Displaying 1 - 20 of 24
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
42 375A1 DIANEAL (L5B5193) 1.5% INJ (BAX) DIALYSIS SOLN 2X5 LITRES BQ 32.38 1.5% 100 2026-04-01 No No Delete from contract 0
42 375A4 DIANEAL (L5B5193) 1.5% INJ (BAX) DIALYSIS SOLN 2X5 LITRES BQ 32.38 1.5% 100 2026-04-01 No No Add to Contract as Cat B 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
42 375B1 DIANEAL (L5B5194) 2.5% SOLN (BAX) DIALYSIS SOLN 2X5 LITRES BQ 32.38 2.5% 0 2026-04-01 No No Delete from contract 0
42 375B3 DIANEAL (L5B5194) 2.5% SOLN (BAX) DIALYSIS SOLN 2X5 LITRES BQ 32.38 2.5% 0 2026-04-01 No No Add to Contract as Cat B 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
42 375C1 DIANEAL (L5B5195) 4.25% SOLN (BAX) DIALYSIS SOLN 2X5 LITRES BQ 33.85 4.25% 0 2026-04-01 2028-03-31 No No Delete from contract 0
42 375C3 DIANEAL (L5B5195) 4.25% SOLN (BAX) DIALYSIS SOLN 2X5 LITRES BQ 33.85 4.25% 0 2026-04-01 No No Add to Contract as Cat B 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
42 375D1 DIANEAL (5B9866) 1.5% SOLN (BAX) DIALYSIS SOLN 6X2L BQ 34.74 1.5% 0 2026-04-01 2028-03-31 No No Delete from contract 0
42 375D6 DIANEAL (5B9866) 1.5% SOLN (BAX) DIALYSIS SOLN 6X2 LITRE BQ 34.74 1.5% 0 2026-04-01 No No Add to Contract as Cat B 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
42 375E1 DIANEAL (5B9876) 2.5% SOLN (BAX) DIALYSIS SOLN 6X2L BQ 34.74 2.5% 0 2026-04-01 2028-03-31 No No Delete from contract 0
42 375E7 DIANEAL (5B9876) 2.5% SOLN (BAX) DIALYSIS SOLN 6X2 LITRE BQ 34.74 2.5% 0 2026-04-01 No No Add to Contract as Cat B 0