Displaying 1 - 10 of 10
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 4621BC XANAX 0.5MG TAB (PFI/SBI) ALPRAZOLAM 100'S C 0.47 0.5MG 0 2022-04-01 2024-03-31 0
41 4621BC XANAX 0.5MG TAB (PFI) ALPRAZOLAM (C) 100'S C 0.4836 0.5MG 30 2024-04-01 2026-03-31 6
40 4621L XANAX 0.5MG TAB (PFI/STO) ALPRAZOLAM 100'S C 0.47 0.5MG 0 2022-04-01 2024-03-31 0
41 4621L XANAX 0.5MG TAB (PFI) ALPRAZOLAM (C) 100'S C 0.4836 0.5MG 30 2024-04-01 2026-03-31 6
40 4621R APO-ALPRAZ 0.5MG TAB (APO/COL) 1000'S A 0.04 0.5MG 30 2022-04-01 2024-03-31 6
41 4621V APO-ALPRAZ 0.5MG TAB (APO) 1000'S A 0.0377 0.5MG 30 2024-04-01 2026-03-31 6
40 46241 APO-ALPRAZ 0.25MG TAB (APO/COL) 100'S A 0.05 0.25MG 30 2022-04-01 2024-03-31 6
41 4624D APO-ALPRAZ 0.25MG TAB (APO) 100'S A 0.0487 0.25MG 30 2024-04-01 2026-03-31 6
40 46251 APO-ALPRAZ 1MG TAB (APO/COL) 100'S A 0.08 1MG 30 2022-04-01 2024-03-31 6
41 4625D APO-ALPRAZ 1MG TAB (APO) ALPRAZOLAM 100'S A 0.0832 1MG 30 2024-04-01 2026-03-31 6