Displaying 1 - 8 of 8
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
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
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