Displaying 1 - 8 of 8
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 2951D APO-MEDROXY 10MG TAB (APO/COL) 100'S A 0.14 10MG 10 2022-04-01 2024-03-31 6
40 2951F PROVERA 10MG TAB (PFI/STO) MEDROXYPROGESTERON 10'S C 0.68 10MG 0 2022-04-01 2024-03-31 0
41 2951F PROVERA 10MG TAB (PFI) MEDROXYPROGESTERO (C) 10'S C 0.6877 10MG 10 2024-04-01 2026-03-31 6
41 2951K APO-MEDROXY 10MG TAB (APO) 100'S A 0.1386 10MG 10 2024-04-01 2026-03-31 6
40 29555 APO-MEDROXY 100MG TAB (APO/COL) 100'S C 0.41 100MG 0 2022-04-01 2024-03-31 0
41 29556 APO-MEDROXY 100MG TAB (APO) (C) 100'S C 0.4159 100MG 30 2024-04-01 2026-03-31 6
40 29563 APO-MEDROXY 2.5MG TAB (APO/COL) 100'S A 0.06 2.5MG 20 2022-04-01 2024-03-31 6
41 29567 APO-MEDROXY 2.5MG TAB (APO) 100'S A 0.0609 2.5MG 20 2024-04-01 2026-03-31 6