Displaying 1 - 18 of 18
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 B0718 KEPPRA 500MG TAB (GSK/COL) LEVETIRACETAM 30'S C 2.54 500MG 0 2022-04-01 2024-03-31 0
41 B0718 KEPPRA 500MG TAB (GSK) LEVETIRACETA (B) 30'S B 2.799 500MG 120 2024-04-01 2026-03-31 6
40 B071A KEPPRA 1G TAB (GSK/COL) LEVETIRACETAM 30'S C 3.23 1G 0 2022-04-01 2024-03-31 0
41 B071A KEPPRA 1G TAB (GSK) LEVETIRACETAM (B) 30'S B 3.5583 1G 60 2024-04-01 2026-03-31 6
41 B071D QUETRA 500MG TAB (REM) LEVETIRACETA 30'S BQ 0.3923 500MG 120 2024-04-02 2026-03-31 6
40 B071F LEVETIRACETAM 500MG TAB (REM/SBI) 100'S B 0.23 500MG 0 2022-04-01 2024-03-31 6
41 B071F LEVETIRACETAM 500MG TAB (REM) (B) 100'S B 0.3912 500MG 120 2024-04-01 2024-05-14 6
40 B071G KOPODEX 1G TAB (ABB/PHA) LEVETIRACETAM 30'S B 2.30 1G 0 2022-04-01 2024-03-31 6
40 B071G KOPODEX 1G TAB (ABB/PHA) LEVETIRACETAM(B) 30'S B 2.296 1G 2022-04-01 2023-03-31 No No Delete from contract 6
40 B071H KOPODEX 500MG TAB (ABB/PHA) LEVETIRACETAM 30'S C 1.95 500MG 0 2022-04-01 2024-03-31 0
40 B071H KOPODEX 500MG TAB (ABB/PHA) LEVETIRACETAM (C) 30'S C 1.9517 500MG 2022-04-01 2023-03-31 No No Delete from contract 0
40 B071HHH KOPODEX 500MG TAB (ABB/PHA) LEVETIRACETAM (C) 30'S C 1.9517 500MG 2022-04-01 2023-03-31 No No Delete from contract 0
40 B071HHH KOPODEX 500MG TAB (ABB/PHA) LEVETIRACETAM (C) 30'S C 1.9517 500MG 2022-04-01 2023-03-31 No No Delete from contract 0
40 B071HHH KOPODEX 500MG TAB (ABB/PHA) LEVETIRACETAM (C) 30'S C 1.9517 500MG 2022-04-01 2023-03-31 No No Delete from contract 0
41 B071R LEVETIRACETAM 1G TAB (SGL) (B) 10X10 B 0.7187 1G 60 2024-04-01 2026-03-31 6
40 B0731 KEPPRA 100MG/ML SYRUP (GSK/COL) LEVETIRACETAM 300ML B 0.31 100MG/ML 0 2022-04-01 2024-03-31 6
41 B0731 KEPPRA 100MG/ML SYRUP (GSK) LEVETIRACETA 300ML B 0.3363 100MG/ML 900 2024-04-01 2026-03-31 6
40 B0735 LACETAM 100MG/ML SYR (LDP/AHI) LEVETIRACETAM 300ML B 0.18 100MG/ML 0 2022-04-01 2024-03-31 6