Displaying 1 - 10 of 10
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 26818 HYDROCORTISONE 10MG TAB (SLS/AHI) 200'S A 0.75 10MG 120 2022-04-01 2024-03-31 6
42 26818 HYDROCORTISONE 10MG TAB (SLS) 200'S A 0.29 10MG 120 2026-04-01 No No 6
41 2681A HYDROCORTISONE 10MG TAB (TEV) 30'S A 0.3081 10MG 120 2024-04-01 2024-12-16 6
41 2681A HYDROCORTISONE 10MG TAB (TEV) 30'S A 0.5863 10MG 120 2024-12-17 2026-03-31 6
42 2681B LEECORT 10MG TAB (JLP) HYDROCORTISONE 100'S A 0.16 10MG 120 2026-04-01 No No 6
41 26827 HYDROCORTISONE 20MG TAB (TEV) 30'S A 0.5944 20MG 120 2024-04-01 2024-12-16 6
41 26827 HYDROCORTISONE 20MG TAB (TEV) 30'S A 0.665 20MG 120 2024-12-17 2026-03-31 6
40 2682A HYDROCORTISONE 20MG TAB (SLS/AHI) 50'S A 1.52 20MG 120 2022-04-01 2024-03-31 6
42 2682A HYDROCORTISONE 20MG TAB (SLS) 50'S A 0.87 20MG 120 2026-04-01 No No 6
42 26853 HISONE 5MG TAB (SLS) HYDROCORTISONE 20X10 A 0.19 5MG 120 2026-04-01 No No 6