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 1321G CODEINE PHOSPHATE 15MG TAB (TEV/COL) 28'S A 0.18 15MG 112 2022-04-01 2024-03-31 2
41 1321G CODEINE PHOSPHATE 15MG TAB (TEV) 28'S A 0.168 15MG 112 2024-04-01 2026-03-31 2
42 1321J CODEINE PHOSPHATE 15MG TAB (CPP) 28'S A 0.14 15MG 112 2026-04-01 No No 2
40 1322L CODEINE PHOSPHATE 30MG TAB (TEV/COL) 28'S A 0.24 30MG 112 2022-04-01 2024-03-31 2
41 1322L CODEINE PHOSPHATE 30MG TAB (TEV) 28'S A 0.2058 30MG 112 2024-04-01 2026-03-31 2
42 1322M CODEINE PHOSPHATE 30MG TAB (CPP) 28'S A 0.23 30MG 112 2026-04-01 No No 2
41 1322R CODEINE PHOSPHATE 30MG TAB (CPP) 3X10 A 0.1468 30MG 112 2024-04-01 2026-03-31 2
40 13235 CODEINE PHOSPHATE 30MG/ML INJ (KWA/ATB) 10X1ML C 20.39 30MG/ML 0 2022-04-01 2024-03-31 0