Displaying 1381 - 1400 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
40 19322 VIAGRA 50MG TAB (PFI/STO) SILDENAFIL 4'S C 14.16 50MG 0 2022-04-01 2024-03-31 0
41 19322 VIAGRA 50MG TAB (PFI) SILDENAFIL (C) 4'S C 14.645 50MG 30 2024-04-01 2026-03-31 6
40 19323 VIAGRA 50MG TAB (PFI/SBI) SILDENAFIL 1'S C 16.04 50MG 0 2022-04-01 2024-03-31 0
41 19323 VIAGRA 50MG TAB (PFI) SILDENAFIL (C) 1'S C 16.5818 50MG 30 2024-04-01 2026-03-31 6
40 19324 VIAGRA 50MG TAB (PFI/SBI) SILDENAFIL 4'S C 14.16 50MG 0 2022-04-01 2024-03-31 0
41 19324 VIAGRA 50MG TAB (PFI) SILDENAFIL (C) 4'S C 14.645 50MG 30 2024-04-01 2026-03-31 6
40 1932AK INTAGRA 50MG TAB (INP/AHI) SILDENAFIL 4'S BQ 0.30 50MG 0 2022-04-01 2024-03-31 6
41 1932AK INTAGRA 50MG TAB (INP) SILDENAFIL (BQ) 4'S BQ 0.2378 50MG 30 2024-04-01 2026-03-31 6
40 1932AR SILDENAFIL 50MG TAB (MCP/AHI) 4'S BQ 0.31 50MG 0 2022-04-01 2024-03-31 6
42 1932AR SILDENAFIL 50MG TAB (MCP) 4'S BQ 0.20 50MG 30 2026-04-01 No No 0
41 1932AU ZENEGRA 50MG TAB (RYV) SILDENAFIL (BQ) 4'S BQ 0.5233 50MG 30 2024-04-01 2024-06-18 6
41 1932AU ZENEGRA 50MG TAB (RYV) SILDENAFIL (BQ) 4'S BQ 0.795 50MG 30 2024-06-19 2026-03-31 6
42 1932BB PENAGRA 50MG TAB (ZYD) SILDENAFIL 4'S BQ 0.32 50MG 30 2026-04-01 No No 0
41 1932V XCITE 50MG TAB (GPC) SILDENAFIL (BQ) 4'S BQ 0.2514 50MG 30 2024-04-01 2026-03-31 6
40 19412 URS-11 STRP (TED/COL) DIAGNOSTIC URINE 100'S B 28.54 0 2022-04-01 2024-03-31 0
41 19412 URS-11 STRP (TED) DIAGNOSTIC URINE (B) 100'S B 40.7749 0 2024-04-01 2026-03-31 0
42 19412 URS-11 STRP (TED) DIAGNOSTIC URINE 100'S C 40.77 0 2026-04-01 No No 0
40 19415 MEDI-TEST COMBI 10 STRP (SCN/PHA) DIAGNOSTIC URINE 100'S B 15.22 0 2022-04-01 2022-07-18 0
40 19415 MEDI-TEST COMBI 10 STRP (SCN/PHA) DIAGNOSTIC URINE 100'S B 20.44 0 2022-07-19 2024-03-31 Price Change 0
41 19415 MEDI-TEST COMBI 10 STRP (SCN) DIAGNOSTIC URINE (B) 100'S B 25.1 0 2024-04-01 2026-03-31 0