Displaying 1 - 10 of 10
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 5841BK APO-LISINOPRIL 10MG TAB (APO/COL) 100'S A 0.07 10MG 120 2022-04-01 2024-03-31 6
41 5841CH LISINOPRIL 10MG TAB (HEA) 10X10 A 0.0685 10MG 120 2024-04-01 2026-03-31 6
40 5841HC LISINOPRIL 10MG TAB (KWA/ATB) 10X10 A 0.06 10MG 120 2022-04-01 2024-03-31 6
40 5842BP APO-LISINOPRIL 20MG TAB (APO/COL) 100'S A 0.08 20MG 60 2022-05-23 2024-03-31 Add to Contract as Cat A 6
40 5842GV LISINOPRIL 20MG TAB (KWA/ATB) 10X10 A 0.07 20MG 60 2022-04-01 2022-09-30 6
40 5842HM ZESTRIL 20MG TAB (AZN/COL) LISINOPRIL 56'S C 0.57 20MG 0 2022-04-01 2024-03-31 0
40 5842HN LISINOPRIL 20MG TAB (RYV/ATB) 100'S A 0.07 20MG 60 2022-04-01 2022-07-04 Delete from contract 6
40 5843AG APO-LISINOPRIL 5MG TAB (APO/COL) 100'S A 0.05 5MG 60 2022-04-01 2024-03-31 6
40 5843DU LISINOPRIL 5MG TAB (FSB/ATB) 10X10 A 0.05 5MG 60 2022-04-01 2022-09-30 6
41 5843EQ APO-LISINOPRIL 5MG TAB (APO) 100'S A 0.0506 5MG 60 2024-04-01 2026-03-31 6