Displaying 1 - 15 of 15
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
41 20918 CHLORTHALIDONE 50MG TAB (FSB) 500'S A 0.0545 50MG 30 2024-04-01 2026-03-31 6
40 2091B CARLIDONE 50MG TAB (CAR/COL) CHLORTHALIDONE 125's A 0.12 50MG 30 2022-05-05 2024-03-31 Add to Contract as Cat A 6
41 2091B CARLIDONE 50MG TAB (CAR) CHLORTHALIDONE 125's A 0.127 50MG 30 2024-04-01 2026-03-31 6
40 2091C CARLIDONE 50MG TAB (CAR/COL) CHLORTHALIDONE 500'S A 0.12 50MG 30 2022-04-01 2024-03-31 6
40 2091D CHLORTHALIDONE 50MG TAB (CHC/ATB) 500'S A 0.12 50MG 30 2022-04-01 2024-03-31 6
41 2091E DIUDONE 50MG TAB (HEA) CHLORTHALIDONE 10X10 A 0.1025 50MG 30 2024-04-01 2026-03-31 6
40 20923 CHLORTHALIDONE 25MG TAB (KWA/ATB) 10X10 A 0.20 25MG 60 2022-04-01 2024-03-31 6
40 20926 CARLIDONE 25MG TAB (CAR/COL) CHLORTHALIDONE 125's A 0.12 25MG 60 2022-04-01 2024-03-31 Package Size Change 6
41 20926 CARLIDONE 25MG TAB (CAR) CHLORTHALIDONE 125'S A 0.1248 25MG 60 2024-04-01 2026-03-31 6
40 20927 CARLIDONE 25MG TAB (CAR/COL) CHLORTHALIDONE 750'S A 0.12 25MG 60 2022-04-01 2024-03-31 6
41 2092B DIUDONE 25MG TAB (HEA) CHLORTHALIDONE 10X10 A 0.0848 25MG 60 2024-04-01 2026-03-31 6
40 20931 CHLORTHALIDONE 12.5MG TAB (MBL/AHI) 30'S A 0.18 12.5MG 30 2022-04-01 2024-03-31 6
41 20933 DICHLOR 12.5MG TAB (IPC) CHLORTHALI 3X10 A 0.145 12.5MG 30 2024-04-01 2026-03-31 6
41 20934 CHLORTHALIDONE 12.5MG TAB (KWA) 100'S A 0.1802 12.5MG 30 2024-04-01 2026-03-31 6
41 20935 CARLIDONE 12.5MG TAB (CAR) CHLORTHALIDONE 125'S A 0.0816 12.5MG 60 2024-04-01 2026-03-31 6