Displaying 1 - 12 of 12
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 375A1 DIANEAL (L5B5193) 1.5% INJ (BAX/STO) DIALYSIS SOLN 2X5 LITRES B 18.02 1.5% 0 2022-04-01 2024-03-31 Add to Contract as Cat B 0
41 375A1 DIANEAL (L5B5193) 1.5% INJ (BAX) DIALYSIS SOLN 2X5 LITRES B 21.6378 1.5% 100 2024-04-01 2026-03-31 0
40 375B1 DIANEAL (L5B5194) 2.5% INJ (BAX/STO) DIALYSIS SOLN 2X5 LITRES B 18.02 2.5% 0 2022-04-01 2024-03-31 0
41 375B1 DIANEAL (L5B5194) 2.5% INJ (BAX) DIALYSIS SOLN 2X5 LITRES B 21.6378 2.5% 100 2024-04-01 2026-03-31 0
40 375C1 DIANEAL (L5B5195) 4.25% INJ (BAX/STO) DIALYSIS SOLN 2X5 LITRES B 18.02 4.25% 0 2022-04-01 2024-03-31 0
41 375C1 DIANEAL (L5B5195) 4.25% INJ (BAX) DIALYSIS SOLN 2X5 LITRES B 21.6378 4.25% 100 2024-04-01 2026-03-31 0
40 375D1 DIANEAL (5B9866) 1.5% INJ (BAX/STO) DIALYSIS SOLN 6X2L B 18.49 1.5% 0 2022-04-01 2024-03-31 0
41 375D1 DIANEAL (5B9866) 1.5% INJ (BAX) DIALYSIS SOLN 6X2L B 22.2 1.5% 100 2024-04-01 2026-03-31 0
40 375E1 DIANEAL (5B9876) 2.5% INJ (BAX/STO) DIALYSIS SOLN 6X2L B 18.49 2.5% 0 2022-04-01 2024-03-31 0
41 375E1 DIANEAL (5B9876) 2.5% INJ (BAX) DIALYSIS SOLN 6X2L B 22.2 2.5% 100 2024-04-01 2026-03-31 0
40 375F1 DIANEAL (5B9896) 4.25% INJ (BAX/STO) DIALYSIS SOLN 6X2L B 18.49 4.25% 0 2022-04-01 2024-03-31 0
41 375F1 DIANEAL (5B9896) 4.25% INJ (BAX) DIALYSIS SOLN 6X2L B 22.2 4.25% 100 2024-04-01 2026-03-31 0