Displaying 1 - 11 of 11
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 12314 ISOREM 10MG TAB (REM) ISOSORBIDE DINITRA 100'S A 0.0348 10MG 180 2024-04-01 2026-03-31 6
42 12314 ISOREM 10MG TAB (REM) ISOSORBIDE DINITRA 100'S A 0.04 10MG 180 2026-04-01 No No 6
42 12315 AAP-ISDN 10MG TAB (APO) 100'S A 0.09 10MG 180 2026-04-01 No No 6
40 1231A ISOSORBIDE DINITRATE 10MG TAB (FSB/ATB) 100'S A 0.11 10MG 180 2022-04-01 2024-03-31 6
40 1231D AAP-ISDN 10MG TAB (APO/COL) 100'S A 0.13 10MG 180 2022-04-01 2024-03-31 6
41 1231T APO-ISOSORBIDE DINITRATE 10MG TAB (APO) (C) 100'S C 0.1079 10MG 180 2024-04-01 2026-03-31 6
41 1231U ISOSORBIDE DINITRATE 10MG TAB (MCP) 10X10 A 0.0897 10MG 180 2024-04-01 2026-03-31 6
42 1231W ISOSORBIDE DINITRATE 10MG TAB (FSB) 100'S A 0.03 10MG 180 2026-04-01 No No Add to Contract as Cat A 6
41 1232B ISOSORBIDE DINITRATE 5MG TAB (ROL) 100'S A 1.1672 5MG 120 2024-04-01 2026-03-31 6
42 1232B ISOSORBIDE DINITRATE 5MG TAB (ROL) 100'S A 1.17 5MG 120 2026-04-01 No No 6
42 12345 AAP-ISOSORBIDE DINITRATE 30MG TAB (APO) 100'S A 0.08 30MG 90 2026-04-01 No No 6