Displaying 1 - 14 of 14
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 B1511 PRADAX 75MG TAB (BOE/STO) DABIGATRAN 3X10 BQ 2.96 75MG 0 2022-04-01 2024-03-31 6
41 B1511 PRADAX 75MG TAB (BOE) DABIGATRAN (BQ) 3X10 BQ 3.2212 75MG 60 2024-04-01 2026-03-31 6
42 B1511 PRADAX 75MG TAB (BOE) DABIGATRAN 3X10 B 3.22 75MG 60 2026-04-01 No No Change status from C to 6
40 B1521 PRADAX 110MG TAB (BOE/STO) DABIGATRAN 3X10 BQ 2.96 110MG 0 2022-04-01 2024-03-31 6
41 B1521 PRADAX 110MG TAB (BOE) DABIGATRAN (BQ) 3X10 BQ 3.2212 110MG 60 2024-04-01 2026-03-31 6
42 B1521 PRADAX 110MG TAB (BOE) DABIGATRAN 3X10 B 3.22 110MG 60 2026-04-01 No No Change status from C to 6
40 B1524 PRADAX 110MG TAB (BOE/STO) DABIGATRAN 60'S BQ 2.96 110MG 0 2022-04-01 2024-03-31 6
41 B1524 PRADAX 110MG TAB (BOE) DABIGATRAN (BQ) 60'S BQ 3.2212 110MG 60 2024-04-01 2026-03-31 6
42 B1524 PRADAX 110MG TAB (BOE) DABIGATRAN 60'S B 3.22 110MG 60 2026-04-01 No No Change status from C to 6
42 B152AC DEBIJOHN 110MG CAP (JLP) DABIGATRAN 10X10 B 0.51 110MG 60 2026-04-01 No No 6
40 B1531 PRADAX 150MG TAB (BOE/STO) DABIGATRAN 60'S BQ 2.96 150MG 0 2022-04-01 2024-03-31 6
41 B1531 PRADAX 150MG TAB (BOE) DABIGATRAN (BQ) 60'S BQ 3.2212 150MG 60 2024-04-01 2026-03-31 6
42 B1531 PRADAX 150MG TAB (BOE) DABIGATRAN 60'S B 3.22 150MG 60 2026-04-01 No No Change status from C to 6
42 B153R DEBIJOHN 150MG CAP (JLP) DABIGATRAN 10X10 B 0.65 150MG 60 2026-04-01 No No 6