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 1601AL ACCORD DIAZEPAM 2MG TAB (INP/AAL) DIAZEPAM 30'S A 0.08 2MG 120 2022-04-01 2024-03-31 6
41 1601AM AAP-DIAZEPAM 2MG TAB (APO) 100'S A 0.0495 2MG 120 2024-04-01 2026-03-31 6
41 1601AN AAP-DIAZEPAM 2MG TAB (APO) 100'S A 0.0495 2MG 120 6
40 1601J DIAZEPAM 2MG TAB (TEV/COL) 28'S A 0.09 2MG 120 2022-04-01 2024-03-31 6
41 16023 AAP-DIAZEPAM 5MG TAB (APO) 100'S 0.0454 5MG 120 6
40 16023 AAP-DIAZEPAM 5MG TAB (APO/COL) 100'S A 0.08 5MG 120 2022-04-01 2024-03-31 6
40 1602AG DIAZEPAM 5MG TAB (GPC/ATB) 1000'S A 0.02 5MG 120 2022-04-01 2024-03-31 6
41 1602BD AAP-DIAZEPAM 5MG TAB (APO) 100'S A 0.0454 5MG 120 2024-04-01 2026-03-31 6
40 1603AG DIAZEPAM 10MG TAB (GPC/ATB) 1000'S A 0.04 10MG 60 2022-04-01 2024-03-31 6
40 1603AK ACCORD DIAZEPAM 10MG TAB (INP/AAL) DIAZEPAM 30'S A 0.12 10MG 60 2022-04-01 2024-03-31 6
41 1603AM AAP-DIAZEPAM 10MG TAB (APO) 100'S A 0.0489 10MG 60 2024-04-01 2026-03-31 6
41 16055 DIAZEPAM 5MG/ML IV/IM INJ (STP) (B) 100X2ML B 3.0717 5MG/ML IV/IM 60 2024-04-01 2026-03-31 0
40 16058 DIAZEPAM 5MG/ML IV/IM INJ (RTM/PHA) 10X2ML B 1.45 5MG/ML IV/IM 0 2022-04-01 2022-05-31 0
40 16058 DIAZEPAM 5MG/ML IV/IM INJ (RTM/PHA) 10X2ML B 2.20 5MG/ML IV/IM 0 2022-06-01 2024-03-31 Price Change 0
40 1605A DIAZEPAM 5MG/ML IV/IM INJ (BRA/COL) 10X2ML B 1.38 5MG/ML IV/IM 0 2022-04-01 2024-03-31 0
41 1605B VERZEPAM 5MG/ML IV/IM INJ (VEV) DIAZEPAM (B) 10X2ML B 2.9358 5MG/ML IV/IM 60 2024-04-01 2026-03-31 0
41 1605W DIAZEPAM 5MG/ML IV/IM INJ (KWA) (B) 10X2ML B 2.1882 5MG/ML IV/IM 60 2024-04-01 2026-03-31 0