Displaying 1 - 20 of 23
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 44634 ARICEPT 5MG TAB (PFI/STO) DONEPEZIL 28'S C 4.71 5MG 0 2022-04-01 2024-03-31 0
41 44634 ARICEPT 5MG TAB (PFI) DONEPEZIL (C) 28'S C 4.192 5MG 30 2024-04-01 2026-03-31 6
42 44634 ARICEPT 5MG TAB (PFI) DONEPEZIL 28'S C 4.19 5MG 30 2026-04-01 No No 6
42 4463B APO-DONEPEZIL 5MG TAB (APO) DONEPEZIL 100'S A 0.22 5MG 30 2026-04-01 No No 6
40 4463F YASNAL Q 5MG TAB (KRK/AHI) DONEPEZIL 28'S C 1.07 5MG 0 2022-04-01 2022-06-16 0
40 4463F YASNAL Q 5MG TAB (KRK/AHI) DONEPEZIL 28'S A 1.07 5MG 30 2022-06-17 2022-09-30 6
41 4463F YASNAL Q 5MG TAB (KRK) DONEPEZIL (C) 28'S C 1.0747 5MG 30 2024-04-01 2026-03-31 6
42 4463F YASNAL Q 5MG TAB (KRK) DONEPEZIL 28'S C 1.07 5MG 30 2026-04-01 No No 6
40 4463M DONEPEZIL 5MG TAB (JUB/AHI) 90'S A 0.29 5MG 30 2022-04-01 2024-03-31 deleted from Contract 6
40 4463M DONEPEZIL 5MG TAB (JUB/AHI) 90'S A 0.29 5MG 30 2022-04-01 2024-03-31 deleted from Contract 6
40 4463N DONEPEZIL 5MG TAB (CIP/AHI) 4X7'S A 0.2875 5MG 30 2022-11-29 2024-03-31 No No Add to Contract as Cat A 6
42 4463W DONEMAX 5MG TAB (JLP) DONEPEZIL 10X10 A 0.21 5MG 30 2026-04-01 No No 6
40 44642 ARICEPT 10MG TAB (PFI/STO) DONEPEZIL 28'S C 5.16 10MG 0 2022-04-01 2024-03-31 0
41 44642 ARICEPT 10MG TAB (PFI) DONEPEZIL (C) 28'S C 4.5911 10MG 30 2024-04-01 2026-03-31 6
42 44642 ARICEPT 10MG TAB (PFI) DONEPEZIL 28'S C 4.59 10MG 30 2026-04-01 No No 6
40 4464A APO-DONEPEZIL 10MG TAB (APO/COL) DONEPEZIL 100'S A 0.95 10MG 30 2022-04-01 2024-03-31 6
40 4464E YASNAL Q DISP 10MG TAB (KRK/AHI) DONEPEZIL 28'S C 1.70 10MG 0 2022-04-01 0
40 4464E YASNAL Q DISP 10MG TAB (KRK/AHI) DONEPEZIL 28'S A 1.70 10MG 30 2022-06-17 2022-09-30 6
41 4464E YASNAL Q 10MG DISP TAB (KRK) DONEPEZIL (C) 28'S C 1.699 10MG 0 2024-04-01 2026-03-31 6
42 4464E YASNAL Q 10MG DISP TAB (KRK) DONEPEZIL 28'S C 1.70 10MG 0 2026-04-01 No No 0