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 3621B APO-LEVOCARB 10MG | 100MG TAB (APO/COL) 100'S A 0.17 10MG|100MG 240 2022-04-01 2024-03-31 Add to Contract as Cat A 6
42 3621B APO-LEVOCARB 10MG|100MG TAB (APO) 100'S A 0.23 10MG|100MG 240 2026-04-01 No No 6
41 3621G APO-LEVOCARB 10MG|100MG TAB (APO) 100'S A 0.2253 10MG|100MG 240 2024-04-01 2026-03-31 6
41 36222 SINEMET 25MG|250MG TAB (MSD) CARBIDOPA|L (C) 100'S C 0.7997 25MG|250MG 240 2024-04-01 2026-03-31 6
40 36227 APO-LEVOCARB 25MG | 250MG TAB (APO/COL) 100'S A 0.27 25MG|250MG 240 2022-04-01 2024-03-31 Add to Contract as Cat A 6
41 3622K CREDANIL 25MG|250MG TAB (REM) CARBIDOPA| 50'S A 0.2267 25MG|250MG 240 2024-04-01 2026-03-31 6
42 3622K CREDANIL 25MG|250MG TAB (REM) CARBIDOPA|LEVODOPA 50'S A 0.23 25MG|250MG 240 2026-04-01 No No 6
41 3622R APO-LEVOCARB 25MG|250MG TAB (APO) 100'S A 0.2561 25MG|250MG 240 2024-04-01 2026-03-31 6