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
40 5521BV DOXYCYCLINE 100MG TAB (GPC/ATB) 100'S A 0.07 100MG 14 2022-04-01 2022-09-30 0
40 5521CJ DOXYCYCLINE 100MG TAB (FSB/ATB) 3X10 A 0.10 100MG 14 2022-04-01 2024-03-31 Add to Contract as Cat A 0
41 5521CK APO-DOXY 100MG TAB (APO) 100'S A 0.1237 100MG 14 2024-04-01 2026-03-31 0
40 5521ZU REMYCIN 100MG TAB (REM/SBI) DOXYCYCLINE 10X10 C 0.14 100MG 0 2022-04-01 2024-03-31 0
41 5521ZU REMYCIN 100MG TAB (REM) DOXYCYCLINE 10X10 A 0.1294 100MG 14 2024-04-01 2026-03-31 0
40 5522C DOXYCYCLINE 100MG INJ (CIR/AHI) 100MG VIAL B 35.23 100MG 0 2022-04-01 2024-03-31 6
40 5522D DOXYCYCLINE 100MG INJ (KWA/ATB) 100MG VIAL B 29.14 100MG 0 2022-04-01 2024-03-31 6
41 5522D DOXYCYCLINE 100MG INJ (KWA) (B) 100MG VIAL B 26.3406 100MG 28 2024-04-01 2026-03-31 1