Displaying 1 - 20 of 28
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 43519 BOTTLE, GLASS RX, 30ML AMBER EACH (BEA/COL) 130'S B 0.33 0 2022-04-01 2024-03-31 0
40 43528 BOTTLE, GLASS RX, 60ML AMBER EACH (BEA/COL) 132'S B 0.40 0 2022-04-01 2024-03-31 Price Change 0
41 43528 BOTTLE, GLASS RX, 60ML AMBER EACH (BEA) 132'S B 0.3985 4 2024-04-01 2025-01-28 0
41 4352A BOTTLE, GLASS RX, 60ML AMBER (BEA) BOTTLES 81'S B 0.3985 4 2024-12-17 2026-03-31
40 43536 BOTTLE, GLASS RX, 100ML FLAT (BEA/COL) BOT 90'S B 0.97 0 2022-04-01 2024-03-31 Price Change 0
41 43536 BOTTLE, GLASS RX, 100ML FLAT (BEA) 90'S B 0.8385 4 2024-04-01 2026-03-31 0
40 43539 BOTTLE, GLASS RX, 100ML AMBER (BEA/COL) BOT 104'S B 0.41 0 2022-04-01 2024-03-31 0
40 43544 BOTTLE, GLASS RX, 200ML AMBER (BEA/COL) BOT 67'S B 0.56 0 2022-04-01 2024-03-31 0
40 43545 BOTTLE, GLASS RX, 200ML FLAT (BEA/COL) BOTT 56'S B 0.67 0 2022-04-01 2024-03-31 0
41 43545 BOTTLE, GLASS RX, 200ML FLAT (BEA) (B) 56'S B 0.5995 4 2024-04-01 2026-03-31 0
41 43547 BOTTLE, GLASS RX, 200ML, AMBER 200ML (BEA) (B) 64'S B 0.8567 200ML 0 2024-04-01 2026-03-31 0
40 43554 BOTTLE, GLASS RX, 500ML AMBER (BEA/COL) 35'S B 0.86 0 2022-04-01 2024-03-31 0
40 43574 BOTTLE, GLASS RX, 150ML AMBER (BEA/COL) BOT 84'S B 0.50 0 2022-04-01 2024-03-31 Price Change 0
41 43574 BOTTLE, GLASS RX, 150ML AMBER (BEA) 84'S B 0.4997 4 2024-04-01 2025-01-28 0
41 43579 BOTTLES, GLASS RX, 150ML AMBER (BEA) 81'S B 0.4998 4 2024-12-17 2026-03-31
40 43719 VIAL PLASTIC, AMBER 15ML/4 DR (DCN/COL) BOT 200'S B 0.14 0 2022-04-01 2024-03-31 0
41 43719 VIAL PLASTIC, AMBER 15ML/4 DR (DCN) 200'S B 0.1502 4 2024-04-01 2026-03-31 0
40 43728 VIAL, PLASTIC, AMBER 25ML/7 DR (DCN/COL) 200'S B 0.16 0 2022-04-01 2024-03-31 0
40 43738 VIAL, PLASTIC, AMBER 40ML/10DR (DCN/COL) BO 200'S B 0.22 0 2022-04-01 2024-03-31 0
41 43738 VIAL, PLASTIC, AMBER 40ML/10DR (DCN) 200'S B 0.2311 4 2024-04-01 2026-03-31 0