Displaying 1 - 4 of 4
| 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 | A681AM | EFAVIRENZ | EMTRICITABINE | TENOFOVIR 600MG | 200MG | 300MG TAB (MAT/AHI) | 30'S | BL | 0.92 | 600MG|200MG|300MG | 0 | 2022-04-01 | 2024-03-31 | 0 | ||||
| 40 | A681EY | VONAVIR 600MG | 200MG | 300MG TAB (EMC/COL) EFAVIRENZ | EMTRICITABINE | TENOFOVI More ... | 30'S | BL | 2.72 | 600MG|200MG|300MG | 0 | 2022-04-01 | 2024-03-31 | 0 | ||||
| 41 | A681EY | VONAVIR 600MG|200MG|300MG TAB (EMC) EFAVIRENZ|EMTRICITABINE| (BL) | 30'S | BL | 2.8995 | 600MG|200MG|300MG | 60 | 2024-04-01 | 2026-03-31 | 6 | ||||
| 40 | A681HC | EFAVIRENZ | EMTRICITABINE | TENOFOVIR 600MG | 200MG | 300MG TAB (MCP/AHI) | 30'S | BL | 0.73 | 600MG|200MG|300MG | 0 | 2022-04-01 | 2024-03-31 | 0 | ||||