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
41 1652C HYDROXYZINE 10MG TAB (WAT) 100'S A 0.1335 10MG 90 2024-04-01 2026-03-31 6
40 1652E AAP-HYDROXYZINE 10MG TAB (APO/COL) HYDROXYZIN 100'S A 0.15 10MG 90 2022-04-01 2024-03-31 6
41 1652G HYDROXYZINE 10MG TAB (CAM) 84'S A 0.1155 10MG 90 2024-04-01 2026-03-31 6
41 16539 HYDROXYZINE 25MG TAB (WAT) 100'S A 0.178 25MG 90 2024-04-01 2026-03-31 6
41 1653D AAP-HYDROXYZINE 25MG TAB (APO) 100'S A 0.1734 25MG 90 6
40 1653D AAP-HYDROXYZINE 25MG TAB (APO/COL) 100'S A 0.17 25MG 90 2022-04-01 2024-03-31 6
41 1653F AAP-HYDROXYZINE 25MG TAB (APO) 100'S A 0.1734 25MG 90 2024-04-01 2026-03-31 6