Displaying 1 - 9 of 9
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 A481E ISOSORBIDE MONONITRATE 10MG TAB (WAT/AHI) 100'S A 0.56 10MG 90 2022-04-01 2024-03-31 6
41 A481E ISOSORBIDE MONONITRATE 10MG TAB (WAT) 100'S A 0.7494 10MG 90 2024-04-01 2026-03-31 6
41 A481F ISOSORBIDE MONONITRATE 10MG TAB (WAT) 56'S A 0.7495 10MG 90 2024-12-19 2026-03-31 6
40 A482F ISOSORBIDE MONONITRATE 20MG TAB (WAT/AHI) 100'S A 0.56 20MG 90 2022-04-01 2024-03-31 6
40 A4839 MONOREM 60MG TAB (REM/SBI) ISOSORBIDE MONONIT 3x10 A 0.16 60MG 60 2022-04-01 2024-03-31 6
41 A4839 MONOREM 60MG TAB (REM) ISOSORBIDE MONONI 3x10 A 0.1921 60MG 60 2024-04-01 2026-03-31 6
40 A483B APO-ISMN 60MG TAB (APO/COL) 100'S A 0.18 60MG 60 2022-04-01 2024-03-31 6
40 A483F ISOSORBIDE MONONITRATE 60MG TAB (KWA/ATB) 3X10 A 0.14 60MG 60 2022-04-01 2022-09-30 6
41 A483L APO-ISMN 60MG TAB (APO) 100'S A 0.1824 60MG 60 2024-04-01 2026-03-31 6