Displaying 1181 - 1200 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 1532AX AMIROL 25MG TAB (REM) AMITRIPTYLINE 10X10 A 0.07 25MG 240 2026-04-01 2028-03-31 No No 6
41 1532E APO-AMITRIPTYLINE 25MG TAB (APO) 1000'S A 0.0441 25MG 240 2024-04-01 2026-03-31 6
40 1532ZC APO-AMITRIPTYLINE 25MG TAB (APO/COL) 1000'S A 0.04 25MG 240 2022-04-01 2024-03-31 6
41 15412 AAP-IMIPRAMINE 10MG TAB (APO) 100'S A 0.1435 10MG 240 2024-04-01 2026-03-31 6
40 15414 AAP-IMIPRAMINE 10MG TAB (APO/COL) 100'S A 0.14 10MG 240 2022-04-01 2024-03-31 6
42 15414 AAP-IMIPRAMINE 10MG TAB (APO) 100'S A 0.14 10MG 240 2026-04-01 No No 6
40 15426 AAP-IMIPRAMINE 25MG TAB (APO/COL) 100'S C 0.19 25MG 0 2022-04-01 2024-03-31 0
42 15426 AAP-IMIPRAMINE 25MG TAB (APO) 100'S A 0.19 25MG 240 2026-04-01 No No 6
40 1542A DIAMIN 25MG TAB (RLS/AHI) IMIPRAMINE 200'S A 0.09 25MG 240 2022-04-01 2024-03-31 6
41 1542B AAP-IMIPRAMINE 25MG TAB (APO) 100'S A 0.1925 25MG 240 2024-04-01 2026-03-31 6
40 15826 CHLORDIAZEPOXIDE 10MG CAP (KWA/ATB) 10X10 A 1.96 10MG 90 2022-04-01 2024-03-31 6
40 1591AJ CHLORPROMAZINE 25MG TAB (REM/SBI) 10x10 A 0.06 25MG 90 2022-04-01 2024-03-31 6
41 1591AJ CHLORPROMAZINE 25MG TAB (REM) 10x10 A 0.0622 25MG 90 2024-04-01 2026-03-31 6
42 1591AJ CHLORPROMAZINE 25MG TAB (REM) 10x10 A 0.06 25MG 90 2026-04-01 No No 6
40 15927 CHLORPROMAZINE 50MG TAB (FSB/ATB) 10X10 A 0.08 50MG 90 2022-04-01 2024-03-31 6
41 15929 CHLORPROMAZINE 50MG TAB (TOR) 500'S A 0.5286 50MG 90 2024-04-01 2026-03-31 6
40 15936 CHLORPROMAZINE 100MG TAB (REM/SBI) 10x10 A 0.12 100MG 90 2022-04-01 2024-03-31 6
41 15936 CHLORPROMAZINE 100MG TAB (REM) 10x10 A 0.115 100MG 90 2024-04-01 2026-03-31 6
42 15936 CHLORPROMAZINE 100MG TAB (REM) 10x10 A 0.11 100MG 90 2026-04-01 No No 6
40 1601AL ACCORD DIAZEPAM 2MG TAB (INP/AAL) DIAZEPAM 30'S A 0.08 2MG 120 2022-04-01 2024-03-31 6