Displaying 1301 - 1320 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 17025 TRIFLUOPERAZINE 5MG TAB (REM) 1000'S A 0.0553 5MG 252 2024-04-01 2026-03-31 6
42 17025 TRIFLUOPERAZINE 5MG TAB (REM) 1000'S A 0.05 5MG 252 2026-04-01 No No 6
40 17026 AAP-TRIFLUOPERAZINE 5MG TAB (APO/COL) 100'S A 0.06 5MG 180 2022-04-01 2024-03-31 NAME CHANGED TO AAP 6
40 17026 AAP-TRIFLUOPERAZINE 5MG TAB (APO/COL) 100'S A 0.0625 5MG 2022-04-01 2024-03-31 No No Name Change 6
41 17211 PMS-METHYLPHENIDATE 10MG TAB (PMS) 100'S A 0.1835 10MG 84 2024-04-01 2026-03-31 6
42 17211 PMS-METHYLPHENIDATE 10MG TAB (PMS) 100'S A 0.18 10MG 84 2026-04-01 No No 6
40 17212 APO-METHYLPHENIDATE 10MG TAB (APO/COL) 100'S A 0.19 10MG 60 2022-04-01 2024-03-31 6
42 17212 APO-METHYLPHENIDATE 10MG TAB (APO) 100'S A 0.19 10MG 84 2026-04-01 No No 6
40 17213 RITALIN 10MG TAB (NVS/COL) METHYLPHENIDATE 30'S C 0.39 10MG 0 2022-04-01 2024-03-31 0
41 17213 RITALIN 10MG TAB (NVS) METHYLPHENIDATE (C) 30'S C 0.704 10MG 84 2024-04-01 2026-03-31 6
42 17213 RITALIN 10MG TAB (NVS) METHYLPHENIDATE 30'S C 0.59 10MG 84 2026-04-01 No No 6
41 1721C APO-METHYLPHENIDATE 10MG TAB (APO) 100'S A 0.1941 10MG 84 2024-04-01 2026-03-31 6
41 17224 PMS-METHYLPHENIDATE 20MG TAB (PMS) 100'S A 0.2243 20MG 90 2024-04-01 2026-03-31 6
40 17225 APO-METHYLPHENIDATE 20MG TAB (APO/COL) 100'S A 0.23 20MG 90 2022-04-01 2024-03-31 6
42 17225 APO-METHYLPHENIDATE 20MG TAB (APO) 100'S A 0.24 20MG 90 2026-04-01 No No 6
41 17228 APO-METHYLPHENIDATE 20MG TAB (APO) 100'S A 0.2357 20MG 90 2024-04-01 2026-03-31 6
42 17229 PMS-METHYLPHENIDATE 20MG CAP (PMS) 100'S A 0.22 20MG 84 2026-04-01 No No 6
40 17231 CONCERTA 18MG TAB (JAC/STO) METHYLPHENIDATE 30'S C 4.35 18MG 0 2022-04-01 2024-03-31 0
41 17231 CONCERTA 18MG ER TAB (JAC) METHYLP (C) 30'S C 4.3477 18MG 42 2024-04-01 2024-06-20 6
41 17231 CONCERTA 18MG ER TAB (JAC) METHYLPHENIDATE 30'S A 4.3477 18MG 30 2024-06-21 2024-07-31 6