Displaying 1161 - 1180 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
41 15132 DILANTIN 25MG/ML SUSP (PFI) PHENYTOIN 237ML A 0.2589 25MG/ML 600 2024-04-01 2026-03-31 6
40 15134 DILANTIN 25MG/ML SUSP (PFI/STO) PHENYTOIN 240ML A 0.26 25MG/ML 600 2022-04-01 2024-03-31 6
41 15134 DILANTIN 25MG/ML SUSP (PFI) PHENYTOIN 237ML A 0.2589 25MG/ML 600 2024-04-01 2026-03-31 6
42 1513B DILANTIN 25MG/ML SUSP (PFI) PHENYTOIN 237ML A 0.26 25MG/ML 600 2026-04-01 No No 6
40 1514M PHENYTOIN 50MG/ML INJ (MON/PHA) 5X5ML B 1.56 50MG/ML 0 2022-04-01 2022-07-18 0
40 1514M PHENYTOIN 50MG/ML INJ (MON/PHA) 5X5ML B 1.92 50MG/ML 0 2022-07-19 2024-03-31 Price Change 0
42 1514M PHENYTOIN 50MG/ML INJ (MON) 5X5ML B 1.60 50MG/ML 2 2026-04-01 No No 0
41 1514N EPAMIN 50MG/ML INJ (PFI) PHENYTOIN (C) 10X5ML C 36.591 50MG/ML 2 2024-04-01 2026-03-31 0
40 1514P EPAMIN 50MG/ML INJ (PFI/STO) PHENYTOIN 10X5ML C 36.26 50MG/ML 0 2022-04-01 2024-03-31 0
41 1514P EPAMIN 50MG/ML INJ (PFI) PHENYTOIN (C) 10X5ML C 36.5914 50MG/ML 2 2024-04-01 2026-03-31 0
41 1514R PHENYTOIN 50MG/ML INJ (STP) (B) 100X5ML B 3.262 50MG/ML 2 2024-04-01 2026-03-31 0
41 1514T PHENYTOIN 50MG/ML INJ (CHC) (B) 5ML B 5.1376 50MG/ML 2 2024-04-01 2026-03-31 0
42 1514Y PHENYTOIN 50MG/ML INJ (FSB) 5X5ML B 1.67 50MG/ML 2 2026-04-01 No No Add to Contract as Cat B 0
40 1521D AAP-PRIMIDONE 250MG TAB (APO/COL) PRIMIDONE 100'S A 0.28 250MG 120 2022-04-01 2024-03-31 6
41 1521F APO-PRIMIDONE 250MG TAB (APO) 100'S A 0.2879 250MG 120 2024-04-01 2026-03-31 6
41 1531AJ AMIROL 10MG TAB (REM) AMITRIPTYLINE 10X10 A 0.0408 10MG 150 2024-04-01 2026-03-31 6
42 1531AJ AMIROL 10MG TAB (REM) AMITRIPTYLINE 10X10 A 0.04 10MG 150 2026-04-01 No No 6
40 1531Z APO-AMITRIPTYLINE 10MG TAB (APO/COL) 1000'S A 0.04 10MG 150 2022-04-01 2024-03-31 6
41 1532AW AMITRIPTYLINE 25MG TAB (GPC) 1000'S A 0.0277 25MG 240 2024-04-01 2026-03-31 6
41 1532AX AMIROL 25MG TAB (REM) AMITRIPTYLINE 10X10 A 0.0438 25MG 240 2024-04-01 2026-03-31 6