Displaying 881 - 900 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
40 1184K BISOPROLOL 10MG TAB (RYV/ATB) 100'S A 0.09 10MG 30 2022-07-20 2024-03-31 Price Change 6
41 1184K BISOPROLOL 10MG TAB (RYV) 100'S A 0.1087 10MG 30 2024-04-01 2026-03-31 6
40 1184M CILENOL 10MG TAB (CIR/AHI) BISOPROLOL 3X10 A 0.17 10MG 30 2022-04-01 2024-03-31 6
40 1184M CILENOL 10MG TAB (CIR) BISOPROLOL 30'S A $0.135 10MG TAB 30 2023-06-06 2024-03-31 6
42 1184X BISOSTAL 10MG TAB (STL) BISOPROLOL 10X10 A 0.03 10MG 30 2026-04-01 No No 6
40 12011 COSOPT 2% | 0.5% EYE DR (MSD/STO) DORZOLAMIDE | TIMOLOL 5ML C 24.76 2%|0.5% 0 2022-04-01 2024-03-31 0
40 12011 COSOPT 2%|0.5% EYE DR (MSD/STO) DORZOLA (C) 5ML C 24.76 2%|0.5% 2022-04-01 2022-12-31 No No Delete from contract 6
40 12012 GLAUCOTENSIL TD 2% | 0.5% EYE DR (LPO/COL) DORZ 5ML A 12.23 2%|0.5% 1 2022-04-01 2024-03-31 6
41 12012 GLAUCOTENSIL TD 2%|0.5% EYE DR (LPO) DORZOLAMIDE|TIMOLOL 5ML A 13.4557 2%|0.5% 1 2024-04-01 2026-03-31 6
42 12012 GLAUCOTENSIL TD 2%|0.5% EYE DR (LPO) DORZOLAMIDE|TIMOLOL 5ML B 19.03 2%|0.5% 1 2026-04-01 No No 6
40 1201P AZARGA 1% | 0.5% EYE DR (NVS/COL) BRINZOLAMIDE | 5ML C 19.79 1%|0.5% 0 2022-04-01 2024-03-31 0
41 1201P AZARGA 1%|0.5% EYE DR (NVS) BRINZOLAMIDE|TIMOLOL (BQ) 5ML BQ 19.7894 1%|0.5% 1 2024-04-01 2026-03-31 6
42 1201P AZARGA 1%|0.5% EYE DR (NVS) BRINZOLAMIDE|TIMOLOL 5ML BQ 19.79 1%|0.5% 1 2026-04-01 No No 0
40 1201Q DORZOL-T 2% | 0.5% EYE DR (CIR/AHI) DORZOLAMIDE 10ML A 21.61 2%|0.5% 1 2022-04-01 2024-03-31 6
41 1201S ENDOR PLUS 2%|0.5% EYE DR (SYP) DORZOLAMIDE|TIMOLOL 5ML A 11.6888 2%|0.5% 1 2024-04-01 2026-03-31 6
42 1201T ENDOR PLUS 2%|0.5% EYE DR (SYP) DORZOLAMIDE|TIMOLOL 5ML A 12.48 2%|0.5% 1 2026-04-01 No No 6
40 12116 ANGIRON 0.5MG SL TAB (CIR/AHI) GLYCERYL TRINI 30'S A 11.53 0.5MG SL 30 2022-04-01 2024-03-31 6
41 12118 GLYCERYL TRINITRATE 0.6MG TAB (KWA) 100'S A 0.1802 0.6MG 30 2024-04-01 2026-03-31 6
40 12121 MINITRAN 5MG PATCH (PMA/AHI) GLYCERYL TRINITR 30'S BQ 46.21 5MG 0 2022-04-01 2024-03-31 6
41 12121 MINITRAN 5MG PATCH (PMA) GLYCERYL TRINIT (BQ) 30'S BQ 54.3665 5MG 6 2024-04-01 2026-03-31 0