Displaying 1 - 17 of 17
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 37019 FREESTYLE OPTIUM GLUC (ABD/PHA) DIAGNOSTIC B 50'S A 42.11 1 2022-04-01 2024-03-31 6
40 37019 FREESTYLE OPTIUM GLUC (ABD/PHA) DIAGNOSTIC B 50'S A 40.01 2023-02-20 2024-03-31 No No Price Change 6
41 37019 FREESTYLE OPTIUM GLUC (ABD) DIAGNOSTIC 50'S A 42.134 1 2024-04-01 2026-03-31 6
40 3701AP BAYER NEXT EZ GLUC (BYC/AHI) DIAGNOSTIC BLOO 50'S A 40.23 1 2022-04-01 2024-03-31 6
41 3701AP CONTOUR NEXT GLUC (BYC) DIAGNOSTIC BLOOD GLUCOSE 50'S A 40.2312 1 2024-04-01 2026-03-31 6
40 3701AW TRUE METRIX (HOM/ALI) DIAGNOSTIC BLOOD GLUC 50'S A 30.04 1 2022-04-01 2024-03-31 6
40 3701AX FREESTYLE NEO H GLUC (ABD/SBI) DIAGNOSTIC BL 50'S BQ 40.10 0 2022-04-01 2024-03-31 0
41 3701AX FREESTYLE NEO H GLUC (ABD) DIAGNOSTIC B 50'S BQ 54.5 1 2024-04-01 2026-03-31 6
40 3701AZ FREESTYLE OPTIUM GLUC (ABD/SBI) DIAGNOSTIC B 50'S A 40.10 1 2022-04-01 2024-03-31 6
41 3701AZ FREESTYLE OPTIUM GLUC (ABD) DIAGNOSTIC 50'S A 42.13 1 2024-04-01 2026-03-31 6
40 3701BA ACCU-CHEK INSTANT GLUC (PRI/STO) DIAGNOSTIC 50'S A 42.30 1 2022-04-01 2024-03-31 6
41 3701BA ACCU-CHEK INSTANT GLUC (PRI) DIAGNOSTIC 50'S A 42.2971 1 2024-04-01 2026-03-31 6
40 3701BE SELECT FLEX PLUS GLUC (JOH/AAL) DIAGNOSTIC B 50'S A 39.42 1 2022-04-01 2024-03-31 6
41 3701BE SELECT FLEX PLUS GLUC (JOH) DIAGNO 50'S A 39.2254 1 2024-04-01 2026-03-31 6
40 3701U SKY ERA GLUC (TTC/COL) DIAGNOSTIC BLOOD GLUC 50'S A 38.00 1 2022-04-01 2024-03-31 6
41 3701U SKY ERA GLUC (TTC) DIAGNOSTIC BLOOD GLU 50'S A 38.0022 1 2024-04-01 2026-03-31 6
40 3701V LIFESCAN ONE TOUCH ULTRA GLUC (JOH/AAL) DIAG 50'S A 39.42 1 2022-04-01 2024-03-31 6