Displaying 1 - 13 of 13
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
41 13315 FENTANYL CITRATE 50MCG/ML INJ (RTM) (BQ) 10X2ML BQ 2.4846 50MCG/ML 0 2024-04-01 2026-03-31 0
42 13315 FENTANYL CITRATE 50MCG/ML INJ (RTM) 10X2ML BQ 1.50 50MCG/ML 0 2026-04-01 No No 0
40 13319 FENTANYL CITRATE 50MCG/ML INJ (MTP/COL) 10X2ML BQ 1.31 50MCG/ML 0 2022-04-01 2024-03-31 0
41 13319 FENTANYL CITRATE 50MCG/ML INJ (MTP) (BQ) 10X2ML BQ 1.7941 50MCG/ML 0 2024-04-01 2026-03-31 0
40 1331K FENTANYL CITRATE 50MCG/ML INJ (KWA/ATB) 10X2ML BQ 0.25 50MCG/ML 0 2022-04-01 2022-09-30 0
41 1331K FENTANYL CITRATE 50MCG/ML INJ (KWA) (BQ) 10X2ML BQ 1.8022 50MCG/ML 0 2024-04-01 2026-03-31 0
40 1331M FENTANYL CITRATE 50MCG/ML INJ (SGH/COL) 10X2ML BQ 1.36 50MCG/ML 0 2022-04-01 2024-03-31 0
40 13325 FENTANYL CITRATE 50MCG/ML INJ (RTM/PHA) 10X10ML BQ 2.74 50MCG/ML 0 2022-04-01 2024-03-31 0
41 13325 FENTANYL CITRATE 50MCG/ML INJ (RTM) (BQ) 10X10ML BQ 3.822 50MCG/ML 0 2024-04-01 2026-03-31 0
40 13329 FENTANYL CITRATE 50MCG/ML INJ (MTP/COL) 10X10ML BQ 3.13 50MCG/ML 0 2022-04-01 2024-03-31 0
41 13329 FENTANYL CITRATE 50MCG/ML INJ (MTP) (BQ) 10X10ML BQ 4.2406 50MCG/ML 0 2024-04-01 2026-03-31 0
42 1332F FENTANYL CITRATE 50MCG/ML INJ (MTP) 10X10ML BQ 5.02 50MCG/ML 0 2026-04-01 No No 0
42 1332L VERFEN 50MCG/ML INJ (VEV) FENTANYL 5X10ML BQ 4.73 50MCG/ML 0 2026-04-01 No No 0