Displaying 1 - 11 of 11
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 11613 HYDRALLAZINE 25MG TAB (REM/SBI) 10X10 A 0.06 25MG 120 2022-04-01 2024-03-31 6
41 11613 HYDRALLAZINE 25MG TAB (REM) 10X10 A 0.0707 25MG 120 2024-04-01 2026-03-31 6
40 11615 APO-HYDRALLAZINE 25MG TAB (APO/COL) 100'S A 0.07 25MG 120 2022-04-01 2024-03-31 6
41 1161AA HYDRALLAZINE 25MG TAB (LDP) 250'S A 0.0595 25MG 120 2024-04-01 2026-03-31 6
41 1161AC APO-HYDRALLAZINE 25MG TAB (APO) 100'S A 0.0642 25MG 120 2024-04-01 2026-03-31 6
40 11625 APO-HYDRALLAZINE 50MG TAB (APO/COL) 100'S A 0.17 50MG 60 2022-04-01 2024-03-31 6
40 1162T HYDRALLAZINE 50MG TAB (FSB/ATB) 25X10 A 0.13 50MG 60 2022-04-01 2024-03-31 6
41 11637 HYDRALLAZINE 20MG/ML INJ (FSB) (B) 20MG VIAL B 38.1109 20MG/ML 0 2024-04-01 2026-03-31 0
40 1163H HYDRALLAZINE 20MG/ML INJ (MON/PHA) 10X1ML B 4.32 20MG/ML 0 2022-04-01 2024-03-31 0
40 1163J LAHYZINE 20MG/ML INJ (LDP/AHI) HYDRALLAZINE 20MG VIAL B 5.71 20MG/ML 0 2022-04-01 2024-03-31 0
41 1163K HYDRALLAZINE 20MG/ML INJ (DIL) (B) 25X1ML B 37.5498 20MG/ML 0 2024-04-01 2026-03-31 0