Displaying 1 - 7 of 7
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 49712 APO-HYDROXYUREA 500MG CAP (APO/COL) 100'S C 0.94 500MG 0 2022-04-01 2024-03-31 0
42 49712 APO-HYDROXYUREA 500MG CAP (APO) 100'S C 0.46 500MG 150 2026-04-01 No No 6
40 4971J HYDROXYUREA 500MG CAP (SLS/AHI) 100'S A 0.33 500MG 150 2022-04-01 2024-03-31 6
41 4971N HYDROXYUREA 500MG CAP (FSB) 100'S A 0.2514 500MG 150 2024-04-01 2026-03-31 6
41 4971X ZYDROX 500MG CAP (ZUV) HYDROXYUREA 100'S A 0.2512 500MG 150 2024-04-01 2026-03-31 6
42 4971X ZYDROX 500MG CAP (ZUV) HYDROXYUREA 100'S A 0.19 500MG 150 2026-04-01 No No 6
42 4971Z HYDROFORD 500MG CAP (JLP) HYDROXYUREA 100'S A 0.18 500MG 150 2026-04-01 No No 6