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 15412 AAP-IMIPRAMINE 10MG TAB (APO) 100'S A 0.1435 10MG 240 2024-04-01 2026-03-31 6
40 15414 AAP-IMIPRAMINE 10MG TAB (APO/COL) 100'S A 0.14 10MG 240 2022-04-01 2024-03-31 6
42 15414 AAP-IMIPRAMINE 10MG TAB (APO) 100'S A 0.14 10MG 240 2026-04-01 No No 6
40 15426 AAP-IMIPRAMINE 25MG TAB (APO/COL) 100'S C 0.19 25MG 0 2022-04-01 2024-03-31 0
42 15426 AAP-IMIPRAMINE 25MG TAB (APO) 100'S A 0.19 25MG 240 2026-04-01 No No 6
40 1542A DIAMIN 25MG TAB (RLS/AHI) IMIPRAMINE 200'S A 0.09 25MG 240 2022-04-01 2024-03-31 6
41 1542B AAP-IMIPRAMINE 25MG TAB (APO) 100'S A 0.1925 25MG 240 2024-04-01 2026-03-31 6