Displaying 1341 - 1360 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 17256 APO-METHYLPHENIDATE 36MG ER TAB (APO) 100'S A 3.8818 36MG 42 2024-04-01 2026-03-31 6
40 17261 CONCERTA 54MG TAB (JAC/STO) METHYLPHENIDATE 30'S C 6.69 54MG 0 2022-04-01 2024-03-31 0
41 17261 CONCERTA 54MG ER TAB (JAC) METHYLPHENIDATE (C) 30'S C 6.6853 54MG 42 2024-04-01 2026-03-31 6
42 17261 CONCERTA 54MG ER TAB (JAC) METHYLPHENIDATE 30'S C 6.69 54MG 42 2026-04-01 No No 6
40 17265 APO-METHYLPHENIDATE ER 54MG TAB (APO/COL) 100'S A 4.08 54MG 30 2022-04-01 2024-03-31 6
42 17265 APO-METHYLPHENIDATE ER 54MG ER TAB (APO) 100'S A 4.16 54MG 42 2026-04-01 No No 6
41 17266 APO-METHYLPHENIDATE 54MG ER TAB (APO) 100'S A 4.159 54MG 42 2024-04-01 2026-03-31 6
40 17283 APO-METHYLPHENIDATE SR 20MG TAB (APO/COL) 100'S A 0.30 20MG 60 2022-04-01 2024-03-31 6
42 17283 APO-METHYLPHENIDATE 20MG SR TAB (APO) 100'S A 0.31 20MG 84 2026-04-01 No No 6
42 17287 PMS-METHYLPHENIDATE 20MG CR CAP (PMS) 100'S C 1.50 20MG 0 2026-04-01 No No 0
41 1728E APO-METHYLPHENIDATE 20MG SR TAB (APO) 100'S A 0.305 20MG 84 2024-04-01 2026-03-31 6
41 17635 PROMETHAZINE 25MG/ML INJ (STP) (B) 100X2ML B 2.1747 25MG/ML 30 2024-04-01 2026-03-31 0
42 17635 PROMETHAZINE 25MG/ML INJ (STP) 100X2ML B 2.17 25MG/ML 30 2026-04-01 No No 0
40 17639 PROMETHAZINE 25MG/ML INJ (KWA/ATB) 5X2ML B 11.42 25MG/ML 0 2022-04-01 2024-03-31 0
40 1763L PROMETHAZINE 25MG/ML INJ (ROL/AHI) 25X1ML B 8.16 25MG/ML 0 2022-04-01 2022-09-30 0
40 1791D POLYBAR ACB 100% (EZM/COL) BARIUM SULPHATE 24X397G BQ 52.10 100% 0 2022-04-01 2024-03-31 0
41 1791D POLYBAR ACB 100% (EZM) BARIUM SULPHATE 24X397G BQ 57.3113 100% 50 2024-04-01 2026-03-31 0
42 1791D POLYBAR ACB 100% (EZM) BARIUM SULPHATE 24X397G BQ 60.14 100% 50 2026-04-01 No No 0
40 1794C E-Z-HD 250% SUSP (EZM/COL) BARIUM SULPHATE 24X340G BQ 47.80 98% 0 2022-04-01 2024-03-31 0
41 1794C E-Z-HD 250% SUSP (EZM) BARIUM SULPHATE 24X340G BQ 52.5543 98% 0 2024-04-01 2026-03-31 0