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 2691AA HYDROCORTISONE SOD SUCC 100MG INJ (CIR/AHI) 100MG VIAL B 1.98 100MG 0 2022-04-01 2024-03-31 0
41 2691AA HYDROCORTISONE SOD SUCC 100MG INJ (CIR) (B) 100MG VIAL B 2.3106 100MG 0 2024-04-01 2026-03-31 0
41 2691AC HYDROCORTISONE SOD SUCC 100MG INJ ( (B) 100MG VIAL B 2.0931 100MG 0 2024-04-01 2026-03-31 0
40 2691AF HYDROCORTISONE SOD SUCC 100MG INJ (MON/PHA) 100MG VIAL B 2.99 100MG 0 2022-04-01 2024-03-31 0
42 2691AT LEECORT 100MG INJ (JLP) HYDROCORTISONE SODIUM SUCCINATE 25X5ML B 0.87 100MG 0 2026-04-01 No No 0
42 2691AU HYDROCORTISONE SOD SUCC 100MG INJ (FSB) 100MG VIAL B 0.71 100MG 0 2026-04-01 No No Add to Contract as Cat B 0
41 2692D HYDROCORTISONE SOD SUCC 250MG INJ (MON) HYDROCORTISONE SODIU (B) 250MG VIAL B 3.4251 250MG 0 2024-04-01 2026-03-31 0
42 2692D HYDROCORTISONE SOD SUCC 250MG INJ (MON) HYDROCORTISONE SODIU 250MG VIAL B 2.85 250MG 0 2026-04-01 No No 0
40 26935 HYDROCORTISONE SOD SUCC 500MG INJ (CIR/AHI) 50X500MG B 5.38 500MG 0 2022-04-01 2024-03-31 0
41 26937 HYDROCORTISONE SOD SUCC 500MG INJ ( (B) 500MG VIAL B 4.5668 500MG 0 2024-04-01 2026-03-31 0
42 26937 HYDROCORTISONE SOD SUCC 500MG INJ (MON) HYDROCORTISONE SODIU 500MG VIAL B 3.89 500MG 0 2026-04-01 No No 0