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 B1516 ELIQUIS 2.5MG TAB (PFI/STO) APIXABAN 60'S C 3.66 2.5MG 0 2022-04-01 2024-03-31 0
41 B1516 ELIQUIS 2.5MG TAB (PFI) APIXABAN (B) 60'S B 2.9222 2.5MG 60 2024-04-01 2026-03-31 6
42 B1516 ELIQUIS 2.5MG TAB (PFI) APIXABAN 60'S B 2.92 2.5MG 60 2026-04-01 No No Change status from C to 6
42 B151N APO-APIXABAN 2.5MG TAB (APO) 60'S B 0.45 2.5MG 60 2026-04-01 No No 6
40 B1526 ELIQUIS 5MG TAB (PFI/STO) APIXABAN 60'S C 3.66 5MG 0 2022-04-01 2024-03-31 0
41 B1526 ELIQUIS 5MG TAB (PFI) APIXABAN (B) 60'S B 2.9222 5MG 60 2024-04-01 2026-03-31 6
42 B1526 ELIQUIS 5MG TAB (PFI) APIXABAN 60'S B 2.92 5MG 60 2026-04-01 No No Change status from C to 6
42 B152N APO-APIXABAN 5MG TAB (APO) 60'S B 0.54 5MG 60 2026-04-01 No No 6