Displaying 1741 - 1760 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 2561H APO-DIMENHYDRINATE 50MG TAB (APO/COL) 1000'S A 0.03 50MG 180 2022-04-01 2024-03-31 6
42 2561H APO-DIMENHYDRINATE 50MG TAB (APO) 1000'S A 0.06 50MG 180 2026-04-01 No No 6
40 2561L GRAVINATE 50MG TAB (CAR/COL) DIMENHYDRINATE 250'S C 0.07 50MG 0 2022-04-01 2024-03-31 0
41 2561L GRAVINATE 50MG TAB (CAR) DIMENHYDRINATE 250'S A 0.07 50MG 180 2024-04-01 2026-03-31 6
42 2561L GRAVINATE 50MG TAB (CAR) DIMENHYDRINATE 250'S A 0.07 50MG 180 2026-04-01 No No 6
41 2561N DIMENHYDRINATE 50MG TAB (GPC) 1000'S A 0.0296 50MG 180 2024-04-01 2026-03-31 6
40 2561S DIMENHYDRINATE 50MG TAB (FSB/ATB) 10X10 A 0.05 50MG 180 2022-04-01 2022-09-30 6
41 2561S DIMENHYDRINATE 50MG TAB (FSB) 10X10 A 0.0459 50MG 180 2024-04-01 2026-03-31 6
40 2561U DIMENHYDRINATE 50MG TAB (RYV/ATB) 250'S A 0.04 50MG 180 2022-04-01 2024-03-31 6
40 25628 GRAVOL KIDS 3MG/ML SYR (CDC/COL) DIMENHYDRINATE 75ML C 0.08 3MG/ML 0 2022-04-01 2024-03-31 0
41 25628 GRAVOL KIDS 3MG/ML SYR (CDC) DIMENHYDRINATE (C) 75ML C 0.0859 3MG/ML 125 2024-04-01 2026-03-31 6
42 25628 GRAVOL KIDS 3MG/ML SYR (CDC) DIMENHYDRINATE 75ML C 0.09 3MG/ML 125 2026-04-01 No No 6
40 25629 GRAVINATE 3MG/ML SYR (CAR/COL) DIMENHYDRINATE 125ML A 0.04 3MG/ML 125 2022-04-01 2024-03-31 6
41 25629 GRAVINATE 3MG/ML SYR (CAR) DIMENHYDRINAT 125ML A 0.0387 3MG/ML 125 2024-04-01 2026-03-31 6
42 25629 GRAVINATE 3MG/ML SYR (CAR) DIMENHYDRINAT 125ML A 0.04 3MG/ML 125 2026-04-01 No No 6
40 2562C DIMENHYDRINATE 3MG/ML SYR (CIR/AHI) 150ML A 0.03 3MG/ML 125 2022-04-01 2024-03-31 6
40 25633 GRAVOL 100MG SUPPOS (CDC/COL) DIMENHYDRINATE 10'S A 0.90 100MG 10 2022-04-01 2024-03-31 6
41 25633 GRAVOL 100MG SUPPOS (CDC) DIMENHYDRINATE 10'S A 0.9813 100MG 10 2024-04-01 2026-03-31 6
42 25633 GRAVOL 100MG SUPPOS (CDC) DIMENHYDRINATE 10'S A 1.06 100MG 10 2026-04-01 No No 6
40 25643 GRAVOL INFANT 25MG SUPPOS (CDC/COL) DIMENHYDR 10'S A 0.79 25MG 10 2022-04-01 2024-03-31 0