Displaying 1 - 13 of 13
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
42 16525 AAP-HYDROXYZINE 10MG CAP (APO) 100'S C 0.22 10MG 90 2026-04-01 No No 0
42 1652B HYDROXYZINE 10MG TAB (IPC) 84'S A 0.13 10MG 90 2026-04-01 No No 6
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
42 1652K HYDROZYL 10MG TAB (JLP) HYDROXYZINE 150'S A 0.07 10MG 90 2026-04-01 No No 6
42 16533 AAP-HYDROXYZINE 25MG CAP (APO) 100'S C 0.26 25MG 90 2026-04-01 No No 0
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
42 1653H HYDROXYZINE 25MG TAB (IPC) 28'S A 0.07 25MG 90 2026-04-01 No No 6
42 1653J HYDROZYL 25MG TAB (JLP) HYDROXYZINE 10X15 A 0.09 25MG 90 2026-04-01 No No 6