Displaying 1621 - 1640 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 22814 ACETAZOLAMIDE 250MG TAB (REM/SBI) 1000's A 0.08 250MG 120 2022-04-01 2024-03-31 6
41 22814 ACETAZOLAMIDE 250MG TAB (REM) 1000'S A 0.1074 250MG 120 2024-04-01 2026-03-31 Yes 6
42 22814 ACETAZOLAMIDE 250MG TAB (REM) 1000'S A 0.11 250MG 120 2026-04-01 No No 6
40 22819 ACETAZOLAMIDE 250MG TAB (KWA/ATB) 10X10 A 0.08 250MG 120 2022-04-01 2024-03-31 6
40 2281AA ACETAZOLAMIDE 250MG TAB (FSB/ATB) 10X10 A 0.07 250MG 120 2022-04-01 2024-03-31 6
41 2281AS APO-ACETAZOLAMIDE 250MG TAB (APO) 100'S A 0.1202 250MG 120 2024-04-01 2026-03-31 Yes 6
42 2281AU ACETAZOLAMIDE 250MG TAB (FSB) 1000'S A 0.06 250MG 120 2026-04-01 No No Add to Contract as Cat A 6
42 2281U ACEMIDE 250MG TAB (JLP) ACETAZOLAMIDE 100'S A 0.08 250MG 120 2026-04-01 No No 6
40 22826 ACETAZOLAMIDE 500MG INJ (XGE/AHI) 1DOSE SYRN BQ 165.44 500MG 0 2022-04-01 2022-09-30 0
40 22827 ACETAZOLAMIDE 500MG INJ (MAT/AHI) 500MG VIAL BQ 182.67 500MG 0 2022-04-01 2024-03-31 0
41 22827 ACETAZOLAMIDE 500MG INJ (MAT) 500MG VIAL BQ 182.8888 500MG 10 2024-04-01 2026-03-31 6
42 22827 ACETAZOLAMIDE 500MG INJ (MAT) 500MG VIAL BQ 189.39 500MG 10 2026-04-01 No No 0
40 22832 ACETAZOLAMIDE SR 250MG TAB (CHC/ATB) 100'S A 1.55 250MG 60 2022-04-01 2024-03-31 6
41 23012 OXYBUPROCAINE MINIMS 0.4% EYE DR (CAM) (B) 20X0.5ML B 4.1264 0.4% 4 2024-04-01 2026-03-31 0
40 23016 OXYBUPROCAINE MINIMS 0.4% EYE DR (CAM/STO) 20X0.5ML B 4.74 0.4% 0 2022-04-01 2024-03-31 6
40 23132 MIOSTAT OCULAR 0.01% INJ (ALC/AHI) CARBACHOL 1.5ML VIAL BQ 59.94 0.01% 0 2022-04-01 2024-03-31 0
41 23132 MIOSTAT OCULAR 0.01% INJ (ALC) CARBACHOL 1.5ML VIAL BQ 55.182 0.01% 0 2024-04-01 2026-03-31 0
42 23132 MIOSTAT OCULAR 0.01% INJ (ALC) CARBACHOL 1.5ML VIAL BQ 52.95 0.01% 0 2026-04-01 No No 0
42 23312 PILOCARPINE 2% EYE DR (MTP) 10ML A 33.49 2% 1 2026-04-01 No No 6
40 2331J PILOCARPINE 2% EYE DR (MTP/COL) 10ML A 15.25 2% 1 2022-04-01 2024-03-31 Price Change 6