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 A322FQ LEXAPRO 10MG TAB (LUN/COL) ESCITALOPRAM 28'S C 3.24 10MG 0 2022-04-01 2024-03-31 0
42 A322HX APO-ESCITALOPRAM 10MG TAB (APO) ESC 100'S C 0.15 10MG 0 2026-04-01 No No 0
40 A322JQ APO-ESCITALOPRAM 20MG TAB (APO/COL) 30'S C 0.30 20MG 0 2022-04-01 2024-03-31 0
40 A322JR APO-ESCITALOPRAM 10MG TAB (APO/COL) 30'S C 0.15 10MG 0 2022-04-01 2024-03-31 0
40 A322KD LEXAPRO 20MG TAB (LUN/COL) ESCITALOPRAM 14'S C 6.40 20MG 0 2022-04-01 2024-03-31 0
41 A322LB APO-ESCITALOPRAM 10MG TAB (APO) ESC (C) 100'S C 0.1498 10MG 0 2024-04-01 2026-03-31 0
41 A322LK APO-ESCITALOPRAM 20MG TAB (APO) (C) 100'S C 0.2996 20MG 0 2024-04-01 2026-03-31 0
42 A322MA APO-ESCITALOPRAM 20MG TAB (APO) 100'S C 0.30 20MG 0 2026-04-01 No No 0