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 2451AF LOPERAMIDE 2MG CAP (CIP/AHI) 30X10 A 0.09 2MG 30 2022-04-01 2024-03-31 6
40 2451AN ALKA AD 2MG TAB (BSP/COL) LOPERAMIDE 60'S C 0.29 2MG 0 2022-04-01 2024-03-31 0
40 2451AP ALKA AD 2MG TAB (BSP/COL) LOPERAMIDE 12'S C 0.30 2MG 0 2022-04-01 2024-03-31 0
41 2451AQ LOPERAMIDE 2MG CAP (TEV) 30'S A 0.0988 2MG 30 2024-04-01 2024-12-16 6
41 2451AQ LOPERAMIDE 2MG CAP (TEV) 30'S A 0.1523 2MG 30 2024-12-17 2026-03-31 6
41 2451AT ALKA AD 2MG TAB (BSP) LOPERAMIDE (C) 72'S C 0.2548 2MG 30 2024-04-01 2026-03-31 6
41 2451AV ALKA AD 2MG TAB (BSP) LOPERAMIDE (C) 72'S C 0.2548 2MG 30 2024-04-01 2026-03-31 6
42 2451AV ALKA AD 2MG TAB (BSP) LOPERAMIDE 72'S A 0.23 2MG 30 2026-04-01 No No 6
40 2451U IMODIUM 2MG TAB (JAC/STO) LOPERAMIDE 60'S C 1.11 2MG 0 2022-04-01 2022-05-24 Delete from contract 0
42 2451Y PMS-LOPERAMIDE 2MG CAP (PMS) 100'S A 0.16 2MG 30 2026-04-01 No No 6