Displaying 1 - 20 of 24
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 A471J CLEXANE 20MG INJ (SFA/COL) ENOXAPARIN 2X20MG B 7.89 20MG 0 2022-04-01 2024-03-31 0
41 A471J CLEXANE 20MG INJ (SFA) ENOXAPARIN (B) 2X20MG B 9.5142 20MG 30 2024-04-01 2026-03-31 6
42 A471J CLEXANE 20MG INJ (SFA) ENOXAPARIN 2X0.2ML C 8.16 20MG 30 2026-04-01 No No 6
41 A471R ENOXAPARIN 20MG INJ (GLN) (B) 2X20MG B 5.9124 20MG 30 2024-04-01 2026-03-31 6
42 A471R ENOXAPARIN 20MG INJ (GLN) 2X20MG B 6.00 20MG 30 2026-04-01 No No 6
40 A472G CLEXANE 40MG INJ (SFA/COL) ENOXAPARIN 2X40MG B 9.52 40MG 0 2022-04-01 2024-03-31 0
41 A472G CLEXANE 40MG INJ (SFA) ENOXAPARIN (C) 2X40MG C 9.8539 40MG 30 2024-04-01 2026-03-31 6
42 A472G CLEXANE 40MG INJ (SFA) ENOXAPARIN 2X40MG C 9.86 40MG 30 2026-04-01 No No 6
40 A472H CLEXANE 60MG INJ (SFA/COL) ENOXAPARIN 2X60MG B 12.37 60MG 0 2022-04-01 2024-03-31 0
41 A472H CLEXANE 60MG INJ (SFA) ENOXAPARIN (B) 2X60MG B 12.545 60MG 30 2024-04-01 2026-03-31 6
42 A472H CLEXANE 60MG INJ (SFA) ENOXAPARIN 2X60MG C 12.55 60MG 30 2026-04-01 No No 6
40 A472X ENOXAPARIN 40MG INJ (GLN/AHI) 2X40MG B 7.55 40MG 30 2022-04-01 2022-05-10 6
40 A472X ENOXAPARIN 40MG INJ (GLN/AHI) 2X40MG B 9.35 40MG 30 2022-06-13 2024-03-31 Price Change 6
41 A472X ENOXAPARIN 40MG INJ (GLN) (B) 2X40MG B 9.3511 40MG 30 2024-04-01 2026-03-31 6
42 A472X MEXAPRIN 40MG INJ (GLN) ENOXAPARIN 2X40MG B 9.35 40MG 30 2026-04-01 No No 6
40 A472Y ENOXAPARIN 60MG INJ (GLN/AHI) 2X60MG B 12.17 60MG 30 2022-06-13 2024-03-31 Price Change 6
41 A472Y ENOXAPARIN 60MG INJ (GLN) (B) 2X60MG B 12.1645 60MG 30 2024-04-01 2026-03-31 6
42 A472Y MEXAPRIN 60MG INJ (GLN) ENOXAPARIN 2X60MG B 12.17 60MG 30 2026-04-01 No No 6
40 A473D CLEXANE 80MG INJ (SFA/COL) ENOXAPARIN 2X80MG B 15.50 80MG 0 2022-04-01 2024-03-31 0
41 A473D CLEXANE 80MG INJ (SFA) ENOXAPARIN (B) 2X80MG B 16.0381 80MG 30 2024-04-01 2026-03-31 6