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 65811 LECTRUM 11.25MG INJ (BCH/COL) LEUPROLIDE KIT C 462.31 11.25MG 0 2022-04-01 2024-03-31 0
41 65811 LECTRUM 11.25MG INJ (BCH) LEUPROLIDE (BQ) KIT BQ 462.3054 11.25MG 0 2024-04-01 2026-03-31 0
42 65811 LECTRUM 11.25MG INJ (BCH) LEUPROLIDE KIT BQ 466.87 11.25MG 0 2026-04-01 No No 0
40 6581C LECTRUM 3.75MG INJ (BCH/COL) LEUPROLIDE 3.75MG KIT BQ 173.97 3.75MG 0 2022-04-01 2024-03-31 0
41 6581C LECTRUM 3.75MG INJ (BCH) LEUPROLIDE (BQ) 3.75MG KIT BQ 173.9727 3.75MG 0 2024-04-01 2026-03-31 0
42 6581C LECTRUM 3.75MG INJ (BCH) LEUPROLIDE 3.75MG KIT BQ 173.97 3.75MG 0 2026-04-01 No No 0
40 6581D LECTRUM 7.5MG INJ (BCH/COL) LEUPROLIDE 7.5MG KIT C 369.04 7.5MG 0 2022-04-01 2024-03-31 0
41 6581D LECTRUM 7.5MG INJ (BCH) LEUPROLIDE (C) 7.5MG KIT C 369.0397 7.5MG 0 2024-04-01 2026-03-31 0
42 6581D LECTRUM 7.5MG INJ (BCH) LEUPROLIDE 7.5MG KIT C 369.04 7.5MG 0 2026-04-01 No No 0