Displaying 1 - 9 of 9
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 1791D POLYBAR ACB 100% (EZM/COL) BARIUM SULPHATE 24X397G BQ 52.10 100% 0 2022-04-01 2024-03-31 0
41 1791D POLYBAR ACB 100% (EZM) BARIUM SULPHATE 24X397G BQ 57.3113 100% 50 2024-04-01 2026-03-31 0
42 1791D POLYBAR ACB 100% (EZM) BARIUM SULPHATE 24X397G BQ 60.14 100% 50 2026-04-01 No No 0
40 1794C E-Z-HD 250% SUSP (EZM/COL) BARIUM SULPHATE 24X340G BQ 47.80 98% 0 2022-04-01 2024-03-31 0
41 1794C E-Z-HD 250% SUSP (EZM) BARIUM SULPHATE 24X340G BQ 52.5543 98% 0 2024-04-01 2026-03-31 0
42 1794C E-Z-HD 250% SUSP (EZM) BARIUM SULPHATE 24X340G BQ 55.16 98% 0 2026-04-01 No No 0
40 1795C READI-CAT 2 2% SUSP (EZM/COL) BARIUM SULPHATE 12X450ML BQ 46.44 2% 0 2022-04-01 2024-03-31 0
41 1795C READI-CAT 2 2% SUSP (EZM) BARIUM SU 12X450ML BQ 50.9686 2% 0 2024-04-01 2026-03-31 0
42 1795C READI-CAT 2% SUSP (EZM) BARIUM SULPHATE 12X450ML BQ 53.46 2% 0 2026-04-01 No No 0