813 VYMADA 97MG | 103MG TAB (NVS/COL) SACUBITRIL | VALSARTAN 28'S B 2.52 97MG|103MG 0 2022-04-01 2024-03-31 6
41 B4813 VYMADA 97MG|103MG TAB (NVS) SACUBITRIL|VALSARTAN (B) 28'S B 2.33 97MG|103MG 60 2024-04-01 2026-03-31 6
42 B4813 VYMADA 97MG|103MG TAB (NVS) SACUBITRIL|VALSARTAN 28'S B 1.75 97MG|103MG 60 2026-04-01 No No 6
40 B4911 XOLAIR 150MG INJ (NVS/COL) OMALIZUMAB 150MG VIAL C 1,304.93 150MG 0 2022-04-01 2024-03-31 0
41 B4911 XOLAIR 150MG INJ (NVS) OMALIZUMAB (C) 150MG VIAL C 1304.9314 150MG 0 2024-04-01 2026-03-31 0
42 B4911 XOLAIR 150MG INJ (NVS) OMALIZUMAB 150MG VIAL C 1,304.93 150MG 0 2026-04-01 No No 0
40 B4913 OMALIREL 150MG INJ (RLS/AHI) OMALIZUMAB 150MG VIAL C 844.86 150MG 0 2022-04-01 2024-03-31 0
41 B4913 OMALIREL 150MG INJ (RLS) OMALIZUMAB (C) 150MG VIAL C 844.8551 150MG 0 2024-04-01 2026-03-31 0
42 B4913 OMALIREL 150MG INJ (RLS) OMALIZUMAB 150MG VIAL BQ 747.54 150MG 0 2026-04-01 No No 0
40 B5012 ANORO ELLIPTA 55/22 INHR (GSK/COL) UMECLIDINI 30 DOSES BQ 141.60 55MCG|22MCG 1 2022-04-01 2024-03-31 6
41 B5012 ANORO ELLIPTA 55MCG|22MCG INHR (GSK) UMECLIDINIUM|VILANTEROL (BQ) 30 DOSES BQ 108.6786 55MCG|22MCG 1 2024-04-01 2024-07-16 Yes 6