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 4622S LORAZEPAM 2MG/ML INJ (KWA/ATB) 10X1ML B 3.82 2MG/ML 0 2022-04-01 2024-03-31 0
41 4622S LORAZEPAM 2MG/ML INJ (KWA) (B) 10X1ML B 3.0907 2MG/ML 1 2024-04-01 2026-03-31 0
40 4622U LORAZEPAM 2MG/ML INJ (FSB/ATB) 1ML VIAL B 4.02 2MG/ML 0 2022-05-27 2024-03-31 Price Change 0
40 46255 APO-LORAZEPAM 1MG TAB (APO/COL) 1000'S A 0.04 1MG 240 2022-04-01 2024-03-31 6
40 46259 LORIVAN 1MG TAB (REM/SBI) LORAZEPAM 100x10 A 0.03 1MG 240 2022-04-01 2024-03-31 6
41 46259 LORIVAN 1MG TAB (REM) LORAZEPAM 100X10 A 0.0332 1MG 240 2024-04-01 2026-03-31 6
40 4625B LORIVAN 1MG TAB (REM/SBI) LORAZEPAM 10x10 C 0.05 1MG 0 2022-04-01 2024-03-31 0
41 4625B LORIVAN 1MG TAB (REM) LORAZEPAM 10X10 A 0.0313 1MG 240 2024-04-01 2026-03-31 6
41 4625E APO-LORAZEPAM 1MG TAB (APO) LORAZEP 1000'S A 0.0388 1MG 240 2024-04-01 2026-03-31 6