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 B2231 HUMULIN-N 100U/ML INJ (LIL/STO) INSULIN ISOPH 10ML VIAL A 14.92 100U/ML 5 2022-04-01 2024-03-31 6
41 B2231 HUMULIN-N 100U/ML INJ (LIL) INSULIN ISOP 10ML VIAL A 20.3602 100U/ML 5 2024-04-01 2026-03-31 6
40 B2232 NOVOLIN-N 100U/ML INJ (NOV/COL) INSULIN ISOPH 10ML VIAL A 11.96 100U/ML 5 2022-04-01 2024-03-31 6
41 B2232 NOVOLIN-N 100U/ML INJ (NOV) INSULIN ISOP 10ML VIAL A 11.9606 100U/ML 5 2024-04-01 2026-03-31 6
42 B2232 NOVOLIN-N 100U/ML INJ (NOV) INSULIN ISOPHANE 10ML VIAL A 11.96 100U/ML 5 2026-04-01 No No 6
40 B2234 HUMILIN-N CARTRIDGE 100U/ML INJ (LIL/STO) ISO 5X3ML C 11.88 100U/ML 2022-07-11 2024-03-31 Add to Contract as Cat C
41 B2234 HUMULIN-N CARTRIDGE 100U/ML INJ (LIL) INSULIN ISOPHANE (C) 5X3ML C 11.2104 100U/ML 5 2024-04-01 2026-03-31 6