Displaying 1321 - 1340 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 17231 CONCERTA 18MG ER TAB (JAC) METHYLP (C) 30'S C 4.3477 18MG 42 2024-08-01 2024-12-31 6
41 17231 CONCERTA 18MG ER TAB (JAC) METHYLPHENIDATE 30'S A 4.3477 18MG 30 2025-01-01 2025-01-31 6
42 17231 CONCERTA 18MG ER TAB (JAC) METHYLPHENIDATE 30'S C 4.35 18MG 30 2026-04-01 No No 6
40 17233 APO-METHYLPHENIDATE ER 18MG TAB (APO/COL) 100'S A 2.45 18MG 30 2022-04-01 2024-03-31 6
42 17233 APO-METHYLPHENIDATE 18MG ER TAB (APO) 100'S A 2.50 18MG 30 2026-04-01 No No 6
41 17235 APO-METHYLPHENIDATE ER 18MG ER TAB (APO) 100'S A 2.4954 18MG 42 2024-04-01 2026-03-31 6
40 17241 CONCERTA 27MG TAB (JAC/STO) METHYLPHENIDATE 30'S C 5.23 27MG 0 2022-04-01 2024-03-31 0
41 17241 CONCERTA 27MG ER TAB (JAC) METHYLP (C) 30'S C 5.2273 27MG 42 2024-04-01 2024-06-20 6
41 17241 CONCERTA 27MG ER TAB (JAC) METHYLPHENIDATE 30'S A 5.2273 27MG 30 2024-06-21 2024-07-31 6
41 17241 CONCERTA 27MG ER TAB (JAC) METHYLP (C) 30'S C 5.2273 27MG 42 2024-08-01 2024-12-31 6
41 17241 CONCERTA 27MG ER TAB (JAC) METHYLPHENIDATE 30'S A 5.2273 27MG 30 2025-01-01 2025-01-31 6
42 17241 CONCERTA 27MG ER TAB (JAC) METHYLPHENIDATE 30'S C 5.23 27MG 30 2026-04-01 No No 6
40 17244 APO-METHYLPHENIDATE ER 27MG TAB (APO/COL) 100'S A 2.77 27MG 30 2022-04-01 2024-03-31 6
42 17244 APO-METHYLPHENIDATE ER 27MG ER TAB (APO) 100'S A 2.83 27MG 30 2026-04-01 No No 6
41 17245 APO-METHYLPHENIDATE ER 27MG ER TAB (APO) 100'S A 2.8281 27MG 42 2024-04-01 2026-03-31 6
40 17251 CONCERTA 36MG TAB (JAC/STO) METHYLPHENIDATE 30'S C 6.37 36MG 0 2022-04-01 2024-03-31 0
41 17251 CONCERTA 36MG ER TAB (JAC) METHYLPHENIDATE (C) 30'S C 6.369 36MG 42 2024-04-01 2026-03-31 6
42 17251 CONCERTA 36MG ER TAB (JAC) METHYLPHENIDATE 30'S C 6.37 36MG 42 2026-04-01 No No 6
40 17254 APO-METHYLPHENIDATE ER 36MG TAB (APO/COL) 100'S A 3.81 36MG 30 2022-04-01 2024-03-31 6
42 17254 APO-METHYLPHENIDATE ER 36MG ER TAB (APO) 100'S A 3.88 36MG 42 2026-04-01 No No 6