Displaying 1 - 4 of 4
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 B5911 AMLOTENSIVE CT 5MG | 25MG TAB (CAR/COL) AMLODIPINE | CHLORTHALIDONE 210'S A 0.13 5MG|25MG 60 2022-04-01 2024-03-31 6
40 B5921 AMLOTENSIVE CT 5MG | 50MG TAB (CAR/COL) AMLODIPINE | CHLORTHALIDONE 210'S A 0.17 5MG|50MG 30 2022-07-11 2024-03-31 Add to Contract as Cat A 6
40 B5931 AMLOTENSIVE CT 10MG | 25MG TAB (CAR/COL) AMLODIPINE | CHLORTHALIDONE 210'S A 0.13 10MG|25MG 30 2022-07-11 2024-03-31 Add to Contract as Cat A 6
40 B5941 AMLOTENSIVE CT 10MG | 50MG TAB (CAR/COL) AMLODIPINE | CHLORTHALIDONE 210'S A 0.17 10MG|50MG 30 2022-07-11 2022-03-31 Add to Contract as Cat A 6