|
|
40
|
1212F
|
NITRODERM TTS 5 25MG PATCH (BCH/COL) GLYCERYL
|
10'S
|
BQ
|
19.68
|
25MG
|
0
|
2022-04-01
|
2022-05-24
|
|
|
Delete from contract
|
0
|
|
|
40
|
1212G
|
NITRODERM TTS 10 50MG PATCH (BCH/COL) GLYCERY
|
10'S
|
BQ
|
45.40
|
50MG
|
0
|
2022-04-01
|
2022-05-24
|
|
|
Delete from contract
|
6
|
|
|
41
|
12136
|
NITROGLYCERINE 5MG/ML INJ (SLS) GLYCERYL (BQ)
|
25X5ML
|
BQ
|
6.8502
|
5MG/ML
|
0
|
2024-04-01
|
2026-03-31
|
|
|
|
0
|
|
|
42
|
12136
|
NITROGLYCERINE 5MG/ML INJ (SLS) GLYCERYL
|
25X5ML
|
BQ
|
6.88
|
5MG/ML
|
0
|
2026-04-01
|
|
No
|
No
|
|
0
|
|
|
40
|
12138
|
GLYCERYL TRINITRATE 5MG/ML INJ (MON/PHA)
|
5X5ML
|
BQ
|
1.89
|
5MG/ML
|
0
|
2022-04-01
|
2024-03-31
|
|
|
|
0
|
|
|
41
|
12138
|
GLYCERYL TRINITRATE 5MG/ML INJ (MON (BQ)
|
5X5ML
|
BQ
|
1.7778
|
5MG/ML
|
0
|
2024-04-01
|
2026-03-31
|
|
|
|
0
|
|
|
40
|
12148
|
NITROCARD 0.4MG SPRAY (ARP/AHI) GLYCERYL TRIN
|
200 DOSES
|
A
|
17.61
|
0.4MG
|
1
|
2022-04-01
|
2024-03-31
|
|
|
|
6
|
|
|
41
|
12149
|
TROCER 0.4MG SPRAY (INC) GLYCERYL TRINITRATE
|
200 DOSES
|
A
|
18.2671
|
0.4MG
|
1
|
2024-04-01
|
2026-03-31
|
|
|
|
6
|
|
|
42
|
12149
|
TROCER 0.4MG SPRAY (INC) GLYCERYL TRINITRATE
|
200 DOSES
|
A
|
18.51
|
0.4MG
|
1
|
2026-04-01
|
|
No
|
No
|
|
6
|
|
|
40
|
12214
|
PIMECROLIMUS 1% CR (KWA/ATB)
|
15G
|
C
|
57.08
|
1%
|
0
|
2022-04-01
|
2024-03-31
|
|
|
|
0
|
|
|
41
|
12314
|
ISOREM 10MG TAB (REM) ISOSORBIDE DINITRA
|
100'S
|
A
|
0.0348
|
10MG
|
180
|
2024-04-01
|
2026-03-31
|
|
|
|
6
|
|
|
42
|
12314
|
ISOREM 10MG TAB (REM) ISOSORBIDE DINITRA
|
100'S
|
A
|
0.04
|
10MG
|
180
|
2026-04-01
|
|
No
|
No
|
|
6
|
|
|
42
|
12315
|
AAP-ISDN 10MG TAB (APO)
|
100'S
|
A
|
0.09
|
10MG
|
180
|
2026-04-01
|
|
No
|
No
|
|
6
|
|
|
40
|
1231A
|
ISOSORBIDE DINITRATE 10MG TAB (FSB/ATB)
|
100'S
|
A
|
0.11
|
10MG
|
180
|
2022-04-01
|
2024-03-31
|
|
|
|
6
|
|
|
40
|
1231D
|
AAP-ISDN 10MG TAB (APO/COL)
|
100'S
|
A
|
0.13
|
10MG
|
180
|
2022-04-01
|
2024-03-31
|
|
|
|
6
|
|
|
41
|
1231T
|
APO-ISOSORBIDE DINITRATE 10MG TAB (APO) (C)
|
100'S
|
C
|
0.1079
|
10MG
|
180
|
2024-04-01
|
2026-03-31
|
|
|
|
6
|
|
|
41
|
1231U
|
ISOSORBIDE DINITRATE 10MG TAB (MCP)
|
10X10
|
A
|
0.0897
|
10MG
|
180
|
2024-04-01
|
2026-03-31
|
|
|
|
6
|
|
|
42
|
1231W
|
ISOSORBIDE DINITRATE 10MG TAB (FSB)
|
100'S
|
A
|
0.03
|
10MG
|
180
|
2026-04-01
|
|
No
|
No
|
Add to Contract as Cat A
|
6
|
|
|
41
|
1232B
|
ISOSORBIDE DINITRATE 5MG TAB (ROL)
|
100'S
|
A
|
1.1672
|
5MG
|
120
|
2024-04-01
|
2026-03-31
|
|
|
|
6
|
|
|
42
|
1232B
|
ISOSORBIDE DINITRATE 5MG TAB (ROL)
|
100'S
|
A
|
1.17
|
5MG
|
120
|
2026-04-01
|
|
No
|
No
|
|
6
|
