Displaying 1 - 20 of 49
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 5691E ACYCLOVIR 50MG/ML INJ (KWA) (BQ) 10ML VIAL BQ 4.893 50MG/ML 15 2024-04-01 2026-03-31 4
40 5691F ZOVIRAX 50MG/ML INJ (GSK/COL) ACYCLOVIR 5X5ML BQ 87.57 50MG/ML 0 2022-04-01 2024-03-31 0
41 5691F ZOVIRAX 50MG/ML INJ (GSK) ACYCLOVIR (C) 5X5ML C 96.3265 50MG/ML 15 2024-04-01 2026-03-31 4
40 5691M ACYCLOVIR 50MG/ML INJ (CHC/ATB) 10ML BQ 9.05 50MG/ML 0 2022-04-01 2024-03-31 Price Change 0
42 5691S SIMPLOVIR 50MG/ML INJ (INC) ACYCLOVIR 500MG VIAL BQ 11.93 50MG/ML 15 2026-04-01 No No 0
42 5691T ACYCLOVIR 50MG/ML INJ (FSB) 10ML BQ 2.36 50MG/ML 15 2026-04-01 No No Add to Contract 0
40 5692K ACYCLOVIR 5% OINT (TOR/AHI) 15G C 69.32 5% 0 2022-04-01 2024-03-31 0
41 5692K ACYCLOVIR 5% OINT (TOR) 15G C 69.3173 5% 2 2024-04-01 2026-03-31 0
42 5692N APO-ACYCLOVIR 5% OINT (APO) 4G A 6.39 5% 2 2026-04-01 No No 0
40 56937 APO-ACYCLOVIR 200MG TAB (APO/COL) 100'S A 0.14 200MG 50 2022-04-01 2024-03-31 0
42 56937 APO-ACYCLOVIR 200MG TAB (APO) 100'S A 0.14 200MG 50 2026-04-01 No No 0
41 5693AZ ACYCLOVIR 200MG TAB (CPP) ACYCLOVIR 25'S A 0.1272 200MG 50 2024-04-01 2026-03-31 0
41 5693CG CYCLOVAX 200MG TAB (REM) ACYCLOVIR (C) 3X10 C 0.1495 200MG 50 2024-04-01 2026-03-31 0
40 5693EC ZOVIRAX 200MG TAB (GSK/COL) ACYCLOVIR 25'S C 2.52 200MG 0 2022-04-01 2024-03-31 0
40 5693EZ ACYCLOVIR 200MG TAB (CHC/ATB) 100'S A 0.17 200MG 50 2022-04-01 2024-03-31 0
41 5693FA APO-ACYCLOVIR 200MG TAB (APO) 100'S A 0.1449 200MG 50 2024-04-01 2026-03-31 0
40 56944 ZOVIRAX 5% CR (GSK/COL) ACYCLOVIR 5G C 20.93 5% 0 2022-04-01 2024-03-31 0
41 56944 ZOVIRAX 5% CR (GSK) ACYCLOVIR (C) 5G C 23.0242 5% 2 2024-04-01 2026-03-31 0
42 56944 ZOVIRAX 5% CR (GSK) ACYCLOVIR 5G C 25.50 5% 2 2026-04-01 No No Price Change 0
40 56949 CYCLOVAX 5% CR (REM/SBI) ACYCLOVIR 10G A 3.07 5% 2 2022-04-01 2024-03-31 0