Displaying 1 - 20 of 42
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 5201EP DUREX INTENSE SENSATION (SSA/STO) CONDOM 3'S C 1.44 0 2022-04-01 2024-03-31 0
40 5201ER DUREX EXTRA SENSITIVE RIBBED (SSA/STO) COND 3'S C 1.24 0 2022-04-01 2024-03-31 0
40 5201EZ DUREX PERFORMAX INTENSE (SSA/STO) CONDOM 3'S C 1.48 0 2022-04-01 2024-03-31 0
40 5201FQ DUREX INVISIBLE (SSA/STO) CONDOM 3'S C 1.92 0 2022-04-01 2024-03-31 0
40 5201FS LIFESTYLES ULTRA THIN (ANS/SBI) CONDOM 3'S C 1.20 0 2022-04-01 2022-06-12 0
40 5201FS LIFESTYLES ULTRA THIN (ANS/SBI) CONDOM 3'S C 1.92 0 2022-06-14 2024-03-31 Price Change 0
41 5201FS LIFESTYLES ULTRA THIN (ANS) CONDO 3'S C 0.6705 0 2024-04-01 2026-03-31 0
40 5201FT LIFESTYLES SKYN ORIGINAL (ANS/SBI) CONDOM 3'S C 1.04 0 2022-04-01 0
40 5201FT LIFESTYLES SKYN ORIGINAL (ANS/SBI) CONDOM 3'S C 1.99 0 2022-06-14 2024-03-31 Price Change 0
41 5201FT LIFESTYLES SKYN ORIGINAL (ANS) CO 3'S C 1.6763 0 2024-04-01 2024-07-22 0
41 5201FT LIFESTYLES SKYN ORIGINAL (ANS) CO 3'S C 1.9633 0 2024-07-23 2026-03-31 0
40 5201FU LIFESTYLE SKYN LRG (ANS/SBI) CONDOM 3'S C 1.41 0 2022-04-01 2022-06-12 0
40 5201FU LIFESTYLE SKYN LRG (ANS/SBI) CONDOM 3'S C 1.99 0 2022-06-14 2024-03-31 Price Change 0
41 5201FU LIFESTYLE SKYN LRG (ANS) CONDOM 3'S C 1.6763 0 2024-04-01 2024-07-22 0
41 5201FU LIFESTYLE SKYN LRG (ANS) CONDOM 3'S C 1.9633 0 2024-07-23 2026-03-31 0
40 5201FV LIFESTYLES SKYN SELLECTION (ANS/SBI) CONDOM 3'S C 1.41 0 2022-04-01 2022-07-25 Delete from contract 0
40 5201FW LIFESTYLES SENSITIVE VARIETY (ANS/SBI) CON 3'S C 1.20 0 2022-04-01 2022-06-12 0
40 5201FW LIFESTYLES SENSITIVE VARIETY (ANS/SBI) CON 3'S C 1.92 0 2022-06-14 2024-03-31 Price Change 0
40 5201FX LIFEESTYLES HOT RIDER (ANS/SBI) CONDOM 3'S C 1.20 0 2022-04-01 2024-03-31 0
41 5201FX LIFEESTYLES HOT RIDER (ANS) CONDO 3'S C 0.4893 0 2024-04-01 2026-03-31 0