Displaying 1 - 8 of 8
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
42 12718 KETAMINE 50MG/ML INJ (RTM) 25X10ML BQ 5.16 50MG/ML 0 2026-04-01 No No 0
40 1271A KETAMINE 50MG/ML INJ (RTM/PHA) 10ML VIAL BQ 7.26 50MG/ML 0 2022-04-01 2022-05-31 0
40 1271A KETAMINE 50MG/ML INJ (RTM/PHA) 10ML VIAL BQ 11.34 50MG/ML 0 2022-06-01 2024-03-31 Price Change 0
41 1271A KETAMINE 50MG/ML INJ (RTM) (BQ) 10ML VIAL BQ 11.4441 50MG/ML 0 2024-04-01 2025-01-28 0
41 1271A KETAMINE 50MG/ML INJ (RTM) (BQ) 10ML VIAL BQ 15.43 50MG/ML 0 2024-05-22 2026-03-31 0
40 1271D KETAMINE 50MG/ML INJ (STP/COL) 100X10ML BQ 3.40 50MG/ML 0 2022-04-01 2022-05-13 Delete from contract 0
42 1271M KETAMINE 50MG/ML INJ (BAX) 5X10ML BQ 5.28 50MG/ML 0 2026-04-01 No No 0
40 1271P KETAMINE 50MG/ML INJ (STP/COL) 10X10ML BQ 3.40 50MG/ML 0 2022-04-01 2024-03-31 Package Size Change 0