Displaying 1 - 8 of 8
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
41 5811KQ AAP-DILTIAZ 60MG TAB (APO) DILTIAZEM 100'S A 0.1109 60MG 90 2024-04-01 2026-03-31 6
40 5811ZD AAP-DILTIAZ 60MG TAB (APO/COL) DILTIAZEM 100'S A 0.11 60MG 90 2022-04-01 2024-03-31 6
40 5813AQ APO-DILTIAZ CD 120MG CAP (APO/COL) 100'S A 0.17 120MG 60 2022-04-01 2024-03-31 6
40 5813AR APO-DILTIAZ CD 180MG CAP (APO/COL) 100'S A 0.23 180MG 60 2022-04-01 2024-03-31 6
40 5813AS APO-DILTIAZ CD 240MG CAP (APO/COL) 100'S A 0.29 240MG 60 2022-04-01 2024-03-31 6
41 5813FV APO-DILTIAZ 240MG CD CAP (APO) 100'S A 0.2996 240MG 60 2024-04-01 2026-03-31 6
41 5813FW APO-DILTIAZ 180MG CD CAP (APO) 100'S A 0.2357 180MG 60 2024-04-01 2026-03-31 6
41 5813FX APO-DILTIAZ 120MG CAP SR (APO) 100'S A 0.1691 120MG 60 2024-04-01 2026-03-31 6