Displaying 1 - 16 of 16
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 67325 ULTRAVIST 300MG/ML INJ (BSP/AHI) IOPROMIDE 50ML BQ 34.31 300MG/ML 0 2022-04-01 2024-03-31 0
41 67325 ULTRAVIST 300MG/ML INJ (BSP) IOPROMIDE (BQ) 50ML BQ 37.4585 300MG/ML 7 2024-04-01 2026-03-31 0
40 6732T ULTRAVIST 300 INJ (BSP/COL) IOPROMIDE 50ML BQ 34.31 300MG/ML 0 2022-04-01 2024-03-31 0
41 6732T ULTRAVIST 300 INJ (BSP) IOPROMIDE (BQ) 50ML BQ 37.4585 300MG/ML 0 2024-04-01 2026-03-31 0
40 6732U ULTRAVIST 300 INJ (BSP/COL) IOPROMIDE 100ML BQ 68.61 300MG/ML 0 2022-04-01 2024-03-31 0
41 6732U ULTRAVIST 300 INJ (BSP) IOPROMIDE (BQ) 100ML BQ 74.9714 300MG/ML 0 2024-04-01 2026-03-31 0
40 6732V ULTRAVIST 300 INJ (BSP/AHI) IOPROMIDE 100ML BQ 68.61 300MG/ML 0 2022-04-01 2024-03-31 0
41 6732V ULTRAVIST 300 INJ (BSP) IOPROMIDE (BQ) 100ML BQ 74.9714 300MG/ML 0 2024-04-01 2026-03-31 0
40 6734Q ULTRAVIST 370 INJ (BSP/COL) IOPROMIDE 50ML BQ 46.76 370MG/ML 0 2022-04-01 2024-03-31 0
41 6734Q ULTRAVIST 370 INJ (BSP) IOPROMIDE (BQ) 50ML BQ 51.0773 370MG/ML 7 2024-04-01 2026-03-31 0
40 6734R ULTRAVIST 370 INJ (BSP/AHI) IOPROMIDE 50ML BQ 46.76 370MG/ML 0 2022-04-01 2024-03-31 0
41 6734R ULTRAVIST 370 INJ (BSP) IOPROMIDE (BQ) 50ML BQ 51.0773 370MG/ML 7 2024-04-01 2026-03-31 0
40 67351 ULTRAVIST 370 INJ (BSP/AHI) IOPROMIDE 100ML BQ 103.05 370MG/ML 0 2022-04-01 2024-03-31 0
41 67351 ULTRAVIST 370 INJ (BSP) IOPROMIDE (BQ) 100ML BQ 112.593 370MG/ML 7 2024-04-01 2026-03-31 0
40 67358 ULTRAVIST 370 INJ (BSP/COL) IOPROMIDE 100ML BQ 103.05 370MG/ML 0 2022-04-01 2024-03-31 0
41 67358 ULTRAVIST 370 INJ (BSP) IOPROMIDE (BQ) 100ML BQ 112.593 370MG/ML 7 2024-04-01 2026-03-31 0