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 2831AG AMARYL 2MG TAB (SFA/COL) GLIMEPIRIDE 15'S C 0.18 2MG 0 2022-04-01 2024-03-31 0
41 2831AG AMARYL 2MG TAB (SFA) GLIMEPIRIDE (C) 15'S C 0.2718 2MG 45 2024-04-01 2026-03-31 6
40 2831GP GLIMEPIRIDE 2MG TAB (DRL/AHI) 100'S C 0.13 2MG 0 2022-04-01 2024-03-31 0
42 2831GV GETRYL 2MG TAB (GET) GLIMEPIRIDE 20'S C 0.05 2MG 45 2026-04-01 No No 6
40 2832BA AMARYL 4MG TAB (SFA/COL) GLIMEPIRIDE 15'S C 0.27 4MG 0 2022-04-01 2024-03-31 0
41 2832BA AMARYL 4MG TAB (SFA) GLIMEPIRIDE (C) 15'S C 0.2718 4MG 60 2024-04-01 2026-03-31 6
40 2832BS GLIMEPIRIDE 4MG TAB (DRL/AHI) 100'S C 0.15 4MG 0 2022-04-01 2024-03-31 0
42 2832GY GETRYL 4MG TAB (GET) GLIMEPIRIDE 20'S C 0.03 4MG 60 2026-04-01 No No 6