Displaying 21 - 37 of 37
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 B1525 XARELTO 15MG TAB (BSP) RIVAROXABAN 28'S C 2.76 15MG 30 2026-04-01 No No 0
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 B152S PMS-RIVAROXABAN 15MG TAB (PMS) 100'S B 1.06 15MG 30 2026-04-01 No No 0
40 B1533 XARELTO 20MG TAB (BSP/AHI) RIVAROXABAN 28'S C 6.07 20MG 0 2022-04-01 2024-03-31 0
41 B1533 XARELTO 20MG TAB (BSP) RIVAROXABAN (C) 28'S C 6.0687 20MG 30 2024-04-01 2026-03-31 0
42 B1533 XARELTO 20MG TAB (BSP) RIVAROXABAN 28'S C 3.04 20MG 30 2026-04-01 No No 0
40 B1534 XARELTO 20MG TAB (BSP/COL) RIVAROXABAN 28'S C 6.07 20MG 0 2022-04-01 2024-03-31 0
41 B1534 XARELTO 20MG TAB (BSP) RIVAROXABAN (C) 28'S C 6.0687 20MG 30 2024-04-01 2026-03-31 0
42 B1534 XARELTO 20MG TAB (BSP) RIVAROXABAN 28'S C 2.76 20MG 30 2026-04-01 No No 0
40 B1535 XARELTO 20MG TAB (BSP/AHI) RIVAROXABAN 14'S C 6.07 20MG 0 2022-04-01 2024-03-31 0
41 B1535 XARELTO 20MG TAB (BSP) RIVAROXABAN (C) 14'S C 6.0696 20MG 30 2024-04-01 2026-03-31 0
40 B1536 XARELTO 20MG TAB (BSP/COL) RIVAROXABAN 14'S C 6.07 20MG 0 2022-04-01 2024-03-31 0
41 B1536 XARELTO 20MG TAB (BSP) RIVAROXABAN (C) 14'S C 6.0696 20MG 30 2024-04-01 2026-03-31 0
42 B153L PMS-RIVAROXABAN 20MG TAB (PMS) 100'S B 1.06 20MG 30 2026-04-01 No No 0