Displaying 1 - 20 of 31
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 20515 DEXTROSE 50% INJ (BRA/COL) 50ML B 1.88 50% 0 2022-04-01 2024-03-31 0
41 20515 DEXTROSE 50% INJ (BRA) 50ML B 2.2834 50% 59 2024-04-01 2026-03-31 0
40 20523 DEXTROSE 5% INJ (CSC/PHA) 250ML B 2.65 5% 0 2022-04-01 2022-06-15 Price Change 0
40 20523 DEXTROSE 5% INJ (CSC/PHA) 250ML B 3.02 5% 0 2022-06-16 2024-03-31 Price Change 0
41 20523 DEXTROSE 5% INJ (CSC) (B) 250ML B 2.1203 5% 100 2024-04-01 2026-03-31 0
40 2052F DEXTROSE (2B0062Q) 5% INJ (BAX/STO) 250ML B 3.32 5% 0 2022-04-01 2024-03-31 0
41 2052F DEXTROSE (2B0062Q) 5% INJ (BAX) (B) 250ML B 5.9259 5% 100 2024-04-01 2026-03-31 0
40 2053A DEXTROSE 5% (CSC/PHA) 500ML B 2.50 5% 0 2022-04-01 2022-06-15 Price Change 0
40 2053A DEXTROSE 5% (CSC/PHA) 500ML B 2.81 5% 0 2022-06-16 2024-03-31 Price Change 0
41 2053A DEXTROSE 5% (CSC) PLASTIC BAG (B) 500ML B 2.4193 5% 100 2024-04-01 2026-03-31 0
40 2053H DEXTROSE (2B0063Q) 5% (BAX/STO) 500ML B 2.56 5% 0 2022-04-01 2024-03-31 0
41 2053H DEXTROSE (2B0063Q) 5% (BAX) (B) 500ML B 5.491 5% 100 2024-04-01 2026-03-31 0
41 20542 DEXTROSE (2B0064X) 5% (BAX) (B) 1 LITRE B 5.7628 5% 100 2024-04-01 2026-03-31 0
40 2054C DEXTROSE 5% (CSC/PHA) 1 LITRE B 3.95 5% 0 2022-04-01 2022-06-15 Price Change 0
40 2054C DEXTROSE 5% (CSC/PHA) 1 LITRE B 4.20 5% 0 2022-06-16 2022-07-18 Price Change 0
40 2054C DEXTROSE 5% (CSC/PHA) 1 LITRE B 3.98 5% 0 2022-07-19 2024-03-31 Price Change 0
41 2054C DEXTROSE 5% (CSC) PLASTIC BAG (B) 1 LITRE B 3.7241 5% 100 2024-04-01 2026-03-31 0
40 20552 DEXTROSE (2B0162Q) 10% (BAX/STO) 250ML B 3.37 10% 0 2022-04-01 2024-03-31 0
41 20552 DEXTROSE (2B0162Q) 10% (BAX) (B) 250ML B 3.5066 10% 50 2024-04-01 2026-03-31 0
40 20553 DEXTROSE 10% (CSC/PHA) 250ML B 2.65 10% 0 2022-04-01 2022-06-15 Price Change 0