Displaying 1 - 13 of 13
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 30214 LIDOCAINE 1% INJ (BRA/COL) 20X20ML B 1.18 1% 0 2022-04-01 2024-03-31 0
41 30214 LIDOCAINE 1% INJ (BRA) (B) 20X20ML B 1.177 1% 0 2024-04-01 2026-03-31 0
40 3021X LIDOCAINE 1% INJ (CIR/AHI) 50ML VIAL B 4.70 1% 0 2022-04-01 2024-03-31 Add to Contract as Cat B 0
40 3021Y LIDOCAINE 1% INJ (BRA/COL) 20X10ML B 0.57 1% 0 2022-04-01 2024-03-31 Package Size Change 0
41 3021Z LIDOCAINE 1% INJ (KWA) (B) 50ML VIAL B 3.8328 1% 0 2024-04-01 2026-03-31 0
41 3023AE LIDOCAINE 2% INJ (KWA) (B) 50ML VIAL B 4.5396 2% 0 2024-04-01 2026-03-31 0
40 3023L LIDOCAINE 2% INJ (BRA/COL) 20X20ML B 1.13 2% 0 2022-04-01 2024-03-31 0
41 3023L LIDOCAINE 2% INJ (BRA) (B) 20X20ML B 1.5494 2% 0 2024-04-01 2026-03-31 0
40 3023U LIDOCAINE 2% INJ (RTM/PHA) 50ML VIAL C 2.99 2% 0 2022-04-01 2024-03-31 0
40 30247 LIDOCAINE 2% GEL (CAD/PHA) 30G B 3.02 2% 0 2022-04-01 2022-07-18 0
40 30247 LIDOCAINE 2% GEL (CAD/PHA) 30G B 3.18 2% 0 2022-07-19 2024-03-31 Price Change 0
41 30247 LIDOCAINE 2% GEL (CAD) 30G B 4.0231 2% 0 2024-04-01 2026-03-31 0
41 30287 LIDPCAINE 2% SPRAY (AKI) LIDOCAINE (B) 100ML B 38.4915 2% 1 2024-04-01 2026-03-31 0