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
41 1531AJ AMIROL 10MG TAB (REM) AMITRIPTYLINE 10X10 A 0.0408 10MG 150 2024-04-01 2026-03-31 6
42 1531AJ AMIROL 10MG TAB (REM) AMITRIPTYLINE 10X10 A 0.04 10MG 150 2026-04-01 No No 6
40 1531Z APO-AMITRIPTYLINE 10MG TAB (APO/COL) 1000'S A 0.04 10MG 150 2022-04-01 2024-03-31 6
41 1532AW AMITRIPTYLINE 25MG TAB (GPC) 1000'S A 0.0277 25MG 240 2024-04-01 2026-03-31 6
41 1532AX AMIROL 25MG TAB (REM) AMITRIPTYLINE 10X10 A 0.0438 25MG 240 2024-04-01 2026-03-31 6
42 1532AX AMIROL 25MG TAB (REM) AMITRIPTYLINE 10X10 A 0.07 25MG 240 2026-04-01 2028-03-31 No No 6
41 1532E APO-AMITRIPTYLINE 25MG TAB (APO) 1000'S A 0.0441 25MG 240 2024-04-01 2026-03-31 6
40 1532ZC APO-AMITRIPTYLINE 25MG TAB (APO/COL) 1000'S A 0.04 25MG 240 2022-04-01 2024-03-31 6