Displaying 1 - 20 of 33
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 25611 GRAVOL 50MG TAB (CDC/COL) DIMENHYDRINAT 100'S C 0.25 50MG 0 2022-04-01 2024-03-31 0
41 25611 GRAVOL 50MG TAB (CDC) DIMENHYDRINAT (C) 100'S C 0.2754 50MG 180 2024-04-01 2026-03-31 6
40 25619 GRAVOL 50MG TAB (CDC/COL) DIMENHYDRINATE 30'S C 0.24 50MG 0 2022-04-01 2024-03-31 0
41 25619 GRAVOL 50MG TAB (CDC) DIMENHYDRINAT (C) 30'S C 0.251 50MG 180 2024-04-01 2026-03-31 6
40 2561B GRAVOL 50MG TAB (CDC/COL) DIMENHYDRINATE 10'S C 0.34 50MG 0 2022-04-01 2024-03-31 0
41 2561B GRAVOL 50MG TAB (CDC) DIMENHYDRINAT (C) 10'S C 0.3724 50MG 180 2024-04-01 2026-03-31 6
40 2561H APO-DIMENHYDRINATE 50MG TAB (APO/COL) 1000'S A 0.03 50MG 180 2022-04-01 2024-03-31 6
40 2561L GRAVINATE 50MG TAB (CAR/COL) DIMENHYDRINATE 250'S C 0.07 50MG 0 2022-04-01 2024-03-31 0
41 2561L GRAVINATE 50MG TAB (CAR) DIMENHYDRINATE 250'S A 0.07 50MG 180 2024-04-01 2026-03-31 6
41 2561N DIMENHYDRINATE 50MG TAB (GPC) 1000'S A 0.0296 50MG 180 2024-04-01 2026-03-31 6
40 2561S DIMENHYDRINATE 50MG TAB (FSB/ATB) 10X10 A 0.05 50MG 180 2022-04-01 2022-09-30 6
41 2561S DIMENHYDRINATE 50MG TAB (FSB) 10X10 A 0.0459 50MG 180 2024-04-01 2026-03-31 6
40 2561U DIMENHYDRINATE 50MG TAB (RYV/ATB) 250'S A 0.04 50MG 180 2022-04-01 2024-03-31 6
40 25628 GRAVOL KIDS 3MG/ML SYR (CDC/COL) DIMENHYDRINATE 75ML C 0.08 3MG/ML 0 2022-04-01 2024-03-31 0
41 25628 GRAVOL KIDS 3MG/ML SYR (CDC) DIMENHYDRINATE (C) 75ML C 0.0859 3MG/ML 125 2024-04-01 2026-03-31 6
40 25629 GRAVINATE 3MG/ML SYR (CAR/COL) DIMENHYDRINATE 125ML A 0.04 3MG/ML 125 2022-04-01 2024-03-31 6
41 25629 GRAVINATE 3MG/ML SYR (CAR) DIMENHYDRINAT 125ML A 0.0387 3MG/ML 125 2024-04-01 2026-03-31 6
40 2562C DIMENHYDRINATE 3MG/ML SYR (CIR/AHI) 150ML A 0.03 3MG/ML 125 2022-04-01 2024-03-31 6
40 25633 GRAVOL 100MG SUPPOS (CDC/COL) DIMENHYDRINATE 10'S A 0.90 100MG 10 2022-04-01 2024-03-31 6
41 25633 GRAVOL 100MG SUPPOS (CDC) DIMENHYDRINATE 10'S A 0.9813 100MG 10 2024-04-01 2026-03-31 6